Point-of-Purchase Alcohol Marketing and Promotion by Store Type --- United States, 2000--2001

Alcohol consumption is the third leading preventable cause of death in the United States, accounting for approximately 100,000 deaths annually (1). Efforts to reduce the adverse health and social consequences from alcohol use include policies to restrict access to alcohol among underaged persons (i.e., persons aged <21 years) and to reduce alcohol-impaired driving among persons of all ages (2). Recent studies have focused on alcohol marketing as a potentially important contributor to alcohol consumption, particularly among underage drinkers (3). Point-of-purchase (POP) (i.e., on-site) marketing, including alcohol advertising and placement, can increase alcohol sales and consumption substantially (4), thereby increasing the risk for various alcohol-related health outcomes, including alcohol-impaired driving and interpersonal violence (5--7). To assess the type and frequency of POP alcohol marketing, researchers with the ImpacTeen Project* collected and analyzed store observation data during 2000--2001 from 3,961 alcohol retailers in 329 communities throughout the United States. This report summarizes the results of the study, which indicate that POP alcohol marketing is extensive in certain store types frequented by teenagers and young adults. Public health agencies and policy makers should work with liquor control boards to reduce POP marketing that could promote risky or underage drinking.

Communities with one or more public schools that participated in either the 2000 or 2001 Monitoring the Future surveys (nationally representative surveys of 8th-, 10th-, and 12th-grade students) (8) were eligible to be included in the study. Private and magnet schools (comprising approximately 20% of the original sample) were not included in this study. Community boundaries were defined by the area from which each school drew >80% of its student population. Retailers selling tobacco and alcohol products in each community were selected randomly for observation from lists of all potential alcohol and/or tobacco retailers as identified by their Standard Industrial Classification codes^†. Of the total 6,031 observed stores, 3,961 (66%) were alcohol retailers and were included in this study.

In each alcohol retail establishment, field staff observed the presence of various POP alcohol marketing characteristics in a standardized manner, including 1) exterior and interior advertisements for alcoholic beverages and the intensity of such advertising, 2) alcohol beverage control signage (e.g., health warnings), 3) alcohol-branded functional objects provided free to retailers (e.g., counter change mats with an alcohol company logo), 4) beer placement (e.g., single cans or bottles chilled in buckets near checkout locations (Figure) or not chilled on shelf), and 5) the presence of low-height advertisements (i.e., advertisements placed within 3.5 feet of the floor, in the sight line of children and adolescents as opposed to adults).

The GENMOD procedure in SAS v.8 was used to determine generalized estimating equations that accounted for community clustering, specifying a binomial distribution and a logit link function. For all analyses, weights were included to account for community sampling procedures and store selection probabilities; supermarkets were the referent category.

The majority of stores (94%) had some form of POP alcohol marketing (i.e., store exterior, store interior, and/or parking lot or other property advertising and/or alcohol-branded functional objects). Exterior alcohol advertisements were observed in 39% of stores (Table 1); 27% of stores had high-intensity exterior advertising^§. Compared with supermarkets, liquor stores (odds ratio [OR] = 176.8), convenience stores (OR = 48.2), convenience/gas stores (OR = 42.3), small grocery stores (OR = 24.5), and drug stores/pharmacies (OR = 15.5) were more likely to have high-intensity exterior alcohol advertising.

Interior alcohol advertisements were observed in 92% of stores, and 37% of stores had high-intensity interior advertising^¶. Liquor stores (OR = 18.5), convenience/gas stores (OR = 4.8), convenience stores (OR = 3.9), and small grocery stores (OR = 3.5) were more likely than supermarkets to have high-intensity interior advertisements. Low-height advertisements were found in 44% of stores. Low-height advertising was more common in liquor stores (OR = 5.1) and in convenience/gas stores (OR = 2.2) than in supermarkets. Less than half (48%) of the stores in the sample had alcohol control or counter-alcohol signage, with no statistically significant differences by store type.

Approximately half (51%) of the stores provided at least one alcohol-branded functional object. These objects were more likely to be in liquor stores (OR = 4.2), convenience stores (OR = 1.8), and small grocery stores (OR = 2.0) than in supermarkets (Table 2).

