Tobacco point-of-sale advertising in Guatemala City, Guatemala and Buenos Aires, Argentina

Article (PDF Available)inTobacco control 19(4):338-41 · August 2010with33 Reads
DOI: 10.1136/tc.2009.031898 · Source: PubMed
Abstract
To determine tobacco point of sale advertising prevalence in Guatemala City, Guatemala and Buenos Aires, Argentina. Convenience stores (120 per city) were chosen from randomly selected blocks in low, middle and high socioeconomic neighbourhoods. To assess tobacco point of sale advertising we used a checklist developed in Canada that was translated into Spanish and validated in both countries studied. Analysis was conducted by neighbourhood and store type. All stores sold cigarettes and most had tobacco products in close proximity to confectionery. In Guatemala, 60% of stores had cigarette ads. High and middle socioeconomic status neighbourhood stores had more indoor cigarette ads, but these differences were determined by store type: gas stations and supermarkets were more prevalent in high socioeconomic status neighbourhoods and had more indoor cigarette ads. In poorer areas, however, more ads could be seen from outside the stores, more stores were located within 100 metres of schools and fewer stores had 'No smoking' or 'No sales to minors' signs. In Argentina, 80% of stores had cigarette ads and few differences were observed by neighbourhood socioeconomic status. Compared to Guatemala, 'No sales to minors' signs were more prevalent in Argentina. Tobacco point of sale advertising is highly prevalent in these two cities of Guatemala and Argentina. An advertising ban should also include this type of advertising.
Tobacco point-of-sale advertising in Guatemala City,
Guatemala and Buenos Aires, Argentina
Joaquin Barnoya,
1,2
Raul Mejia,
3
Debora Szeinman,
3
Carlos E Kummerfeldt
4
ABSTRACT
Objectives To determine tobacco point of sale
advertising prevalence in Guatemala City, Guatemala and
Buenos Aires, Argentina.
Methods Convenience stores (120 per city) were
chosen from randomly selected blocks in low, middle and
high socioeconomic neighbourhoods. To assess tobacco
point of sale advertising we used a checklist developed
in Canada that was translated into Spanish and validated
in both countries studied. Analysis was conducted by
neighbourhood and store type.
Results All stores sold cigarettes and most had tobacco
products in close proximity to confectionery. In
Guatemala, 60% of stores had cigarette ads. High and
middle socioeconomic status neighbourhood stores had
more indoor cigarette ads, but these differences were
determined by store type: gas stations and supermarkets
were more prevalent in high socioeconomic status
neighbourhoods and had more indoor cigarette ads. In
poorer areas, however, more ads could be seen from
outside the stores, more stores were located within 100
metres of schools and fewer stores had ‘No smoking’ or
‘No sales to minors’ signs. In Argentina, 80% of stores
had cigarette ads and few differences were observed by
neighbourhood socioeconomic status. Compared to
Guatemala, ‘No sales to minors’ signs were more
prevalent in Argentina.
Conclusions Tobacco point of sale advertising is highly
prevalent in these two cities of Guatemala and
Argentina. An advertising ban should also include this
type of advertising.
INTRODUCTION
Tobacco industry marketing campaigns have been
instrumental in spreading the tobacco epidemic
worldwide. Since the early 1970s, forseeing
government tobacco advertising bans the industry
noted that their brands would be dominantly
displayed and advertised at the point of sale.
1 2
This type of advertising has been found to increase
brand recognition, decrease smoking cessation
attempts and to increase smoking relapse in former
smokers.
3e8
In adolescents, advertising at the point
of sale increase smoking susceptibility, experimen-
tation, and uptake.
9
It has also been found to
increase students perception about the ease of
purchasing cigarettes and decrease the likelihood of
requiring proof of age.
10
The USA, Australia,
Canada, New Zealand and Malaysia have docu-
mented a high prevalence of tobacco point of sale
advertising.
311e15
In the Americas region, aside
from the Bahamas, Brazil, Canada, Jamaica,
Mexico, Peru, Venezuela and the USA, most coun-
tries lack any government enforced advertising ban.
Of these countries, only the Bahamas has banned
point of sale advertising.
16
In addition, tobacco
point of sale advertising has not yet been docu-
mented in this region.
As of February 2009, Guatemala and Argentina
lack comprehensive tobacco advertising bans. In
Guatemala, advertising (written, graphic, radio,
television, lms and other electric or electronic
media) requires prior authorisation of the Ministry
of Public Health and Social Aid. In addition,
tobacco billboards are banned within 500 metres of
entrances and exits of pre-school, elementary or
high schools.
