Disparities in Point-of-Sale Advertising and Retailer Density

The tobacco industry uses common marketing techniques to sell their products to specific communities. Marketing for any product includes advertisements based on demographics, but for a product with significant negative health impacts, like tobacco, focusing on a particular audience creates health disparities that further impact communities that are already hindered by social inequity. The tobacco industry’s advertisements for communities of color (Black and Latinx), low income communities, and LGBTQ+ (Lesbian, Gay, Bisexual, Trans*, and Queer) communities are often capitalizing off of stereotypes or shallow perceptions of culture, and these marketing ploys work. Despite an overall decline in smoking since 1964, higher rates of smoking exist among individuals of specific racial, ethnic, socioeconomic and educational backgrounds.^[1]

What’s on this page?

• Disparities in Smoking Rates by Education & Income
• Disparities in Retailer Density & Advertising by Targeted Group
• Targeted Advertising Case Studies
• More Resources
• Next Steps

Learn more about tobacco as an “Unequal Opportunity Killer”. 

Disparities in Smoking Rates by Education & Income

The tobacco industry’s level of sophistication and persistence in targeting individuals of specific ethnic and socioeconomic backgrounds has resulted in higher rates of smoking among these groups.

Data from the National Health Interview Survey shows that in 2020, 12.5% of people 18 and older currently smoked, the lowest percentage ever.^[3] However, individuals with less education are much more likely to currently smoke: 

Looking at smoking rate by education in those 25 and older,

• 32.0% of individuals with a GED currently smoked
• 17.6% of individuals with a high school diploma currently smoked 
• 14.4% of individuals with some college education currently smoked
• 12.7% of individuals with an associates degree currently smoked
• 5.6% of those holding an Bachelor’s degree currently smoked
• 3.5% of those with a graduate degree currently smoked ^[3]

Education level and income level are linked, meaning the higher education attained, the more income received over time.^[4]  Data analyzed by income level indicate that smoking rates increase as income decreases, where the percent of individual who smoke in each income bracket was:

• 20.2% of individuals with household incomes $35,000
• 14.1% of individuals with household incomes $35,000-$74,999
• 10.5% of individuals with household incomes $74,999 – $99,999
• 6.2% of individuals with household incomes > $100,000 ^[3]

Unfortunately, this disparity is not improving. Between 2011-2017, New York was the only state to reduce income-based disparities in smoking.^[4] Elsewhere in the country, the disparity was unchanged or worsened.^[4]

For more information on Smoking Rate Disparities check out the following:

• CDC page on Smoking Disparities
• CDC Fact Sheet on Health Disparities in Cigarette Smoking

Disparities in Retailer Density & Advertising by Targeted Group

To explore the relationship between tobacco retailer density and community characteristics, researchers identified and mapped over 300,000 tobacco retailers across the US. Findings indicate higher density of tobacco retailers in communities with higher percentages of African-Americans, individuals living below the poverty line, or women older than 25 without a high school diploma.^{[2, 9]} Even while controlling for population size, there were 32% more tobacco retailers in urban areas than non-urban areas.^[2]  For every 1% increase in the number of families living below the poverty line, there was a .83% increase in tobacco retailer density for that community.^[2]  Findings from international studies suggest that this strategy of disproportionately exposing communities of particular racial, ethnic, and socioeconomic backgrounds to POS tobacco advertising is not unique to the US alone. An analysis of Western Australia found that there are more tobacco retailers in communities with a lower socioeconomic status than in areas with a higher socioeconomic status.^[10] Similarly, research out of New South Wales, Australia found that regardless of smoking prevalence, more tobacco retailers were found in economically disadvantaged areas.^[11] 

Lower-Income Populations

A 2016 study from John Hopkins Bloomberg School of Public Health shows that income can be the major determining factor of retailer density, given that higher income communities of underrepresented groups have a lower rate of tobacco retailers than low income communities of the same racial demographic.^[6]  

According to the study:

• Prince George’s County, MD has a 67.5% Black population, an average income of about $77,000 per year and an average of 3.94 tobacco outlets per 1000 persons per tract.
• Baltimore, MD has a 65.3% Black population, an average income of about $43,500 per year, and an average of 7.95 tobacco outlets per 1000 persons per tract.^[6]

Another study found that within the city of Baltimore, lower-income neighborhoods had twice the number of tobacco retailers per person that higher-income neighborhoods.^[7] In addition, greater tobacco retailer density was linked with lower life expectancies and higher age-adjusted mortality rates, even when controlling for other factors.^[7] In models adjusting for neighborhood characteristics, spatial autocorrelation, and alcohol and fast food outlet densities, income was no longer significantly associated with health outcomes, suggesting that social context, such as the density of tobacco retailers, influences health outcomes more than income alone.^[7]  Another study out of Mecklenberg County, North Carolina found that residences in neighborhoods with the lowest income were closer to multiple retail outlets than residences in the highest income neighborhoods. ^[32] A national study found that in lower income neighborhoods, more stores had exterior ads for tobacco products, sold flavored little cigars and cigarillos, and had tobacco ads targeted to youth.^[24] Uneven distribution of tobacco retailers and disproportionate exposure to tobacco advertising contributes to disparities in smoking rates. High tobacco retailer density in a given community makes it easier for consumers to purchase the harmful product and be exposed to the industry’s persuasive marketing. 

