Objectives. We have documented little cigar and cigarillo (LCC) availability, advertising, and price in the point-of-sale environment and examined associations with neighborhood demographics.

Methods. We used a multimodal real-time surveillance system to survey LCCs in 750 licensed tobacco retail outlets that sold tobacco products in Washington, DC. Using multivariate models, we examined the odds of LCC availability, the number of storefront exterior advertisements, and the price per cigarillo for Black & Mild packs in relation to neighborhood demographics.

Results. The odds of LCC availability and price per cigarillo decreased significantly in nearly a dose-response manner with each quartile increase in proportion of African Americans. Prices were also lower in some young adult neighborhoods. Having a higher proportion of African American and young adult residents was associated with more exterior LCC advertising.

Conclusions. Higher availability of LCCs in African American communities and lower prices and greater outdoor advertising in minority and young adult neighborhoods may establish environmental triggers to smoke among groups susceptible to initiation, addiction, and long-term negative health consequences.

During the past decade, the popularity of little cigars and cigarillos (LCCs) has risen dramatically. From 2000 to 2011, cigar sales increased by 221%,1 whereas cigarette sales continued a decades-long decline.2,3 As other venues for tobacco advertising have become increasingly limited, the point-of-sale environment is a critical battleground for companies to market their products.4 Although there is no recent data on tobacco industry advertising budgets for LCCs specifically, the latest reports indicate that companies spent more than 90% of their $8.4 billion marketing budget in 2011 for retail advertising and promotions.2 Evidence suggests this strategy is highly effective: exposure to point-of-sale displays is a risk factor for youth initiation5,6 and higher levels of smoking among adults.7

LCCs are popular among populations of interest to tobacco control, including young adults and African Americans. National surveys show that the average age at first cigar use was 20.5 years in 2010.8 Young adults aged 18 to 25 years have the highest rates of past month cigar use (11.2%) compared with youths and older adults.8 However, these estimates may underestimate prevalence. Because most state and national surveillance surveys do not ask questions specific to LCCs, it is difficult to validly estimate patterns of use of these products among different populations.9–12 One exception is a recent nationally representative study of young adults aged 18 to 34 years, which reported that 26.0% of respondents had ever smoked little cigars, cigarillos, or bidis and that 16.0% of everyday or occasional smokers currently smoked these products.13

Recent regional surveys that include brand-specific items for LCCs document higher estimates of use, particularly for minority populations. Tercheck et al.12 found a near doubling of reported cigar use among adolescents when use of the brand Black & Mild, a popular cigarillo product, was measured by a question added to a regional Youth Risk Behavior Survey. This increase was most distinctive among African Americans, among whom reported prevalence rose from 11.7% to 22.0%. LCC product use and dual use of cigars and cigarettes14 have been found to be more common among males, African Americans, and low-income adults.9,15,16

Ample evidence demonstrates greater point-of-sale cigarette advertising in neighborhoods with minority and younger populations, including more storefront cigarette advertising,17 a greater number of cigarette advertisements and promotions,18,19 and a trend toward higher levels of cigar self-service in low-income communities.20 Furthermore, studies suggest selective marketing to young people and minorities with specific product types, such as smokeless tobacco in neighborhoods with younger populations21 and menthol cigarettes in minority communities.17,22–29 Although self-reported data from inner-city youths and young adults point to community-level factors as determinants of LCC use,30,31 to our knowledge no previous research has systematically documented how LCCs are advertised and priced in the retail environment and how marketing may differ by community demographics.

Unlike cigarettes, LCCs are not currently regulated by the Food and Drug Administration under the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA).32 Thus, LCCs are not subject to the same regulations as cigarettes regarding characterizing flavors, sales, and marketing. For example, the FSPTCA bans on flavored cigarettes and sales of packages containing fewer than 20 cigarettes do not apply to LCCs. LCCs are often sold individually or in packs of fewer than 20. Furthermore, these products often come in flavors appealing to youth and young adult populations, including candy and alcohol flavors. Moreover, differences in federal and state taxing of cigarettes, cigars, and LCCs often make these products less expensive than cigarettes.33

Surveillance of LCC advertising in the point-of-sale environment is critical for monitoring tobacco industry marketing strategies and informing Food and Drug Administration policy. Because of the current lack of data on LCC marketing and a history of differential marketing of tobacco products in vulnerable communities, we have documented LCC availability, advertising, and price in the retail environment and examined differences by neighborhood demographics. We examined availability and store exterior advertising of LCCs overall and across communities as a function of neighborhood proportion of African Americans and young adults. We also examined prices for Black & Mild LCC packs, a top-selling cigarillo brand.1,9,12,15 Specifically, we examined Black & Mild price per cigarillo as a function of neighborhood and other characteristics.

From September 2011 to March 2012, trained fieldworkers visited retail outlets designated as licensed to sell tobacco in 2011 (n = 1060) by the Department of Health of Washington, DC. Washington, DC, the capital city of the United States, is a midsized urban city with a large African American population and is among the top 25 largest cities in the country.34 We obtained data on store type, exterior and interior advertising, prices, and placement for every tobacco retail outlet using a multimodal surveillance system. The system utilized phone-based interactive voice recording, photo, and Web capabilities to unobtrusively collect information in the point-of-sale environment. We used ArcGIS 10.135 to create routes and guide fieldworkers through the city. Fieldworkers visually inspected retail outlets, emailed interior and exterior store photos, and recorded observations via interactive voice recording. All data flowed directly into a real-time surveillance database that the study coordinator monitored.36 Although all outlets on the license list were surveyed, for this analysis we excluded outlets that were no longer in business or not open to the public (i.e., in a secured building; n = 212) or did not sell tobacco despite having a license (n = 98). The final sample totaled 750 outlets.