Among all types of stores, beer was located most commonly in coolers (96%), in floor displays (44%), on shelves (23%), and as singles in ice buckets (16%). Single beers in ice buckets, located most often near checkout locations, were most likely to be found in convenience stores (27%), convenience/gas stores (18%), and small grocery stores (27%) (Table 2). Shelf displays of beer were most common in supermarkets (47%) and drug stores (43%); 1% of stores placed beer behind a counter or in a closed or locked cabinet.

Reported by: YM Terry-McElrath, MSA, Univ of Michigan, Ann Arbor. EM Harwood, PhD, AC Wagenaar, PhD, Univ of Minnesota, Minneapolis. S Slater, MS, FJ Chaloupka, PhD, Univ of Illinois at Chicago. RD Brewer, MD, TS Naimi, MD, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

The findings in this report indicate that POP alcohol marketing is extensive in stores frequented by U.S. teenagers and young adults. POP marketing was found in >90% of stores, and 44% of stores had low-height interior alcohol advertising. Although liquor stores generally had the most aggressive POP marketing strategy, convenience stores (with or without gasoline) and small grocery stores had the most accessible alcohol products and were the most likely to sell chilled single beers in buckets. Alcohol control signage was displayed in <50% of stores, and almost no stores kept beer in locked cabinets or behind the counter.

POP marketing can increase total beer sales by as much as 17% (4) and influences consumer purchase behavior, with 70% of a buyer's purchasing choice occurring after the buyer enters the retail establishment (4). Persons aged 21--27 years are more likely to purchase beer in convenience stores and liquor stores than in supermarkets and drug stores (9), and 75% of teenagers shop at convenience or convenience/gas stores weekly (10). Therefore, aggressive POP marketing in convenience and liquor stores might influence young adults, underage persons, and adolescents disproportionately. These age groups also have the highest rates of binge drinking and alcohol-impaired driving (1). The findings in this report are subject to at least two limitations. First, the communities and retail stores included in this study might not be representative of all communities and stores in the United States. Second, although retailer selection was random, no effort was made to ensure that the various store types were represented proportionally.

Few POP alcohol marketing guidelines exist. Given the efficacy and widespread use of POP alcohol marketing, policy makers and public health agencies should work with liquor control boards to curb sales practices that could either increase risky drinking (e.g., selling iced single beers, particularly near checkout counters, which might increase drinking and driving) or promote drinking among young adults, adolescents, and children (e.g., high-intensity or low-height advertising).

References

1. Naimi TS, Brewer RD, Mokdad A, Denny C, Serdula MK, Marks JS. Binge drinking among U.S. Adults. JAMA 2003;289:70--5.
2. Alcohol Epidemiology Program. Alcohol policies in the United States: highlights from the 50 states. Minneapolis, Minnesota: University of Minnesota, 2000. Available at http://www.epi.umn.edu/alcohol/pdf/chrtbook.pdf.
3. Center on Alcohol Marketing and Youth. Overexposed: youth a target of alcohol advertising in magazines. Washington, DC: Center on Alcohol Marketing and Youth, 2002. Available at http://camy.org/research/mag0902.
4. Beverage Industry. POP proves its worth. Beverage Industry 2001;92:44--7.
5. Grossman M, Chaloupka FJ, Saffer H, Laixuthai A. Effects of alcohol price policy on youth: a summary of economic research. Journal of Research on Adolescence 1994;4:347--64.
6. Stout EM, Sloan FA, Liang L, Davies HH. Reducing harmful alcohol-related behaviors: effective regulatory methods. J Stud Alcohol 2000;61:402--12.
7. Skog O. An experimental study of a change from over-the-counter to self-service sales of alcoholic beverages in monopoly outlets. J Stud Alcohol 2000;61:95--100.
8. Bachman JG, Johnston LD, O'Malley PM. The Monitoring the Future Project after twenty-seven years: design and procedures. Ann Arbor, Michigan: Institute for Social Research, University of Michigan, 2001 (Monitoring the Future Occasional Paper No. 54).
9. Miller Brewing Company. Beer is Volume with Profit. Milwaukee, Wisconsin: Miller Brewing Company, 1997.
10. Point of Purchase Advertising Institute. The Point-of-Purchase Advertising Industry Fact Book. Englewood, New Jersey: The Point of Purchase Advertising Institute, 1992.

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