Article

Identifying Disparities and Policy Needs with the STARS Surveillance Tool

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Abstract

Objectives: The Standardized Tobacco Assessment for Retail Settings (STARS) tool has emerged as a means for health departments and community groups to gather evidence about point-of-sale tobacco marketing practices. This paper documents methods and findings from a multi-stakeholder effort using the STARS tool to identify point-of-sale tobacco disparities in Milwaukee, WI. Method: Three demographically distinct zip code clusters were identified, and random samples of tobacco retailers were drawn from each. Store audits were conducted by community tobacco control workers and volunteers at 195 tobacco retailers between July and September 2016. Results: Compared to retailers in the predominantly white zip code cluster, retailers in African-American and Hispanic zip code clusters engaged in more harmful point-of-sale practices, particularly with regard to the sale and display little cigars/cigarillos. Menthol cigarette marketing and promotion was most common in the African American zip code cluster. Conclusions:The STARS tool allowed for identification of previously undocumented disparities in the tobacco point-of-sale environment in Milwaukee and facilitated discussion about possible policy inter-ventions. The STARS tool offers an accessible, low-cost means of conducting store audits that allow for community engagement. However, state preemption remains a regulatory barrier to local policy action.

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... An additional three studies were identified after contacting key informants and one after searching reference lists of included studies (Fig. 1). Out of the 20 studies, three were from Australia (McCarthy et al., 2011;Dalglish et al., 2013;Burton et al., 2014), one from Scotland (Shortt et al., 2020) and 16 were from the United States (Toomey et al., 2009;Seidenberg et al., 2010;Henriksen et al., 2012Henriksen et al., , 2016Henriksen et al., , 2017Cantrell et al., 2013Cantrell et al., , 2015Lipperman-Kreda et al., 2014;Resnick et al., 2012;Lee et al., 2015b;Schleicher et al., 2015;Laestadius et al., 2018;Mills et al., , 2019Epperson et al., 2019;Kephart et al., 2019), of which four were conducted nationally, (Resnick et al., 2012;Lee et al., 2015b;Mills et al., , 2019, one both nationally and in California (Henriksen et al., 2016), five in California (Henriksen et al., , 2017Lipperman-Kreda et al., 2014;Schleicher et al., 2015;Epperson et al., 2019), two in Washington DC (Cantrell et al., 2013(Cantrell et al., , 2015, one in Wisconsin (Laestadius et al., 2018), one in Minnesota (Toomey et al., 2009) and two in Massachusetts (Seidenberg et al., 2010;Kephart et al., 2019). The first study was published in 2009 and presented data from the Minneapolis-St. ...
... An additional three studies were identified after contacting key informants and one after searching reference lists of included studies (Fig. 1). Out of the 20 studies, three were from Australia (McCarthy et al., 2011;Dalglish et al., 2013;Burton et al., 2014), one from Scotland (Shortt et al., 2020) and 16 were from the United States (Toomey et al., 2009;Seidenberg et al., 2010;Henriksen et al., 2012Henriksen et al., , 2016Henriksen et al., , 2017Cantrell et al., 2013Cantrell et al., , 2015Lipperman-Kreda et al., 2014;Resnick et al., 2012;Lee et al., 2015b;Schleicher et al., 2015;Laestadius et al., 2018;Mills et al., , 2019Epperson et al., 2019;Kephart et al., 2019), of which four were conducted nationally, (Resnick et al., 2012;Lee et al., 2015b;Mills et al., , 2019, one both nationally and in California (Henriksen et al., 2016), five in California (Henriksen et al., , 2017Lipperman-Kreda et al., 2014;Schleicher et al., 2015;Epperson et al., 2019), two in Washington DC (Cantrell et al., 2013(Cantrell et al., , 2015, one in Wisconsin (Laestadius et al., 2018), one in Minnesota (Toomey et al., 2009) and two in Massachusetts (Seidenberg et al., 2010;Kephart et al., 2019). The first study was published in 2009 and presented data from the Minneapolis-St. ...
... Racial or ethnic composition. 18 studies investigated the association between cigarette pricing and the racial or ethnic compositions of the area units (Toomey et al., 2009;Seidenberg et al., 2010;Henriksen et al., 2012Henriksen et al., , 2016Henriksen et al., , 2017Burton et al., 2014;Lipperman-Kreda et al., 2014;Resnick et al., 2012;Cantrell et al., 2015;Lee et al., 2015b;Schleicher et al., 2015Laestadius et al., 2018Mills et al., , 2019Epperson et al., 2019;Kephart et al., 2019). 14 studies examined associations between cigarette prices and the proportion of Blacks or African Americans. ...
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Objective To examine associations between area-level characteristics (socioeconomic status, racial or ethnic characteristics, age, and any other characteristics that may be associated with vulnerability) and the prices of tobacco products and electronic nicotine delivery systems (ENDS). Data sources We searched MEDLINE, EconLit and Scopus, unpublished and grey literature, hand-searched four specialty journals, examined references of relevant studies, and contacted key informants. Study selection We considered all studies that quantitatively examined area-level variations in the prices of tobacco products and ENDS. We included all studies that examined any area-level measures regardless of the geographic location, language or time of publication. At least two reviewers independently screened the articles. We identified 20 studies. Data extraction At least two reviewers independently extracted the characteristics, methods, and main results and assessed the quality of each included study. Data synthesis Overall, cigarette prices were found to be lower in lower socioeconomic status neighbourhoods, and in neighbourhoods with a higher percentage of youth, and Blacks or African Americans. We identified too few studies that examined price differences for cigarillos, chewing tobacco, roll-your-own, and ENDS to reach any conclusions. Conclusions Our findings are in keeping with tobacco industry documents that detailed how manufacturers used race, class, and geography to target vulnerable populations and suggest that regulations that can limit industry price manipulation such as minimum, maximum, and uniform prices, and high specific excise taxes should be considered. More frequent and systematic monitoring of tobacco prices and ENDS is warranted.
... Store assessment resources are available at CounterTobacco.org, including the Standardized Tobacco Assessment for Retail Settings (STARS), with additional modules for vaping devices and electronic products (25,26). Data may include the percentage of stores in a geographic area of interest that offer tobacco price promotions (eg, cents off or multipack offers that undermine tobacco excise tax policies and promote consumption). ...
Article
In 2015, the tobacco industry spent $8.24 billion to market tobacco products in convenience stores, supermarkets, pharmacies, and other retail or point-of-sale settings. Community tobacco control partnerships have numerous evidence-based policies (eg, tobacco retailer licensing and compliance, tobacco-free-school buffer zones, eliminating price discounts) to counter point-of-sale tobacco marketing. However, deciding which point-of-sale policies to implement - and when and in what order to implement them - is challenging. The objective of this article was to describe tools and other resources that local-level tobacco use prevention and control leaders can use to assemble the data they need to formulate point-of-sale tobacco policies that fit the needs of their communities, have potential for public health impact, and are feasible in the local policy environment. We were guided by Kingdon's theory of policy change, which contends that windows of policy opportunity open when 3 streams align: a clear problem, a solution to the problem, and the political will to work for change. Community partnerships can draw on 7 data "springs" to activate Kingdon's streams: 1) epidemiologic and surveillance data, 2) macro retail environment data, 3) micro retail environment data, 4) the current policy context, 5) local legal feasibility of policy options, 6) the potential for public health impact, and 7) political will.
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