As business classification data on licensed outlets were unavailable, we categorized stores as convenience store, gas station, pharmacy, grocery store, liquor store, tobacco store, mass retailer, newsstand or kiosk, and other store types. Convenience stores were the most common store type, constituting nearly 30% of the sample, followed by liquor stores (21%), other store types (20%), gas stations (12%), grocery stores (11%), and pharmacies (7%). Other store types included small percentages of a variety of store types, including mass retailers, newsstands or kiosks, gift and discount stores, restaurants, and bars and hookah lounges.

We developed the survey on the basis of a literature review, including surveys of retail environments that surveyor groups used,37–39 cigar brand sales,40 price and purchasing behavior,25,41 and corporate guidelines on point-of-sale marketing.42 A 3-month pilot phase included development of the data collection system, testing questions for the survey, development of the protocol for conducting interactive voice recording surveys and collecting photos, and staff training. We conducted reliability assessments in 9 stores in a single block group. We chose 3 of each of the most common store types (convenience, grocery, and liquor) and 6 fieldworkers independently visited each store. We calculated interrater reliability using ICC.43,44 ICCs ranged from 0.62 to 1.00 for LCC items, with the exception of tax items, which were closer to 0.30. Fieldworkers were retrained on items that fell below 0.75.

We enumerated all tobacco advertisements and LCC-specific advertisements on the exterior. Fieldworkers recorded LCC product availability and noted whether products came in singles or packs of more than 1 cigarillo and whether packs of Black & Mild cigarillos were sold. We noted the type of LCCs and categorized them as regular, menthol, or flavored. We recorded the lowest price without tax for a pack of Black & Mild (excluding single cigarillos), the number of cigarillos in the lowest priced pack, and whether this price was advertised. We also recorded promotions for Black & Mild with response options of buy 1 and get 1 free, other multipack discount, and other bonuses, rebates, or coupons. We defined the 3 study outcomes as whether LCCs were available in the store, the number of LCC advertisements on the store exterior, and the price per cigarillo for the lowest priced pack of Black & Mild. We converted prices to the price of an individual cigarillo because lowest priced Black & Mild packs ranged in size.

We geocoded the addresses of all stores and spatially joined them with census block groups using ArcGIS software.35 We used data from the 2010 US Census, Short Form 1, to determine the demographic characteristics at the block group level. The final analytic sample of 750 stores were located in 265 census block groups, with the number of outlets ranging from 1 to 25 per block group (mean = 5.5; SD = 5.4). Block groups in Washington, DC, range from less than 0.5 miles to 2.5 miles, which represents a walking area range similar to accessibility studies found in the literature.45–48 Census variables included percentage of African Americans aged 18 to 34 years and population per square mile, which we categorized into quartiles on the basis of the sample distribution (cutpoints: % African American at 11.4%, 56.1%, 89.1%; % aged 18–34 years at 23.2%, 31.1%, 44.0%; population per square mile: 8872, 15 991, 23 778). The use of categories derived from the distribution is a common approach, as it makes no assumptions regarding linearity and is easy to interpret. Other independent variables included store type and the number of registers (a proxy for store size), dichotomized as less than 3 versus 3 or more. For the price model, additional variables included whether the Black & Mild price was advertised and whether the cigarillos came in 2-packs or 5-packs.

We examined the study outcomes of LCC availability, exterior advertising, and price per cigarillo as a function of census block group demographics, number of outlets, store type, and number of registers. For the number of LCC advertisements on the store exterior, we used zero-inflated negative binomial regression rather than Poisson regression, similar to the methodology Widome et al. used.21 We utilized zero-inflated negative binomial models, which are appropriate when the data include excess zeros (i.e., stores with no LCC advertisements) and there are concerns that processes, such as store policies around exterior tobacco advertising, might drive the zero and count values. We used a variable to reflect the total amount of non-LCC advertising to predict the zeros and used the other predictors for the LCC advertisement count. We used robust sandwich estimates to address clustering. The dispersion coefficient (α) was significantly different from zero, indicating that the data were overdispersed and the negative binomial was more appropriate than a Poisson model.49 The Vuong test50 was significant, indicating that the zero-inflated negative binomial was superior to a standard negative binomial. The predictor of excess zeros was statistically significant as well. We have reported prevalence ratios with 95% confidence intervals (CIs).

We used Stata version 11.2 (StataCorp, LP, College Station, TX) to calculate outcomes for availability of LCC products and the price per cigarillo using binary and linear multilevel models, respectively, which included a random intercept and adjusted for predictors at the store and block group level. We have provided a visual analysis of findings from the price model, utilizing ArcGIS 10.1. We mapped the geographic distribution of the African American population in Washington, DC, with a quartile distribution map of the African American population by 2010 US Census block groups.

Next, we utilized the Geostatistical Analysts extension toolbar to produce a prediction map of LCC price using kriging methodology. Kriging produces an estimate of the underlying surface by a weighted average of the data, with weights declining with distance between the point at which the surface is being estimated and the locations of the data points. We assumed data points and the associated surface at nearby locations to be more similar to each other than points at locations distant from each other. For our prediction map, data points are the spatial locations of tobacco retail outlets in Washington, DC, that have an associated Black & Mild price. We then chose ordinary kriging using a K-Bessel model to produce our kriged surface. This model tends to produce surfaces that are more smooth locally than those of other models.