17
However, the tobacco industry
(Philip Morris (PM) and British American Tobacco
(BAT)) has voluntarily removed radio and television
advertising. In Argentina, there is no national
advertising ban and advertising is still allowed in
newspapers, magazines, television and billboards.
16
Since October 2005, the City of Buenos Aires has
a tobacco advertising ban that includes newspapers,
television, radio and billboards.
18
This ban does not
apply to the rest of the country. Regarding the
point of sale, neither Guatemala nor Argentina has
an advertising ban and retailers do not need
a government licence to sell tobacco.
The objective of this study is to document the
prevalence of tobacco point-of-sale advertising in
the capital city of Guatemala (Guatemala City) and
Argentina (Buenos Aires).
METHODS
From March to May 2008, we selected 240 (120 per
country) convenience stores in Guatemala City,
Guatemala, and Buenos Aires, Argentina, without
any prior knowledge of whether they sell cigarettes
or about the presence of tobacco point-of-sale
advertising. Because others have found tobacco
point-of-sale advertising is more prevalent in less
privileged neighbourhoods, we selected our sample
based on socioeconomic neighbourhood.
19 20
To get
stores from high, middle and low socioeconomic
status (SES) neighbourhoods, we selected one
neighbourhood from each of these three rankings.
In Guatemala, to dene neighbourhood SES, we
used the average unit price of land dened by the
Municipalidad de Guatemala. We then located the
three different SES neighbourhoods in Mapquest.
In Argentina, we used the 2007 Encuesta Nacional
de Hogares de Buenos Aires (National Home Sur vey
of Buenos Aires). We then used a random digit
generator to identify 30 blocks per SES neighbour-
hood in each city where stores would be evaluated.
Every store in each block was evaluated, and when
a block had no store, the next adjacent block was
chosen. All stores in each block were evaluated.
To assess the prevalence and characteristics of
point of sale advertising in stores we used
1
Cardiovascular Unit of
Guatemala, Guatemala
2
Washington University in St
Louis, School of Medicine,
Missouri, USA
3
Hospital de Clinicas, University
of Buenos Aires. Buenos Aires,
Argentina
4
Aldo Castan˜eda Foundation.
Guatemala
Correspondence to
Dr Joaquin Barnoya,
Cardiovascular Unit of
Guatemala, 6a Ave 8-71 zona
10, Clinica #3, Ala Sur 01010,
Guatemala, USA;
jbarnoya@post.harvard.edu
Received 4 June 2009
Accepted 22 March 2010
Published Online First
7 June 2010
This paper is freely available
online under the BMJ Journals
unlocked scheme, see http://
tobaccocontrol.bmj.com/site/
about/unlocked.xhtml
338 Tobacco Control 2010;19:338e341. doi:10.1136/tc.2009.031898
Brief report
a checklist developed by Cohen and Di Nardo in Canada.
11
The
checklist, designed to be completed in no more than 10 minutes,
assesses the tobacco advertising type, feature, brand, location
and displays within each store. In addition, the observer esti-
mated the percentage of space in front of the client occupied by
tobacco advertising and if tobacco products or advertising were
located less than 50 centimetres of confectionary. After
obtaining per mission from the authors, we translated and
adapted the checklist to Spanish. Then it was pilot tested in
Argentina and Guatemala and found to be appropriate.
We used SPSS (version 11.0, 2001) to enter and analyse data.
Analyses were done primarily with
c
2
testing (nominal variables)
and analysis of variance (ANOVA, interval variables). Percentage
of space in front of the client occupied by tobacco advertising is
reported as mean (SD) for each store type and neighbourhood SES.
In Guatemala, data were rst analysed by SES and then by store
type. In Argentina, given that there were only two types of stores
surveyed (small (15%) and big (85%) stores) and the location of
these stores did not differ by neighbourhood, data were only
analysed by neighbourhood SES.
RESULTS
A total of 120 stores were surveyed in each city. All stores in
Guatemala and Argentina sold cigarettes. Sixty per cent of stores
in Guatemala and 78% in Argentina had cigarette advertising
(p¼0.003). In Guatemala, in the high SES neighbourhoods, most
stores evaluated were gas stations; while in the middle and low
SES neighbourhoods they were small stores (table 1).