Prices are also often cheaper in lower-income neighborhoods. A national study of a representative sample of tobacco retailers across the United States found that the average price for the cheapest pack of cigarettes was $0.22 cheaper in neighborhoods with the lowest median household income compared to neighborhoods with the highest median household income.^[8]

For more information on retailer density in low-income communities check out the following:

• Socioeconomic Disparities in Proximity of Schools to Tobacco Outlets & Fast-food Restaurants
• The Inequitable Distribution of Tobacco Outlet Density: the role of income in two Black Mid-Atlantic geopolitical areas

African-Americans

Low income Black communities are more likely to have high density of tobacco retailers than other communities. African-American communities have been a very specific target for the tobacco industry for advertisement of menthol cigarettes. Through out the US, areas with a larger proportion of African Americans have significantly higher retailer density, a greater presence of tobacco ads on store exteriors, higher numbers of menthol advertisements, higher availability of flavored cigars, more price promotions, and lower prices for menthol cigarettes (including Newport menthols), little cigars, and cigarillos. ^{[12, 13, 24]} This has been found to be the case both in national studies and in localized areas. For example, observational store audits conducted in Los Angeles, CA between January 2016 and April 2017 showed that tobacco retailers located in zip codes with a high percentage of residents who are non-Hispanic Black were 8 times as likely to sell little cigars and cigarillos, 5 times as likely to sell flavored little cigars and cigarillos, and over 6 times as likely to have exterior advertisements for little cigars and cigarillos compared to tobacco retailers located in zip codes with a high percentage of non-Hispanic White residents.^[14] Another study, out of Mecklenberg County, North Carolina, found that residents of neighborhoods with the lowest proportion of White people were on average only 0.6 miles away from a tobacco retailer, while residents of neighborhoods with the largest proportion of White residents were farther away from a tobacco retailer at an average of 1.11 miles. ^[32]  As well, neighborhoods with the highest proportion of Black residents, compared to neighborhoods with the lowest proportion of Black residents, were significantly closer to multiple tobacco retailers.^[32] An analysis of tobacco pricing survey data at the block group level collected in Boston between July 2015 and June 2016 found that for every 10% increase in the proportion of black residents, prices for menthol cigarettes decreased by 3 cents. Additionally, for every 10% increase in the proportion of black residents, the proportion of retailers selling menthol cigarettes at a price at least 25 cents below the established minimum price rose by 19%.^[15]

Emerging evidence also suggests that potentially less harmful products like e-cigarettes are less available and less advertised in predominantly Black, Hispanic, and low-income neighborhoods. ^[16] Also of note, one study found that non-Hispanic Blacks had 1.18 times the odds of noticing POS marketing, compared to non-Hispanic Whites, and individuals below the poverty level had 1.28 times the odds of noticing POS marketing, compared to those at or above twice the poverty level.^[33] As well, people who have incomes below the poverty level and smoke were significantly more likely to purchase a brand of tobacco product due to a promotion, special price offer, or store display.^[33] 

Learn more about the tobacco industry’s targeting of Black communities:

• Black Lives/Black Lungs – upcoming documentary on tobacco targeting Black communities
• Read about RJ Reynold’s sponsored meeting in Black Churches here.
• Public Health Law Center’s resource: The Tobacco Industry & The Black Community: The Targeting of African Americans.

LGBTQ+

 A higher density of tobacco retailer outlets also has been found in areas where greater numbers of LGBTQ couples live^[17], and according to CDC MMWR data, 20.5% of LGBTQ individuals smoke compared to 15.3% of heterosexual individuals. ^[3] The FDA recently launched “This Free Life” public education campaign to reduce tobacco use in the LGBTQ community and counter the tobacco industry’s targeted marketing. 