Nearly 40% of stores had exterior tobacco advertising of any kind, whereas 12% of stores had exterior LCC advertisements, as shown in Table 1. Among stores with any exterior tobacco advertising, the number of tobacco advertisements per store ranged from 1 to 20, with a mean of 3.3 (SD = 2.7), and among stores with any LCC advertising, the number of LCC advertisements ranged from 1 to 8, with a mean of 1.9 (SD = 1.3). LCCs were available for sale at more than 80% of stores selling tobacco in Washington, DC. Nearly 60% of these stores sold single LCCs, 74% sold LCC packs, and 70% offered Black & Mild packs. Of the stores that sold LCCs, a full 95% sold LCCs in flavors, such as fruit, candy, and wine, and 13% sold menthol LCCs. Black & Mild pack types for the lowest priced pack were most commonly available as 2-packs and 5-packs. Promotions on packs of Black & Mild were available in approximately 6% of stores. The average price per cigarillo for the lowest priced Black & Mild pack was $0.91 (SD = 0.21). Price varied across Washington, DC, with the maximum per cigarillo price 6 to 7 times higher ($1.65) than was the lowest per cigarillo price ($0.25). Prices for Black & Mild cigarillos were advertised in 37% of stores. A t test indicated that price per cigarillo was significantly lower for 2-packs versus 5-packs (P ≤ .001) and for advertised prices versus nonadvertised prices (P ≤ .001).

Table

TABLE 1— Descriptive Statistics of Little Cigar and Cigarillo Availability, Advertising, and Price Across Tobacco Retail Outlets: Washington, DC, 2011–2012

TABLE 1— Descriptive Statistics of Little Cigar and Cigarillo Availability, Advertising, and Price Across Tobacco Retail Outlets: Washington, DC, 2011–2012

Variable% or Mean (SD)MinimumMaximum
Among all stores (n = 750)
 Stores with exterior LCC advertising12.000.001.00
 Store sells any LCCs80.000.001.00
 Store sells single LCCs60.000.001.00
 Store sells packs of LCCs74.000.001.00
 Store sells Black & Mild LCCs70.000.001.00
Among stores selling LCCs (n = 588)
 Store sells regular LCCs98.000.001.00
 Store sells menthol LCCs13.000.001.00
 Store sells flavored LCCs95.000.001.00
Among stores selling Black & Mild (n = 513)
 Price had a promotion6.00 (24.00)0.001.00
 Price was advertised37.00 (48.00)0.001.00
Price/cigarillo, $
 Advertised0.84 (0.24)0.491.65
 Nonadvertised0.95 (0.18)0.251.60
 Overall0.91 (0.21)0.251.65

Note. LCC = little cigar and cigarillo.

Block groups in the higher quartiles for proportion of African American residents were significantly more likely to have LCCs available than were block groups in the lowest quartile (Table 2). There were no differences in LCC availability by quartiles of the population aged 18 to 34 years. For LCC exterior advertisements, the estimated prevalence of exterior LCC advertisements also increased significantly with each quartile increase in proportion of African Americans in a dose-response manner, with the highest quartile reaching a prevalence ratio of 10.16. Block groups in the third and fourth quartiles for proportion of young adults aged 18 to 34 years also had a significantly higher prevalence of exterior LCC advertisements than did those in the first quartile.

Table

TABLE 2— Associations for Little Cigar and Cigarillo Availability and for Exterior Advertising Regressed on Store Characteristics and Neighborhood Demographics: Washington, DC, 2011–2012

TABLE 2— Associations for Little Cigar and Cigarillo Availability and for Exterior Advertising Regressed on Store Characteristics and Neighborhood Demographics: Washington, DC, 2011–2012

Variable% or Mean (SD)LCCs available (n = 725), OR (95% CI)Exterior Advertising (n = 731), PR (95% CI)
Intercept1.80 (0.65, 5.00)0.12*** (0.04, 0.36)
Store
 Convenience store291.00 (Ref)1.00 (Ref)
 Gas station121.81 (0.67, 4.85)1.19 (0.70, 2.01)
 Pharmacy73.14 (0.90, 10.92)0.00*** (0.00, 0.00)
 Grocery110.56 (0.28, 1.24)0.79 (0.38, 1.64)
 Liquor210.51* (0.28, 0.93)0.81 (0.43, 1.53)
 Other200.29*** (0.16, 0.52)0.36 (0.12, 1.04)
Store’s registers, no.
 < 3871.00 (Ref)1.00 (Ref)
 ≥ 3131.02 (0.46, 2.28)0.22 (0.02, 2.41)
African American,%
 First quartile1.00 (Ref)1.00 (Ref)
 Second quartile2.82*** (1.67, 4.77)2.50* (1.10, 5.70)
 Third quartile13.5*** (5.56, 32.82)5.30*** (2.21, 12.71)
 Fourth quartile11.8*** (4.51, 30.67)10.16*** (4.21, 24.56)
Residents 18–34 y, %
 First quartile1.00 (Ref)1.00 (Ref)
 Second quartile0.99 (0.42, 2.32)1.27 (0.61, 2.65)
 Third quartile1.36 (0.46, 4.00)2.92* (1.13, 7.50)
 Fourth quartile0.96 (0.34, 2.70)3.23** (1.52, 6.8)
Population/square mile
 First quartile1.00 (Ref)1.00 (Ref)
 Second quartile0.75 (0.39, 1.45)1.05 (0.59, 1.89)
 Third quartile1.25 (0.59, 2.66)0.72 (0.33, 1.58)
 Fourth quartile1.50 (0.68, 3.30)1.20 (0.52, 2.73)
Outlets, no.4.6 (2.9)0.98 (0.93, 1.02)0.92* (0.86, 0.99)

Note. CI = confidence interval; OR = odds ratio; PR = prevalence ratio. We did not include newsstands and kiosks in this analysis, as these establishments did not have exterior walls.

