comparing sugary drinks in the food retail environment in six nyc neighborhoods
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ORIGINAL PAPER
Comparing Sugary Drinks in the Food Retail Environment in SixNYC Neighborhoods
Tamar Adjoian • Rachel Dannefer •
Rachel Sacks • Gretchen Van Wye
Published online: 17 September 2013
� Springer Science+Business Media New York 2013
Abstract Obesity is a national public health concern
linked to numerous chronic health conditions among
Americans of all age groups. Evidence suggests that dis-
cretionary calories from sugary drink consumption have
been a significant contributor to excess caloric intake
among both children and adults. Research has established
strong links between retail food environments and pur-
chasing habits of consumers, but little information exists on
the sugary drink retail environment in urban neighbor-
hoods. The objective of this assessment was to compare
various aspects of the sugary drink retail environment
across New York City (NYC) neighborhoods with dispa-
rate self-reported sugary drink consumption patterns. In-
store retail audits were conducted at 883 corner stores,
chain pharmacies, and grocery stores in 12 zip codes
throughout NYC. Results showed that among all beverage
types assessed, sugary drinks had the most prominent
presence in the retail environment overall, which was even
more pronounced in higher-consumption neighborhoods. In
higher- versus lower-consumption neighborhoods, the
mean number of sugary drink varieties available at stores
was higher (11.4 vs. 10.4 varieties), stores were more likely
to feature sugary drink advertising (97 vs. 89 %) and
advertising at multiple places throughout the store (78 vs.
57 %), and several sugary drinks, including 20-oz Coke�
or Pepsi�, were less expensive ($1.38 vs. $1.60). These
results, all statistically significant, indicate that neighbor-
hoods characterized by higher levels of sugary drink
consumption expose shoppers to sugary drinks to a greater
extent than lower-consumption neighborhoods. This builds
upon evidence documenting the association between the
environment and individual behavior.
Keywords Sugar-sweetened beverage � Sugary
drink � Food retail � Beverage consumption � Food
environment
Introduction
Obesity in the United States affects more than one third of
American adults [1], and the consequences of this health
condition are numerous, including heart disease, stroke,
type 2 diabetes and certain types of cancer [1–5]. Because
obesity disproportionately affects people of lower socio-
economic status (SES) [6, 7], as well as certain ethnic and
racial minority groups [8–10], obesity contributes to health
disparities, worsening the health status of population
groups that already are excessively burdened by chronic
disease. The contribution of sugary drinks to weight gain
has gained increased attention. Daily calorie intake from
sugary drinks has nearly tripled since the 1970s [11], and
among both children and adults, studies have found that the
largest single source of added sugars comes from the
consumption of sugary drinks [12, 13]. The consumption of
calories found in sugary drinks has been linked to the
prevalence of obesity in the United States[11, 13, 14] and
increased risk for heart disease and diabetes [15–17].
In order to better understand the relationship between
sugary drink consumption and the obesity epidemic,
researchers have increasingly turned to the retail food
environment. Evidence suggests that both consumption
habits and body weight can be influenced by retail outlet
T. Adjoian (&) � R. Dannefer � R. Sacks � G. Van Wye
Bureau of Chronic Disease Prevention and Tobacco Control,
New York City Department of Health and Mental Hygiene,
Gotham Center, 42-09 28th Street, 9th Floor, CN 46, Long Island
City, NY 11101-4132, USA
e-mail: tadjoian@health.nyc.gov
123
J Community Health (2014) 39:327–335
DOI 10.1007/s10900-013-9765-y
proximity, type, or inventory [18], and studies have
established credible relationships between these aspects of
the retail environment and the availability, placement,
advertising, and pricing of foods and beverages [19, 20]. A
number of researchers have found that low-income and
minority communities have fewer supermarkets and more
small convenience stores [21–24] than other communities,
and in both urban and rural environments, with few
exceptions [25], relatively consistent conclusions about the
food retail environment have emerged: supermarkets or
larger grocery stores, and stores in higher-income neigh-
borhoods, tend to offer more healthy products than smaller
stores and stores in lower-income, lower-SES neighbor-
hoods [23, 24, 26, 27].
