Standardized Tobacco Assessment for Retail Settings (STARS): Comparative data for US stores

Background: Omnipresent tobacco product marketing and availability at the point of sale (POS) increases youth and adult tobacco consumption. The Standardized Tobacco Assessment for Retail Settings (STARS) is a 10-minute assessment with supporting materials, developed by NCI’s State & Community Tobacco Control Initiative in collaboration with CDC, the Tobacco Control Legal Consortium, and five state Tobacco Control Programs. The purpose of this presentation is to summarize current levels of tobacco marketing, promotions and product availability ascertained using STARS questions. These data provide a national comparison for tobacco control professionals who are increasingly adopting the STARS instrument for local, state or regional retail assessments.

Methods: We used a two-stage sampling design to select a random sample of 97 counties in 40 states in the contiguous United States proportionate to county population size, and a random selection of retail stores within each county. In 2014, professional data collectors completed assessments in 2,278 stores.

Results: Tobacco marketing materials are ubiquitous: all stores displayed at least one interior branded sign, display or functional item and 56.8% of stores displayed exterior advertisements. In addition, 72.9% of stores displayed at least one interior tobacco product price promotion, including 61.0% featuring menthol cigarettes. Although only 22.3% of stores featured interior cigarette marketing below three feet, 86.0% of stores sold flavored cigarillos, which often appeal to youth.  Electronic cigarettes were sold at 69.8% of stores, and 47.3% sold flavored e-cigarettes. The average price without sales tax was $6.23 for one major brand, $6.87 for a major menthol brand, and $10.01 for a disposable e-cigarette.

Conclusions: Cigarette companies use retail stores extensively to promote products to current and future customers. STARS allows comparisons across jurisdictions and informs local practitioners advocating for evidence-based policies for the retail environment. These results provide the first benchmark from a representative sample of US stores.