*P < .05; **P < .01; ***P < .001.

Price per cigarillo decreased significantly in a dose-response manner, with increasing quartiles for African American population (Table 3). Price per cigarillo in areas in the third quartile for proportion of young adults was significantly lower by $0.09 than was the first quartile. Price per cigarillo for cigarillos sold in 2-packs was significantly lower than were those sold in 5-packs; advertised prices were significantly lower than were nonadvertised prices. Figure 1a shows the quartile distribution of the African American population for Washington, DC, with darker colors representing the higher quartiles. Figure 1b shows the prediction map of price per cigarillo across block groups using kriging methodology, with the darker color representing lower prices. Side-by-side, these maps illustrate the inverse relationship between proportion of African Americans in the block group and lower predicted price.

Table

TABLE 3— Regression Coefficients for Price per Little Cigar and Cigarillo Regressed on Store and Product Characteristics and Neighborhood Demographics: Washington, DC, 2011–2012

TABLE 3— Regression Coefficients for Price per Little Cigar and Cigarillo Regressed on Store and Product Characteristics and Neighborhood Demographics: Washington, DC, 2011–2012

VariablePrice Model 1 (n = 449), b (95% CI)
Intercept1.05*** (0.97, 1.14)
Store
 Convenience store (Ref)1.00
 Gas station0.02 (−0.04, 0.07)
 Pharmacy0.17*** (0.08, 0.27)
 Grocery0.04 (−0.03, 0.10)
 Liquor0.03 (−0.02, 0.08)
 Other0.04 (−0.01, 0.10)
Store registers, no.
 < 3 (Ref)1.00
 ≥30.02 (−0.05, 0.10)
Packs, no.
 5 (Ref)1.00
 2−0.07* (−0.12, −0.02)
Price
 Nonadvertised (Ref)1.00
 Advertised−0.15*** (−0.19, −0.10)
African American, %
 First quartile (Ref)1.00
 Second quartile−0.08** (−0.14, −0.02)
 Third quartile−0.12** (−0.19, −0.05)
 Fourth quartile−0.14*** (−0.22, −0.07)
Residents 18–34 y, %
 First quartile (Ref)1.00
 Second quartile−0.00 (−0.06, 0.05)
 Third quartile−0.09* (−0.16, −0.01)
 Fourth quartile−0.02 (−0.09, 0.06)
Population/square mile
 First quartile (Ref)1.00
 Second quartile−0.01 (−0.05, 0.04)
 Third quartile0.02 (−0.03, 0.07)
 Fourth quartile0.00 (−0.06, 0.06)
Outlets, no.0.00 (−0.00, 0.01)

Note. CI = confidence interval.

*P < .05; **P < .01; ***P < .001.

To our knowledge, this study is the first to examine LCC marketing and price in the retail environment in relation to neighborhood demographics. Data indicated that LCCs are more available in predominantly African American neighborhoods, and cheaper in African American and some young adult neighborhoods. The use of exterior advertising is significantly more prevalent in neighborhoods with African Americans and young adults. As previous studies have shown, initiation of LCC use typically occurs early in young adulthood.8 Without ever entering a store or approaching an LCC retail display, young adults and individuals in African American communities are disproportionately exposed to storefront LCC advertisements in their neighborhoods. Furthermore, individuals in African American neighborhoods and in certain young adult neighborhoods can purchase LCCs at lower prices, a proven technique for increasing demand among price-sensitive populations.51,52

Similar to menthol cigarettes that have been marketed to minority communities,17,22–29 LCCs were more likely to be available in neighborhoods with more African American residents. Widespread availability of tobacco products can contribute to a normative environment that reinforces smoking and undermines cessation.41,53–55 Such norms may be further compounded by the misperception of LCC products as less harmful than cigarettes,56–59 despite being as, or more, toxic and carcinogenic than are cigarettes. Prosmoking norms, perceptions of reduced harm, and easy access are likely to increase use of LCCs and magnify disparities among a population that already suffers from a disproportionate burden of tobacco-related morbidity and mortality.60–62

Beyond the concentration of LCCs in stores in African American communities, exterior advertising of these products was greater in communities with more minority and young adult members. The findings echo previous studies demonstrating greater storefront advertising of menthol cigarettes in minority communities.17,27,29 The higher level of exterior advertising in communities with young adults has not been previously reported. This age group continues to experiment with tobacco products, particularly novel or emerging products and occasional use.63–66 After the 1998 Master Settlement Agreement, advertising shifted from billboard to storefront exterior cigarette advertising in minority communities17,18,29,67 and has increasingly focused on young adults.68 We might expect similar shifts in marketing after the passage of the FSPTCA. Although exterior advertising of LCCs was not widespread overall, storefront advertising remains a potentially salient venue to further market LCCs in anticipation of greater restrictions on cigarette advertising and decreasing cigarette sales. These trends, if left unchecked, can serve to increase initiation and progression to established smoking and delay cessation.