However, simply increasing healthy food availability
may not be sufficient to impact the obesity epidemic. The
availability of unhealthy foods and beverages across all
types of retail outlets has emerged as a key factor in weight
gain, irrespective of the availability of healthier choices
[18, 28]. In-store studies of shelf space allocation and
marketing and placement of unhealthy versus healthy
products have documented an overabundance and promi-
nence of unhealthy food choices [19, 20], and research
suggests [19] that the marketing and promotion of
unhealthy foods influence purchasing behaviors, particu-
larly on impulsive purchases of unhealthy foods that lead to
higher consumption of ‘‘empty’’ calories [18, 29]. These
findings indicate that a variety of factors are at play in
determining food purchasing behaviors [25, 28].
The objective of this study was to look more closely at
neighborhoods in which sugary drink consumption was rel-
atively higher or lower than the city’s average, and conduct a
survey of food retail stores in those neighborhoods. Specifi-
cally, we compared the availability, marketing, and pricing of
sugary drinks and other beverages in neighborhoods with
higher and lower reported sugary drink consumption. Our
objective was to identify factors in the in-store environment
that may be associated with sugary drink consumption.
Methods
Data Sources
The NYC Health Department tracks consumption of sugary
drinks through its Community Health Survey, an annual
population-based, random-digit dial telephone survey of
NYC adults. The 2009 Community Health Survey asked
respondents how many sugar-sweetened beverages (sodas,
iced tea, sports drinks, etc.) they drink per day on average
[30]. We used 2009 survey data to group NYC’s neighbor-
hoods into tertiles by reported sugary drink consumption: in
the highest tertile, identified as ‘‘higher-consumption’’
neighborhoods, between 35 and 46 % of respondents
reported drinking one or more sugary drinks per day; in the
lowest tertile, identified as ‘‘lower-consumption’’ neigh-
borhoods, between 11 and 27 % of respondents reported
doing so. Three higher-consumption and three lower-con-
sumption neighborhoods were selected for this assessment.
The South Bronx (Bronx), Central Harlem (Manhattan), and
East New York (Brooklyn) were selected as higher-con-
sumption neighborhoods; Greenpoint (Brooklyn), Astoria
(Queens), and the Upper West Side (Manhattan) were
selected as lower-consumption neighborhoods (Fig. 1).
In 2009, the three higher-consumption neighborhoods
had higher rates of obesity and diet-related chronic dis-
eases, such as diabetes and high blood pressure, than NYC
overall [30]. In addition, these neighborhoods were char-
acterized by higher rates of poverty and greater proportions
of minority residents than NYC overall [31]. In contrast,
the three lower-consumption neighborhoods were charac-
terized by lower obesity rates [30] and greater proportions
of white residents than NYC overall (Table 1) [32].
We conducted a cross-sectional retail audit to assess the
relative availability, promotion, and price of sugary drinks
at retail locations in the selected NYC neighborhoods that
reported either higher or lower consumption of these bev-
erages. Two ZIP codes were randomly selected from each
neighborhood after excluding atypical ZIP codes, such as
those that had few retail outlets, for a total of 12 ZIP codes.
Instrument
Since there was no validated survey instrument appropriate
to our objectives, we developed a retail setting assessment
tool. The tool was designed to capture the following
Fig. 1 Percentage of adults who report drinking one or more sugary
drink per day by UHF neighborhood, New York City Community
Health Survey, 2009. Source: New York City Department of Health
and Mental Hygiene. Epiquery: NYC Interactive Health Data System-
Community Health Survey 2009. June 20, 2012. http://nyc.gov/
health/epiquery
328 J Community Health (2014) 39:327–335
123
information: store characteristics (store type, name, and
address); the availability in the refrigerator of 13 sugary
drink varieties and their low-calorie counterparts, as well as
water, seltzer, flavored seltzer, and 100 % juice (yes/no);
the price of multiple sizes and brands of regular and low-
calorie soda, sweetened and low-calorie iced tea, seltzer,
and water (data were only collected if price was posted);
the presence of advertising for each beverage category at
multiple locations throughout the store, including outside,
on refrigerators, at the checkout counter, or any other
indoor location (yes/no); sales promotions (yes/no); and
beverage placement at multiple promotional locations
throughout the store, including end caps of aisles, special
displays, and refrigerators at checkout (yes/no). Prior to
data collection, we pre-tested the instrument at 29 stores to
ensure feasibility of use and inter-rater reliability.