In Guatemala, very few stores had exterior ads and the
proportion did not vary by neighbourhood (p¼0.08). By
contrast, most had interior ads and tobacco products in close
proximity to confectionary (table 2). The number of interior ads
differed signicantly by area with a tendency for more ads in the
higher SES neighbourhood (table 2). Yet No smoking or No
sales to minors signs were also more frequent in this neigh-
bourhood. By contrast the low SES neighbourhood had a signif-
icantly greater proportion of ads that could be seen from outside
the store and were more likely to have stores within 100 metres
of a school. Most stores had tobacco products close to confec-
tionary, except stores in the middle SES where only 38% of
stores did (p¼0.002). It appears, however, that these neigh-
bourhood differences were largely determined by store type,
notably the predominance of gas stations in the high SES
neighbourhood and small stores in low and middle SES neigh-
bourhoods (table 3). Gas stations had signicantly greater
Table 1 Store type by city and socioeconomic neighbourhood, 2008
Percentage of stores in each neighbourhood*
No of stores
High
(n[40)
Middle
(n[40)
Low
(n[40)
Guatemala (n¼20)
Big store/pharmacy 8 18 3
Small storey 88 27 100 92
Gas stations 17 42
Supermarket 7 12 5
Argentina (n¼120)
Big store 100 80 87 82
Small store 20 20 3 8
*Percentages do not add up to 100 owing to rounding.
yIn Guatemala: A small store is wooden, made and located on sidewalks. Big stores are
permanent constructions and have a larger variety of products. In Argentina: In small stores
purchase is made through a window while the customer stands on the sidewalk. Only in big
stores customers walk through the store to pick up groceries.
Table 2 Tobacco point-of-sale advertising prevalence. 2008
Guatemala City, Guatemala Buenos Aires, Argentina
Neighbourhood socioeconomic status Neighbourhood socioeconomic status
All High Middle Low All High Middle Low
120 40 40 40 p* 120 40 40 40 p
Stores (%) with exterior ads 3 10 0 0 0.08 10 0 15 14 0.4
Stores (%y) with interior ads
None 40 22 48 52 <0.001 18 10 18 35 0.07
1e2 34325022 4745 55 50
3e9 23 46 2 25 28 45 26 19
Stores (%) with interior ads that can be
seen from the outside
18 10 48 47 0.005 61 91 77 72 0.1
Mean (%,SDz) of the total percentage of
space occupied in front of the client
18.28 (8.37) 13.57 (4.22) 17.37 (5.37) 0.04 21.47 (15.20) 21.94 (20.39) 26.67 (13.73) 0.5
Stores (%) with tobacco ads/products
<50 cm of confectionary
60 77 38 66 0.002 52 57 28 54 0.03
Stores (%) with ‘No smoking’ signs 88 26 2 2 0.002 20 24 16 3 0.1
Stores (%) with ‘No sales to minors’ sign 8 13 2 0 0.08 57 61 66 31 0.1
Stores (%) within 100 metres of a school 63 26 70 97 <0.001 5 3 13 0 0.03
*p Value for difference between socioeconomic status.
yPercentages do not add up to 100% owing to rounding.
z%, SD: Refers to the mean and the SD of the total percentage of space that the cigarette counter occupied in front of the client.
Tobacco Control 2010;19:338e341. doi:10.1136/tc.2009.031898 339
Brief report
numbers of large, indoor ads occupying more space while most
small stores did not have No sales to minors signs, but were
more likely to be located within 100 metres of a school.
In Argentina, few stores had exterior ads and the percentage of
stores with interior ads did not differ signicantly by neigh-
bourhood SES (table 2). However, a lower percentage of stores in
high and middle SES did not have any interior ads compared to
stores in the low SES. In all the different SES neighbourhoods,
most stores have interior ads that can be seen from the outside.
The percentage of space in front of the client occupied by
tobacco ads did not differ across neighbourhood SES. More
stores in the high and middle SES neighbourhoods did have No
sales to minor signs compared to stores in the low SES (p¼0.1).
Half the stores in high and low SES neighbourhoods have
tobacco products in close proximity to confectionary compared
to 28% of those in the middle SES (p¼0.03). Regarding store
location in relation to schools, most stores were not located
within 100 metres of a school. Analysis by store type did not
yield any signicant differences (results not shown).
In Guatemala, cigarettes were displayed on top of the counter
in 100% of big stores, 54% of small stores and 83% of super-
markets. Only in gas stations, most (56%) cigarettes were
displayed behind the counter, but still in sight. In Argentina,
cigarettes were displayed on top of the counter in 90% of big
stores and in 77% of small stores.
In Guatemala, most of the advertising was dominated by BAT
(Pall Mall was the most common brand advertised) as opposed
to Argentina, where it was dominated by PM (Marlboro was the
most common brand advertised).