Findings also indicated lower prices for LCCs in neighborhoods with more African Americans. Similarly, Henriksen et al. found lower prices for Newport cigarettes in communities with a higher percentage of African American students.25 The average price per cigarillo for the lowest priced packs of Black & Mild was relatively high at $0.91 without sales tax compared with an approximate per cigarette price of $0.24 without sales tax for a 20-pack of cigarettes at current estimated DC prices.69 However, the overall price range for LCC packs is lower considering that the products generally come in smaller pack sizes, ranging from 2 to 5 cigarillos. This provides an affordable way for price-sensitive customers to purchase the product, even though the unit cost is considerably high. Smaller pack products are reminiscent of “loosies,” cigarettes that were highly popular in certain inner-city African American communities before the FSPTCA was passed.55,70 LCC prices were lower in some young adult neighborhoods as well, but prices did not consistently decrease in a dose-response fashion for increasing quartiles of young adults, as did prices across African American block groups. Considering previous research pointing to youths as a price-sensitive population,52,71 the industry may focus promotional allowances that reduce price while enticing potential young adult smokers in venues other than retail outlets, such as bars, cafes, and nightclubs.66,72,73

Our data suggest that retail marketing of LCCs is widespread, with 80% of tobacco-selling outlets providing LCCs. Furthermore, 2 key provisions of the FSPTCA—the ban on single sales and flavored cigarettes—are undermined by the widespread presence of single-pack LCCs (60% of tobacco-selling outlets) and flavored versions (95%). It will be critical for researchers and policymakers to continue to monitor the LCC market, particularly considering its rapid growth and increasing industry interest in these products.74,75

Limitations

In this survey, we focused on the presence of product, price, and exterior advertising but did not include the characteristics of advertising inside the store. Our efforts were limited in obtaining reliable tax data on the basis of posted prices and discussions with store clerks. Interviews with fieldworkers indicated that price data collected did not include taxes, but error may have been introduced to the extent that price data with or without taxes differed between neighborhoods.

Because this study was conducted in a single city, findings may not be generalizable to all areas, including smaller cities or areas with fewer minorities. However, results likely reflect other medium to large urban areas with large populations of minorities living in concentrated neighborhoods. In addition, results may have differed if neighborhoods were measured at larger or smaller area ranges. However, these results are consistent with findings from retail surveys of Newport, menthol, and related cigarette products that have been identified as more prevalent in areas with a greater number of minorities and youths.17,19,25,27,29

Conclusions

Multiple approaches are needed to counteract the marketing and promotion of LCCs. First, LCCs should be subject to the same federal regulations as cigarettes, specifically bans on flavors, taxation, and advertising restrictions. Second, state and local governments can take action to counter advertising of LCCs in their communities, including restrictions on pack sizes76 and bans on exterior storefront advertising of tobacco.4 Furthermore, legislative mandates to report yearly advertising and promotion expenditures for cigar products, similar to those mandated for cigarettes and smokeless products,77,78 can be enacted for systematic monitoring of LCC marketing and advertising practices. Lastly, ongoing consumer behavior and product surveillance 79,80 can inform our understanding of the potential public health impact of these new products and improve the ability to respond through regulatory channels such as the FSPTCA.

Research among young adults and African Americans demonstrating the increasing popularity of LCCs has been accumulating for the past decade, yet strategies used to market to these populations at retail have not been widely documented. To our knowledge this study is the first to examine LCC marketing in the retail environment and differences in marketing by neighborhood demographics. Findings of broad LCC availability, including single sales and flavored versions, likely reflect differential regulation of cigarettes as compared with cigar products. Higher availability of these products, lower prices in African American and some young adult communities, and greater outdoor advertising in minority and young adult neighborhoods may establish environmental triggers to smoke among groups susceptible to initiation, addiction, and long-term negative health consequences.60–62,64 Real-time surveillance of the retail environment can allow rapid policy responses to emerging tobacco products to prevent industry targeting of vulnerable populations.

Acknowledgments

This research was supported by the Centers for Disease Control and Prevention, Communities Putting Prevention to Work from the District of Columbia Department of Health (contract PO358719 to T. R. K.) and the Legacy Foundation.

We thank Denise Grant and Bonita McGee from the DC Department of Health; Tac Tacelosky of Smokescreen LLC; and Matthew de Gannes, Phillip Dubois, Bethany Mitchell, Nakkia McRae, Michael Asimenios, and all of the staff at the Legacy Foundation.

Human Participant Protection

No protocol approval was necessary because this study involved no human participants, as determined by the Independent Institutional Review Board, Inc.