Measures
All corner stores, chain pharmacies, and grocery stores
within the sampled ZIP codes were included in our assess-
ment. These stores are among the most common types of
food retail establishments in NYC and are the food retail
stores at which residents of several NYC neighborhoods
most often purchase sugary drinks [33–35]. Corner stores
(commonly known in NYC as ‘‘bodegas’’) were small con-
venience stores that had no more than two cash registers
and sold a variety of mostly non-perishable grocery items;
chain pharmacies exclusively included CVS/pharmacy�,
DUANEreadeTM, Rite Aid�, and Walgreens�; grocery
stores were larger chain or independent stores carrying a
wide selection of fresh produce and other grocery items.
We defined sugary drinks as having added caloric
sweetener and greater than 25 cal per 8-oz serving, and
low-calorie beverages as having 25 cal or fewer per 8-oz
serving. Sugary drink types included soda, sports drinks,
energy drinks, iced tea, fruit drinks, and brand-specific
vitamin-enhanced water (VITAMINWATER� and True
Colors�). We excluded sweetened milk-based beverages,
sugar-sweetened bottled smoothies, coffee drinks (unless
specifically marketed as ‘‘energy drinks’’), coconut waters,
powdered drinks, unsweetened flavored waters, fountain
drinks, and any beverages that could not be decisively
placed into one of our beverage types. For this assessment,
low-calorie drinks included the counterparts to each type of
sugary drink. While literature varies in defining sugary
drinks, several other studies have included similar sets of
beverage types in their assessments [14, 35–37].
One-hundred-percent juice included fruit and/or vegetable
juice labeled ‘‘100 % juice’’ and having no added sweeteners.
Water was included if unflavored and unsweetened, and both
plain and flavored unsweetened seltzer were included.
Data Collection
Data collectors received a one-day classroom training fol-
lowed by field training. During field training, the study
coordinator took data collectors out in pairs to stores within
Table 1 Characteristics of the neighborhoods selected for the sugary drink retail audit, New York City, 2000 and 2009
Sugary drink
consumption
Neighborhood % Adults who report
drinking 1 ? sugary
drinks/daya
% Residents living
below poverty level
%
Obese
adultsb
% Adults ever
diagnosed with
diabetes
Race/ethnicity
Higher South Bronx 46 42 32 13 2 % white, 63 % Hispanic,
33 % black, 1 % Asian
Central Harlem 44 35 36 13 8 % white, 19 % Hispanic,
67 % black, 3 % Asian
East New York 43 34 28 18 3 % white, 39 % Hispanic,
50 % black, 3 % Asian
Lower Greenpoint 27 34 20 11 58 % white, 31 %
Hispanic, 3 % black, 2 %
Asian
Astoria 25 20 17 9 43 % white, 28 %
Hispanic, 6 % black,
15 % Asian
Upper West Side 18 11 9 7 66 % white, 16 %
Hispanic, 9 % black, 6 %
Asian
Sources: NYC Community Health Survey 2009 [30], US Census Bureau, Census 2000 [32]a 2009 New York City Community Health Survey (CHS) respondents were asked how many 12-oz sugary drinks (soda, iced tea, sports drinks,
etc.) they drink per day on averageb Obesity is defined as a body-mass index (BMI) of 30 or greater
J Community Health (2014) 39:327–335 329
123
sampled ZIP codes. The three surveyors completed the
assessment tool together at two stores, then each inde-
pendently at a third store. After the independent store
assessment, all three survey instruments were compared.
Any discrepancies were clarified, and if necessary, this
process was repeated until data collection was consistent
among all surveyors.
Once trained, data collectors were assigned to ZIP codes
in pairs, but conducted store assessments independently as
they covered different sections of their assigned ZIP code.
Data collectors were made aware of which neighborhoods
were higher- and lower-consumption, and they were
responsible for collecting data in both, in order to negate
the effect of systematic data collection errors. They were
given corresponding neighborhood maps as a guide. From
January to March, 2011, data collectors canvassed each
selected ZIP code, identifying and visiting every corner
store, chain pharmacy, and grocery store within the ZIP
code boundaries. Data collectors introduced themselves to
personnel at each eligible store and offered to provide more
information about the study upon request before under-
taking the audit; consent was not required, but personnel
had the option to refuse participation. The study coordi-
nator periodically conducted separate assessments at stores
to spot-check each data collectors’ work. Institutional
Review Board approval was not required because human
subjects were not involved. Audits took approximately
30–60 min to complete, depending on the store size.
Statistical Analyses
Data were entered and analyzed using SPSS 18.0 statistics
software. Twenty percent of assessment tools were either
double-entered or entries were spot-checked to ensure
accurate and consistent data entry among multiple entrants.