Learn more about the tobacco industry’s targeting of LGBTQ communities through advertising:

• Is There a Relationship Between the Concentration of Same-Sex Couples and Tobacco Retailer Density?
• Truth Initiative’s Tobacco is a Social Justice Issue: Smoking and LGBT Communities
• Public Health Law Center’s The Tobacco Industry & The Black Community: The Targeting of African Americans

Mental Illness

The tobacco industry also has a history of targeting people with mental illness. In San Francisco, a study found that tobacco retailer density was twice as high near where people who smoke and have a Serious Mental Illness (SMI) lived than near where other members of the general population lived.^[18] For individuals with SMI, living near a greater number of tobacco retailers was also associated with having greater nicotine dependence and lower readiness to quit.^[19] This density may be a factor in the disparate rates in smoking between individuals with serious psychological distress, 35.8% of whom smoke compared to 14.7% of individuals without a mental illness.^[3]  

Learn more about the tobacco industry’s targeting of individuals struggling with mental health communities through advertising:

• The Truth Initiative’s Fast Facts about Smoking and Mental Health

Targeted Advertising Case Studies

Increased retailer density not only creates additional access points for individuals to acquire tobacco products but also increases exposure to POS advertising. The tobacco industry strategically customizes their POS marketing to appeal to the particular socio-economic and racial/ethnic backgrounds of those living in these communities where they have a high number of outlets.

African Americans & Menthol Cigarettes

The first concerted minority advertising push took place during the early 1970’s. During this time, major tobacco companies fought for share of the young urban African American market in what has been coined the “Menthol Wars”. Rival companies noticed Kool’s popularity in the African American market niche, and began vying for brand loyalty and profit. What started as a niche market has, over time, become a highly valued target audience segment for tobacco advertising, as discussed in these Phillip Morris documents about their Black Marketing Task Force.

During the Menthol War era, tobacco companies also began taking into account the physical attributes of stores in low-income minority communities in order to design the physical characteristics of their POS promotional campaigns. For example, in 1984, Phillip Morris released a series of window display ads with suction cups on them so that they could be placed behind bulletproof windows and still be seen by consumers.  Additionally, displays, originally designed for larger stores, were re-designed and scaled down to fit better in smaller inner-city convenience stores, as part of Phillip Morris’s Ethnic Program Development. A 2013 study of Washington D.C. tobacco retailers found that retailers within predominately African-American areas of the city were 2-3 times more likely to display interior and exterior advertisements than stores in areas with lower African-American populations.^[20] A systematic review found more menthol marketing in areas with higher numbers of low-income and black residents.^[21] A recent study in both rural and urban Ohio found a higher prevalence of ads for cigarillos, cigars, and e-cigarettes in African American communities and found that urban, disadvantaged, African-American communities had advertisements for more types of tobacco products overall.^[22] In addition, research has shown Newport (menthol) cigarettes to be cheaper and more often discounted in geographic areas with a higher proportion of African American residents.^{[23, 34]}

Wright, former Trade Marketing Manager and Controlling Manager of Brown and Williamson (tobacco company), discusses the importance of using price discounts in low-income African-American neighborhoods with high menthol sales deemed as, “focus communities.”^[24] Wright explains that a higher number of interior and exterior ads showcasing mentholated tobacco products were displayed in retail outlets located in “focus communities.” The use of price discounts and retailer incentive programs were also used to establish Kool’s presence at the point of sale.  Kool’s share of market for mentholated products increased in stores where Kool offered a Buy-One-Get-One free promotion.^[18] The use of these price cutting strategies coupled with strategic POS brand presence such as flashy colors, motorized displays, plastic countertop mats, and more mentholated product pack facings allowed for Kool to gain ground with African-American consumers.^[25]

Low Income Women & Price Discounts

In 1977, RJR first attempted to reach low income female consumers of African American and Latino neighborhoods by pairing 25 cent off Salem Light coupons with food stamp distribution.^[26] These coupons targeted packs instead of cartons because RJR noted that lower income consumers tended to buy single packs to avoid purchasing the more highly priced cigarette carton.^[27] The economic downturn of the 1980s spurred the importance of discounting at the point of sale to the forefront once again. Leveraging in depth marketing analysis, tobacco companies counteracted female consumers’ guilt of purchasing cigarettes in the midst of economic hardship by offering coupons and discounts at the point of sale.^[28] Tobacco companies like Brownson and Williamson leveraged price discounting as a major marketing tactic of retaining low income female consumers.^[29] To this day, price discounting is a cornerstone of the tobacco industry’s marketing strategy. The 2018 Federal Trade Commission report shows that 85.8% of the tobacco industry’s multi-billion dollar marketing budget for cigarettes is dedicated to price discounts. ^[30] In addition, a 2012 study in Philadelphia found tobacco retailer outlets that accept Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to be more likely to display both exterior and interior tobacco advertisements as well as tobacco advertisements near products targeted to children, leading to greater exposure to tobacco advertising among SNAP and WIC recipients.^[31]

More Resources:

• Fact sheet from the Public Health and Tobacco Policy Center: “Tobacco Disparities: Evidence Supports Policy Change“
• Achieving Health Equity in Tobacco Control, a joint publication of a consortium of organizations working to coordinate efforts around the 50th anniversary of the Surgeon General’s report on smoking and health.
• ChangeLab Solution’s Addressing Tobacco-Related Health Inequities: Resources to Inform Point-of-Sale Policies.

Next Steps:

To combat disproportionate tobacco advertising in your neighborhood consider:

Last updated March 17, 2022