DISCUSSION
In these two Latin American cities in Guatemala and Argentina,
tobacco point-of-sale advertising is highly prevalent. In
Guatemala prevalence appears to be related to store type rather
than neighbourhood SES. In the USA, convenience, conve-
nience/gas and liquor stores have been found to have higher
prevalence of tobacco point-of-sale advertising compared to
grocery stores and pharmacies.
21
Similarly, in Canada, chain
convenience stores had the largest amount of tobacco point-of-
sale advertising.
11
Tobacco product placement in close proximity to confec-
tionary was highly prevalent in both cities. It has been suggested
that such placement encourages the young to see tobacco as
benign and commonplace in the market like confectionary.
2
In
addition, cigarettes were placed in prime locations, behind the
cashier and on the counter-top, positions for which retailers
usually charge a premium.
1
We also assessed the presence of the tobacco industrys No sales
to minors signage. In Guatemala, fewer stores had the signage
compared to Argentina where most stores did. In the USA, PM
requires the placement of this signage in stores that participate in
the Retail Leaders Program. Given that PM brands dominated the
Argentinian point-of-sale environment, this might help explain
the difference with Guatemala. However, these youth access
programmes do not affect teen smoking prevalence.
22 23
Our study has strengths and limitations. To our knowledge, it
is the rst study to document the prevalence of tobacco point of
sale advertising in two Latin American countries. We randomly
selected stores from different SES neighbourhoods but used
neighbourhood as a proxy for SES, when it may, in fact, vary by
block. In Guatemala, where the WHO Framework Convention
on Tobacco Control (FCTC) has been ratied, we do not have
data pre-FCTC and post-FCTC ratication to assess whether the
prevalence of point of sale advertising has changed since rati-
cation. Regardless of these limitations, none of them should be
a source of bias or limit the policy implications of our study.
In conclusion, tobacco point-of-sale advertising is highly
prevalent in the capital cities of Guatemala and Argentina. Both
countries as FCTC signatories should be committed to apply
Article 13 and undertake a comprehensive ban of all tobacco
advertising, promotion and sponsorship.(emphasis added).
24
Our data underline the importance of ensuring that point-of-sale
advertising is included when a tobacco advertising ban is
proposed in either country.
Acknowledgements We thank Jose Carlos Monzo
´
n who collaborated with data
collection in Guatemala. Maria Alegre provided information regarding marketing
strategies. In addition, Joanna Cohen granted us permission to use the point-of-sale
checklist.
Table 3 Point-of-sale advertising by store type in Guatemala City. 2008
Big store/pharmacy Small store Gas station Super market
888177p
Stores with exterior ads (%) 0 0 24 0 <0.001
Stores (%*) with interior ads. <0.001
None 25 53 0 0
1e263341933
3e912128168
Stores (%) with interior ads than can be seen from the outside. 0 29 13 17 0.1
Mean (%,SDy) of space occupied in front of the client 15.00 (4.47) 15.00 (5.63) 22.19 (8.56) 11.67 (5.16) 0.001
Stores (%) with tobacco ads or products <50 cm of candy 86 47 94 100 <0.001
Stores (%) with ‘No smoking’ signs 14 2.3 56 0 <0.001
Stores (%) with ‘No sales to minors’ signs 0 2.3 25 0 0.002
Stores (%) within 100 metres of a school 14 77 25 57 <0.001
*Percentages do not add up to 100% owing to rounding.
y%, SD: Refers to the mean and the SD of the total percentage of space that the cigarette counter occupied in front of the client.
What this paper adds
Tobacco point-of-sale advertising has been found to increase
brand recognition and adolescents’ perception about the ease of
purchasing cigarettes. In the USA, Canada, Australia and
Malaysia, a high prevalence of tobacco point-of-sale advertising
has been documented. Guatemala and Argentina are two Latin
American countries that lack comprehensive advertising bans.
Consistent with findings elsewhere, we document a high preva-
lence of tobacco point-of-sale advertising in Guatemala and
Argentina. These countries need comprehensive advertising bans
that include point-of-sale restrictions.
340 Tobacco Control 2010;19:338e341. doi:10.1136/tc.2009.031898
Brief report
Funding This work was carried out with the aid of a grant from the Research for
International Tobacco Control (RITC) program of the International Development
Research Centre (IDRC) in Ottawa, Canada. Joaquin Barnoya is partially supported by
an unrestricted grant from the American Cancer Society.
Competing interests None.
Contributors RM and JB conceived the study and lead the data analysis. JB took the
lead in manuscript writing. DS and CK pilot tested the survey and contributed to data
analysis. All authors have approved the final version of the manuscript.
Provenance and peer review Not commissioned; externally peer reviewed.
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Brief report
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