References

1. Maxwell JC. The Maxwell Report: Cigar Industry in 2011. Richmond, VA; 2012. Google Scholar
2. Federal Trade Commission. Federal Trade Commission Cigarette Report for 2011. Washington, DC; 2012. Google Scholar
3. Maxwell JC. The Maxwell Report: Second Quarter 2012: Cigarette Industry. Richmond, VA; 2012. Google Scholar
4. Campaign for Tobacco-Free Kids. Deadly Alliance: How Big Tobacco and Convenience Stores Partner to Market Tobacco Products and Fight Life-Saving Policies. Washington, DC: American Heart Association; 2012. Google Scholar
5. Henriksen L, Schleicher NC, Feighery EC, Fortmann SP. A longitudinal study of exposure to retail cigarette advertising and smoking initiation. Pediatrics. 2010;126(2):232238. Crossref, MedlineGoogle Scholar
6. Paynter J, Edwards R. The impact of tobacco promotion at the point of sale: a systematic review. Nicotine Tob Res. 2009;11(1):2535. Crossref, MedlineGoogle Scholar
7. Burton S, Clark L, Jackson K. The association between seeing retail displays of tobacco and tobacco smoking and purchase: findings from a diary-style survey. Addiction. 2012;107(1):169175. Crossref, MedlineGoogle Scholar
8. Substance Abuse and Mental Health Services Administration. Results From the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD; 2011. HHS publication no. (SMA)11–4658. Google Scholar
9. Cullen J, Mowery P, Delnevo C, et al. Seven-year patterns in US cigar use epidemiology among young adults aged 18–25 years: a focus on race/ethnicity and brand. Am J Public Health. 2011;101(10):19551962. LinkGoogle Scholar
10. Delnevo CD. Smokers’ choice: what explains the steady growth of cigar use in the US? Public Health Rep. 2006;121(2):116119. MedlineGoogle Scholar
11. Nasim A, Blank MD, Berry BM, Eissenberg T. Cigar use misreporting among youth: data from the 2009 Youth Tobacco Survey, Virginia. Prev Chronic Dis. 2012;9:E42. MedlineGoogle Scholar
12. Terchek JJ, Larkin EM, Male ML, Frank SH. Measuring cigar use in adolescents: inclusion of a brand-specific item. Nicotine Tob Res. 2009;11(7):842846. Crossref, MedlineGoogle Scholar
13. Rath JM, Villanti AC, Abrams DB, Vallone DM. Patterns of tobacco use and dual use in US young adults: the missing link between youth prevention and adult cessation. J Environ Public Health; 2012;2012:19. CrossrefGoogle Scholar
14. Richardson A, Xiao H, Vallone DM. Primary and dual users of cigars and cigarettes: profiles, tobacco use patterns and relevance to policy. Nicotine Tob Res. 2012;14(8):927932. Crossref, MedlineGoogle Scholar
15. Borawski EA, Brooks A, Colabianchi N, et al. Adult use of cigars, little cigars, and cigarillos in Cuyahoga County, Ohio: a cross-sectional study. Nicotine Tob Res. 2010;12(6):669673. Crossref, MedlineGoogle Scholar
16. King BA, Dube SR, Tynan MA. Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey. Am J Public Health. 2012;102(11):e93e100. LinkGoogle Scholar
17. Seidenberg AB, Caughey RW, Rees VW, Connolly GN. Storefront cigarette advertising differs by community demographic profile. Am J Health Promot. 2010;24(6):e26e31. Crossref, MedlineGoogle Scholar
18. Feighery EC, Schleicher NC, Boley Cruz T, Unger JB. An examination of trends in amount and type of cigarette advertising and sales promotions in California stores, 2002–2005. Tob Control. 2008;17(2):9398. Crossref, MedlineGoogle Scholar
19. John R, Cheney MK, Azad MR. Point-of-sale marketing of tobacco products: taking advantage of the socially disadvantaged? J Health Care Poor Underserved. 2009;20(2):489506. Crossref, MedlineGoogle Scholar
20. Frick RG, Klein EG, Ferketich AK, Wewers ME. Tobacco advertising and sales practices in licensed retail outlets after the Food and Drug Administration regulations. J Community Health. 2012;37(5):963967. Crossref, MedlineGoogle Scholar
21. Widome R, Brock B, Klein EG, Forster JL. Smokeless tobacco advertising at the point of sale: prevalence, placement, and demographic correlates. Nicotine Tob Res. 2012;14(2):217223. Crossref, MedlineGoogle Scholar
22. Anderson SJ. Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents. Tob Control. 2011;20(suppl 2):ii20ii28. Crossref, MedlineGoogle Scholar
23. Cruz TB, Wright LT, Crawford G. The menthol marketing mix: targeted promotions for focus communities in the United States. Nicotine Tob Res. 2011;12(suppl 2):S147S153. Google Scholar
24. Hafez N, Ling PM. Finding the Kool Mixx: how Brown & Williamson used music marketing to sell cigarettes. Tob Control. 2006;15(5):359366. Crossref, MedlineGoogle Scholar
25. Henriksen L, Schleicher NC, Dauphinee AL, Fortmann SP. Targeted advertising, promotion, and price for menthol cigarettes in California high school neighborhoods. Nicotine Tob Res. 2012;14(1):116121. Crossref, MedlineGoogle Scholar
26. Johnson DM, Wine LA, Zack S, et al. Designing a tobacco counter-marketing campaign for African American youth. Tob Induc Dis. 2008;4:7. Crossref, MedlineGoogle Scholar
27. Laws MB, Whitman J, Bowser DM, Krech L. Tobacco availability and point of sale marketing in demographically contrasting districts of Massachusetts. Tob Control. 2002;11(suppl 2):ii71ii73. MedlineGoogle Scholar
28. Yerger VB, Przewoznik J, Malone RE. Racialized geography, corporate activity, and health disparities: tobacco industry targeting of inner cities. J Health Care Poor Underserved. 2007;18:1038. Crossref, MedlineGoogle Scholar
