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Healthy Retail as a Tobacco Control Strategy in SF

Institution: University of California, Berkeley
Investigator(s): Meredith Minkler, DrPH Jessica Estrada, B.A. Lisa Juachon, BA
Award Cycle: 2014 (Cycle 23) Grant #: 23AT-0008 Award: $440,546
Subject Area: Industry Influence/Policy
Award Type: Full CARA
Abstracts

Initial Award Abstract

Hypothesis or Research Question:
We hypothesize that: (1) Tenderloin neighborhood corner stores participating in HealthyRetail SF will reduce their tobacco and e-cigarette product advertising, displays, and sales; 2) Tenderloin neighborhood corner stores participating in the program will reduce their tobacco and e-cigarette product advertising, availability and displays more than other Tenderloin corner stores; 3) Tenderloin corner stores that applied to, but did not participate in, the program will reduce their tobacco and e-cigarette product advertising and displays more than stores that did not apply.

Specific Aims:
This proposed community-based participatory research (CBPR) study will support, expand and evaluate healthy retail efforts in the Tenderloin neighborhood. Using the Collective Impact model as a conceptual framework, we also will collaboratively explore the contributions of a coalition of city agencies and individual residents (The Tenderloin Healthy Corner Store Coalition, TLHCSC) to the implementation of a larger, citywide healthy retail program. This research will offer insight into the impact of a healthy retail program on tobacco advertising, display, and purchase, and will offer guidance to other communities considering adopting healthy retail policies to control tobacco. Through this project we will accomplish the following specific aims:

Aim 1: To evaluate the effects on tobacco and e-cigarette promotion and sales of San Francisco’s healthy retail program (HealthyRetailSF) by: a) assessing whether Tenderloin neighborhood corner stores participating in the program reduce their tobacco and e-cigarette product advertising, displays, and sales; b) comparing tobacco and e-cigarette product advertising, availability and displays in Tenderloin neighborhood corner stores participating in the program to (i) Tenderloin corner stores that applied, but were not chosen to participate in the program and (ii) Tenderloin corner stores that did not apply to the program.

Aim 2: To collect data on e-cigarette advertising, self serve and counter display in 50-55 Tenderloin stores in 2016 and 2017 and compare findings with baseline data collected just prior to the enforcement of recent (2014) city legislation banning these practices and in 2015, following the onset of enforcement.

Aim 3: To conduct a participatory evaluation of the Tenderloin Healthy Corner Store Coalition and a multi- method assessment of its functioning, relationship to the outcomes assessed in Aim 1 and its contributions to HealthyRetailSF.

Background/Significance:
Tobacco outlet density is linked to a greater likelihood of youth and adult smoking, and living in close proximity to tobacco outlets is associated with unsuccessful quit attempts. One explanation is pervasive tobacco advertising and tobacco displays in tobacco retail outlets, which encourage smoking initiation by youth, and, among smokers and former smokers, trigger smoking. District 6, in which the Tenderloin is the largest neighborhood, has the highest proportion of tobacco outlets in the city, mostly in 73 corner stores. Early work in the Bayview Hunters Point and the Tenderloin has shown promise using healthy retail as a tobacco control strategy, but has not rigorously evaluated its role in tobacco control, nor the impact of special anti-tobacco enhancements.

Approach or Methods:
This CBPR study includes several distinct parts, each of which will involve different methodological components. The overall study design for Aim 1 is a three-group, non-equivalent comparison group design with pretest and posttest. The groups are the treated group, the untreated but applied for treatment group, and the group that did not apply for treatment. With two waves of data collection, linear (for continuous outcome variables) and logistic (for binary outcome variables) regression will be best suited to this design by including the pretest measures as covariates in the model along with a few other potential confounds (e.g. store size). For the five stores in the treatment group (the only ones for which sales data will be available), the point–of- sales data will first be examined using a descriptive analysis. We will compute the means and 95% confidence intervals for the group of stores at each time point and display the results graphically to examine the time trend. If the confidence interval for the last time point does not overlap with the confidence interval for the first time point we would have a conservative inferential test of the change over time. We will also conduct a one way repeated measures, mixed model analysis of variance (ANOVA). Once we learn the nature of the POS data, some transformation of the data may be required to satisfy the model's assumptions about normality and homogeneity of variance.

For Aim 2, we will examine the time trend for e-cigarette store advertising and counter display in 50-55 Tenderloin stores before (2014) and after (2015, 2017) city legislation bans this advertising. Since the outcome is binary (e-cig advertising vs. no e-cig advertising) and we have three time points, we will conduct a repeated measures logistic regression using the general linear model and specifying a binomial probability distribution and a logit link function. This will enable us to assess whether there is a decrease in advertising from baseline (2014) to follow up (2016 and 2017). Aim 3 involves conducting a participatory evaluation of the Tenderloin Healthy Corner Store Coalition, assessing its efficacy as a collaborative as well as its impact on the outcomes assessed in Aim 1 and 2 and the group’s contributions to Healthy Retail SF.

Expected Results/Impact:
This study will provide one of the first rigorous evaluations of healthy retail as a tobacco control strategy, illuminating both the collaborative process as well as the work’s impact at the individual, store and community levels. Further, this study will show the impact of Collective Impact as an approach to achieving healthy retail and policy change.