Research suggests that low income, minority neighborhoods tend to have a great density

of unhealthy consumer products with a heavy marketing influence for these goods, which

translates into environments that both promote and sustain adverse health behaviors. The

limited availability of nutritious foods in conjunction with high density alcohol and tobac-

co outlets in low-income neighborhoods may contribute to disparities in smoking, cancer,

diabetes, obesity and cardiovascular disease.

This study aims to improve the understanding of the retail environment (the “point of

sale”) in Orleans Parish as it relates to tobacco, alcohol and food. This study maps and

analyzes the relationship between the 4Ps (product, placement, pricing and promotion)

of tobacco, alcohol and food in Orleans Parish, a county in Southeast Louisiana. The 4Ps

influence purchasing decisions and ultimately affect the health of a community.

Healthy Stores: The 4Ps of Food, Alcohol, and Tobacco in New Orleans, Louisiana

Thomas W. Carton, PhD, MS1, Megan C. Tulikangas, MPP

1, Jaffer A. Shariff, (MPH), BDS

1, Iben M. Rickett, MPH

2, Lindsey S. Rudov, (MPH), BA

1

1 Louisiana Public Health Institute

2 William Carey University

O B J E C T I V E

M E T H O D O L O G Y

R E S U L T S

The study population consists of retail stores in Orleans Parish that sell tobacco, alcohol,

and/or food. Store types included beer, wine & liquor stores; convenience stores; gasoline

stations; meat markets (not wholesale stores); pharmacies and drug stores; and supermar-

ket & other grocery (except convenience) stores.

Tobacco stores were identified by obtaining a complete list of stores with active Tobacco

Retail Permits from the Louisiana Office of Alcohol and Tobacco Control.1 Alcohol

stores were identified by obtaining the Active Alcohol Beverages Licenses list from the

City of New Orleans, Department of Finance.2 Food stores were identified by obtaining a

complete census of food retail stores in Orleans Parish compiled by the Tulane Prevention

and Research Center.

Number of Tobacco, Alcohol, and Healthy Food Retail Stores Per Capita

and Per Capita Income by Neighborhood in Orleans Parish, Louisiana

N E X T S T E P S This analysis demonstrates that low-income neighborhoods in New Orleans are tobacco

and alcohol “swamps” and food “deserts”. Over the next three to five years, LPHI will

undertake the following activities to reduce health disparities related to tobacco, alcohol,

and food in New Orleans: Research

Store Surveys will be performed annually to create a longitudinal record of tobacco,

alcohol, and food products available by neighborhood.

Interviews with store owners and managers will supplement assessment data by adding

insight into why products are sold and how they are promoted.

Case Studies will qualitatively highlight

differences in the way products are

presented to purposively selected

neighborhoods.

Billboard Surveys will supplement

unhealthy product promotion inside

stores with promotion throughout the

community.

Phone Surveys of Orleans Parish

residents measure their perceptions of

tobacco, alcohol, and food availability and promotion.

Photovoice interviews of Orleans Parish residents will document unhealthy product

promotion from a consumer perspective.

Longitudinal Tracking of Orleans Parish residents will measure exposure to products

and advertising in real time.

Advocacy & Awareness A curriculum for 5th and 6th grade New Orleans public school students will teach

youth about disparities in access to unhealthy products and healthy food, and encourage

them to become conscientious shoppers and advocates for change.

Throughout Louisiana, TFL grantee organizations are performing store surveys in their

own communities to demonstrate that the marketing of tobacco products is an issue for

all residents in the state.

Policy Change Leverage research to investigate policy responses to results.

Investigate healthy store certification criteria and processes.

Store Census

Data Collection

Six pairs of data collectors visited all 465 retail stores that sell food, tobacco and/or alco-

hol in Orleans Parish. Every store was visited at least three times, i.e. once for each prod-

uct type. Each sub-team visited approximately 37 stores per week for 7 weeks from May

to July 2013. Stores that could not be visited during this period (due to safety concerns,

store closures, or other valid reasons) were revisited in August and September 2013.

In addition, a pair of quality control data collectors visited 4 stores per product each week

(12 total stores) and completed the data collection modules in order to measure reliability.

All data collection was performed on mobile phones using an electronic survey applica-

tion called “doForms.” Within each pair, data collectors were assigned distinct roles: one

quantified exterior signage, interior signage, and types of products present in the store,

while the other quantified exterior and interior store characteristics and documented price.

Both socio-economic status

and retail access were cate-

gorized as four-level varia-

bles defined by quar-

tiles. Socio-economic status

was consistent across all

three analyses. Quartiles for

tobacco, alcohol, and

healthy food access were

constructed individually and

calculated based on the

number of stores per capita

per neighborhood. Ordinal

probit regressions tested the

association between neigh-

borhood-level SES and to-

bacco, alcohol, and healthy

food access.

In each case, there was a

statistically significant

relationship between SES

and access.

The number of tobacco

(F=9.17; p=0.02) and

alcohol (F=8.25; p=0.04)

outlets per capita was

inversely associated with

neighborhood-level SES,

meaning that lower income

neighborhoods had higher

numbers of tobacco and al-

cohol outlets per capita.

The number of healthy food

outlets (F=6.70; p=0.08) was

positively associated with

neighborhood-level SES,

meaning that lower income

neighborhoods had lower

numbers of healthy food

outlets per capita.

Tobacco products include cigarettes, menthol cigarettes, little cigars and cigarillos, chew-

ing tobacco and snuff, and electronic cigarettes.

Alcohol products include beer, malt liquor, hard liquor, and alcopops (sweet alcoholic

beverages in colorful packaging designed to appeal to women and underage consumers).

Food products fall into two categories: unhealthy and nutritionally valuable. Nutritionally

valuable foods include milk, fresh fruit and vegetables, and fruit juice.

References: 1 Louisiana Office of Alcohol and Tobacco Control. Active Tobacco Retail Permits. http://atcpub.license.louisiana.gov/Lookup/GenerateRoster.aspx

(database) 2 City of New Orleans, Department of Finance. Active Alcohol Beverages Licenses. https://data.nola.gov/Geographic-Reference/Active-Alcohol-

Beverage-Outlet-ABO-Licenses/p7tq-v6ni

Product Definitions

This preliminary analysis investigated the first P, product, through correlations between the

number of tobacco, alcohol, and health food outlets per neighborhood and neighborhood-

level socio-economic status – measured as median per capita income and drawn from the

2011 American Community Survey. Tobacco outlets included stores that sold any tobacco

product, and alcohol outlets included stores that sold any alcohol product. Healthy food

stores were defined as stores that sold all healthy foods surveyed in the food module. Over-

all, there were 424 tobacco outlets (91%), 315 alcohol outlets (74%), and 41 stores that sold a

full selection of healthy food (8%).