29. Pucci LG, Joseph HM Jr, Siegel M. Outdoor tobacco advertising in six Boston neighborhoods. Evaluating youth exposure. Am J Prev Med. 1998;15(2):155159. Crossref, MedlineGoogle Scholar
30. Page JB, Evans S. Cigars, cigarillos, and youth: emergent patterns in subcultural complexes. J Ethn Subst Abuse. 2003;2(4):6376. CrossrefGoogle Scholar
31. Singer M, Mirhej G, Page JB, Hastings E, Salaheen H, Prado G. Black ’N Mild and carcinogenic: cigar smoking among inner city young adults in Hartford, CT. J Ethn Subst Abuse. 2007;6(3–4):8194. Crossref, MedlineGoogle Scholar
32. Family Smoking Prevention and Tobacco Control Act. Pub L. No. 111-31, 123, HR 1256. Stat. 1776–1858 (2009). Google Scholar
33. US Government Accountability Office. Large Disparities in Rates for Smoking Products Trigger Significant Market Shifts to Avoid Higher Taxes. Washington, DC; 2012. Google Scholar
34. US Census Bureau, Population Division. Table 1. Annual Estimates of the Resident Population for Incorporated Places Over 50,000, Ranked by July 1, 2011 Population: April 1, 2010 to July 1, 2011. Washington, DC; 2012. Google Scholar
35. ArcGIS Desktop, Version 10.0. [computer program]. Redlands, CA: Environmental Systems Research Institute; 2012. Google Scholar
36. Kirchner TR, Cantrell J, Anesetti-Rothermel A, et al. Individual mobility patterns and real-time geo-spatial exposure to point-of-sale tobacco marketing. In: Proceedings of ACM Wireless Health; October 23–25, 2012; San Diego, CA. CrossrefGoogle Scholar
37. Cohen JE, Planinac LC, Griffin K, et al. Tobacco promotions at point-of-sale: the last hurrah. Can J Public Health. 2008;99(3):166171. MedlineGoogle Scholar
38. Siahpush M, Jones PR, Singh GK, Timsina LR, Martin J. The association of tobacco marketing with median income and racial/ethnic characteristics of neighbourhoods in Omaha, Nebraska. Tob Control. 2010;19(3):256258. Crossref, MedlineGoogle Scholar
39. Watson K, Kim A, Nonnemaker J. Highlights From the Retail Advertising Tobacco Survey 2009. Research Triangle Park, NC: Research Triangle Institute International; 2009. Google Scholar
40. Maxwell JC. The Maxwell Report: Cigar Industry in 2009. Richmond, VA; 2010. Google Scholar
41. Henriksen L. Comprehensive tobacco marketing restrictions: promotion, packaging, price and place. Tob Control. 2012;21(2):147153. Crossref, MedlineGoogle Scholar
42. Liljenwall R. The Power of Marketing at-Retail. 3rd ed. Alexandria, VA: Point-Of-Purchase Advertising International; 2008. Google Scholar
43. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420428. Crossref, MedlineGoogle Scholar
44. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Methods. 1996;1(1):3046. CrossrefGoogle Scholar
45. Reitzel LR, Cromley EK, Li Y, et al. The effect of tobacco outlet density and proximity on smoking cessation. Am J Public Health. 2011;101(2):315320. LinkGoogle Scholar
46. Frank LD, Schmid TL, Sallis JF, Chapman J, Saelens BE. Linking objectively measured physical activity with objectively measured urban form: findings from SMARTRAQ. Am J Prev Med. 2005;28(2, suppl 2):117125. Crossref, MedlineGoogle Scholar
47. Berke EM, Gottlieb LM, Moudon AV, Larson EB. Protective association between neighborhood walkability and depression in older men. J Am Geriatr Soc. 2007;55(4):526533. Crossref, MedlineGoogle Scholar
48. Tucker P, Irwin JD, Gilliland J, He M, Larsen K, Hess P. Environmental influences on physical activity levels in youth. Health Place. 2009;15(1):357363. Crossref, MedlineGoogle Scholar
49. Cameron AC, Trivedi PK. Regression Analysis of Count Data. Cambridge, UK: Cambridge University Press; 1998. CrossrefGoogle Scholar
50. Vuong Q. Likelihood ratio tests for model selection and non-nested hypotheses. Econometrica. 1989;57(2):307333. CrossrefGoogle Scholar
51. Chaloupka FJ. Macro-social influences: the effects of prices and tobacco-control policies on the demand for tobacco products. Nicotine Tob Res. 1999;1(suppl 1):S105S109. Crossref, MedlineGoogle Scholar
52. Rice N, Godfrey C, Slack R, Sowden A, Worthy G. Final Report: A Systematic Review of the Effects of Price on the Smoking Behavior of Young People. London, UK: Public Health Research Consortium; 2006. Google Scholar
53. Ahern J, Galea S, Hubbard A, Syme SL. Neighborhood smoking norms modify the relation between collective efficacy and smoking behavior. Drug Alcohol Depend. 2009;100(1–2):138145. Crossref, MedlineGoogle Scholar
54. Karasek D, Ahern J, Galea S. Social norms, collective efficacy, and smoking cessation in urban neighborhoods. Am J Public Health. 2012;102(2):343351. LinkGoogle Scholar
55. Stillman FA, Bone L, Avila-Tang E, et al. Barriers to smoking cessation in inner-city African American young adults. Am J Public Health. 2007;97(8):14051408. LinkGoogle Scholar
56. O’Connor RJ, McNeill A, Borland R, et al. Smokers’ beliefs about the relative safety of other tobacco products: findings from the ITC collaboration. Nicotine Tob Res. 2007;9(10):10331042. Crossref, MedlineGoogle Scholar
57. Steinberg MB, Delnevo CD. Tobacco smoke by any other name is still as deadly. Ann Intern Med. 2010;152(4):259260. Crossref, MedlineGoogle Scholar
58. Burns DM. Cigar Smoking: Overview and Current State of the Science. Bethesda, MD: National Cancer Institute; 1998. Google Scholar
59. Rickert WS, Robinson JC, Bray DF, Rogers B, Collishaw NE. Characterization of tobacco products: a comparative study of the tar, nicotine, and carbon monoxide yields of cigars, manufactured cigarettes, and cigarettes made from fine-cut tobacco. Prev Med. 1985;14(2):226233. Crossref, MedlineGoogle Scholar
60. Fagan P, Moolchan ET, Lawrence D, Fernander A, Ponder PK. Identifying health disparities across the tobacco continuum. Addiction. 2007;102(suppl 2):529. Crossref, MedlineGoogle Scholar
61. Vidrine JI, Reitzel LR, Wetter DW. The role of tobacco in cancer health disparities. Curr Oncol Rep. 2009;11(6):475481. Crossref, MedlineGoogle Scholar
62. Centers for Disease Control and Prevention. Racial/Ethnic disparities and geographic differences in lung cancer incidence—38 states and the District of Columbia, 1998–2006. MMWR Morb Mortal Wkly Rep. 2010;59(44):14341438. MedlineGoogle Scholar
63. Wray RJ, Jupka K, Berman S, Zellin S, Vijaykumar S. Young adults’ perceptions about established and emerging tobacco products: results from eight focus groups. Nicotine Tob Res. 2012;14(2):184190. Crossref, MedlineGoogle Scholar
64. Biener L, Albers AB. Young adults: vulnerable new targets of tobacco marketing. Am J Public Health. 2004;94(2):326330. LinkGoogle Scholar
65. Hammond D. Smoking behaviour among young adults: beyond youth prevention. Tob Control. 2005;14(3):181185. Crossref, MedlineGoogle Scholar
66. Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. Am J Public Health. 2002;92(6):908916. LinkGoogle Scholar
67. Celebucki CC, Diskin K. A longitudinal study of externally visible cigarette advertising on retail storefronts in Massachusetts before and after the Master Settlement Agreement. Tob Control. 2002;11(suppl 2):ii47ii53. MedlineGoogle Scholar
68. Hafez N, Ling PM. How Philip Morris built Marlboro into a global brand for young adults: implications for international tobacco control. Tob Control. 2005;14(4):262271. Crossref, MedlineGoogle Scholar
69. Boonn A, Campaign for Tobacco-Free Kids. State cigarette tax rates & rank, date of last increase, annual pack sales & revenues, and related data. 2012. Available at: http://www.tobaccofreekids.org/research/factsheets/pdf/0099.pdf. Accessed September 18, 2012. Google Scholar
70. Smith KC, Stillman F, Bone L, et al. Buying and selling “loosies” in Baltimore: the informal exchange of cigarettes in the community context. J Urban Health. 2007;84(4):494507. Crossref, MedlineGoogle Scholar
71. Farrelly MC, Bray JW, Pechacek TP, Woollery TA. Response by adults to increase in cigarette prices by sociodemographic characteristics. South Econ J. 2001;68(1):156165. CrossrefGoogle Scholar
72. Gilpin EA, White VM, Pierce JP. How effective are tobacco industry bar and club marketing efforts in reaching young adults? Tob Control. 2005;14(3):186192. Crossref, MedlineGoogle Scholar
73. Jalleh G, Donovan RJ, Stewart S, Sullivan D. Selling or promotion? Tob Control. 2005;14(6):430. Crossref, MedlineGoogle Scholar
74. Altria Group, Inc. Altria Group, Inc. agrees to acquire John Middleton, Inc. for $2.9 billion: extends its US tobacco business into the growing cigar category. 2007. Available at: http://investor.altria.com/phoenix.zhtml?c=80855&p=irol-newsArticle&ID=1070876&highlight=. Accessed September 18, 2012. Google Scholar
75. Foster L. Reynolds to acquire Conwood. Financial Times. April 26, 2006. Google Scholar
76. Milam AJ, Bone L, Furr-Holden D, et al. Mobilizing for policy: using community-based participatory research to impose minimum packaging requirements on small cigars. Prog Community Health Partnership. 2012;6(2):205212. Crossref, MedlineGoogle Scholar
77. Cigarette Labeling and Advertising Act. 15 USC §1331–1341 (1965). Google Scholar
78. Comprehensive Smokeless Tobacco Health Education Act of 1986. 15 USC §§ 4401–4408 (1986). Google Scholar
79. O’Connor RJ, Cummings KM, Rees VW, et al. Surveillance methods for identifying, characterizing, and monitoring tobacco products: potential reduced exposure products as an example. Cancer Epidemiol Biomarkers Prev. 2009;18(12):33343348. Crossref, MedlineGoogle Scholar
80. O’Connor RJ. Postmarketing surveillance for “modified-risk” tobacco products. Nicotine Tob Res. 2012;14(1):2942. Crossref, MedlineGoogle Scholar

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Jennifer Cantrell, DrPH, MPA, Jennifer M. Kreslake, MPH, Ollie Ganz, MSPH, Jennifer L. Pearson, PhD, MPH, Donna Vallone, PhD, MPH, Andrew Anesetti-Rothermel, MPH, Haijun Xiao, MS, and Thomas R. Kirchner, PhDJennifer Cantrell, Jennifer M. Kreslake, Ollie Ganz, Donna Vallone, and Haijun Xiao are with the Research and Evaluation Department, Legacy Foundation, Washington, DC. Jennifer L. Pearson, Andrew Anesetti-Rothermel, and Thomas R. Kirchner are with the Schroeder Institute for Tobacco Research and Policy Studies, Legacy Foundation. “Marketing Little Cigars and Cigarillos: Advertising, Price, and Associations With Neighborhood Demographics”, American Journal of Public Health 103, no. 10 (October 1, 2013): pp. 1902-1909.

https://doi.org/10.2105/AJPH.2013.301362

PMID: 23948008