Univariate and bivariate analyses were conducted on all
variables to obtain descriptive statistics (frequencies,
means, ranges) on availability, promotion, and pricing of
beverages by store type and by neighborhood sugary drink
consumption category. Chi square and two-tailed inde-
pendent samples t-tests were used to determine the statis-
tical significance of bivariate relationships at the .05 alpha
level. For instances where the sample size fell below 30,
Monte Carlo exact tests were used to determine
significance.
Results
Store Participation
Data collectors determined that 911 stores met eligibility
criteria within the six sampled neighborhoods. All eligible
stores were approached; 97 % participated in the assess-
ment (N = 883), while 3 % refused (N = 28). Of those
that refused, the majority of store personnel said that they
did not feel comfortable participating because the manager
was not present. There was no apparent pattern of refusals
by store type or neighborhood consumption level. All
results presented hereafter exclude stores that refused the
assessment.
There were significant differences in the distribution of
store types by neighborhood category, with relatively more
corner stores and fewer pharmacies and grocery stores in
higher-consumption neighborhoods compared to lower-con-
sumption neighborhoods (Table 2). When store types were
examined at the neighborhood level, there was some variation
within higher- and lower-consumption neighborhoods. In
Table 2 Description of 883 retail stores within New York City neighborhoods by higher and lower consumption of sugary drinks, sugary drink
retail audit, 2011
Store type Higher-consumption Lower-consumption p value Higher-
vs. Lower-
consumption
neighborhoods
(all)
South
Bronx
(N = 189)
Central
Harlem
(N = 63)
East New
York
(N = 266)
Total
(N = 518)
Greenpoint
(N = 174)
Astoria
(N = 84)
Upper
West Side
(N = 107)
Total
(N = 365)
Corner store,
N (%)
166 (88) 49 (78) 228 (86) 443 (86) 134 (77) 65 (77) 52 (49) 251 (69) \.001
Chain
pharmacy,
N (%)
7 (4) 2 (3) 3 (1) 12 (2) 5 (3) 6 (7) 20 (19) 31 (8) \.001
Grocery
store, N (%)
16 (8) 12 (19) 35 (13) 63 (12) 35 (20) 13 (15) 35 (33) 83 (23) \.001
2009 New York City Community Health Survey (CHS) respondents were asked how many 12-oz sugar sweetened beverages (soda, iced tea,
sports drinks, etc.) they drink per day on average. Consumption levels were grouped into tertiles based on the percentage of adults reporting
consumption of 1 or more sugary drink per day. In higher-consumption neighborhoods, the rate was between 35–46 % of adults, and in lower-
consumption neighborhoods, the rate was 11–27 % of adults
Due to rounding, percentages may not always add to 100 %
330 J Community Health (2014) 39:327–335
123
particular, though Harlem was a higher-consumption neigh-
borhood, it had a smaller percentage of corner stores and a
larger percentage of supermarkets than the other higher-
consumption neighborhoods, making the store distribution
there more analogous to the lower-consumption neighbor-
hoods of Greenpoint and Astoria. In addition, the proportion
of chain pharmacies on the Upper West Side was much higher
than in any other neighborhood.
Availability of Sugary Drinks Versus Other Drinks
We assessed the availability of 13 varieties of sugary
drinks, their low-calorie counterparts, water, seltzer, fla-
vored seltzer, and 100 % juice in store refrigerators.
Overall, far more varieties of sugary drinks were available
than low-calorie drinks, with a mean of 11.0 sugary drink
varieties per store, versus 4.7 low-calorie varieties.
The mean number of refrigerated sugary drink varieties
was significantly higher in stores in neighborhoods with
higher- versus lower- sugary drink consumption (11.4 vs.
10.4 varieties, p \ .001). Conversely, fewer varieties of
refrigerated low-calorie beverages (4.1 vs. 5.6 varieties,
p \ .001) were available in higher-consumption neighbor-
hoods (Table 3). Low-calorie drink availability also varied
among neighborhoods within each consumption category,
with Central Harlem and the Upper West Side both offering,
on average, 1.4 to 2.3 more low-calorie options than other
neighborhoods in their respective category.
Marketing of Sugary Drinks Versus Other Drinks
Advertising
Sugary drinks were advertised much more heavily than other
beverages, with 93 % of stores overall featuring sugary
drink advertising. Substantially fewer stores, regardless of
type or neighborhood, featured any advertising for low-
calorie beverages (32 %) or water/seltzer (27 %).
When comparing neighborhoods, we found that stores in
higher-consumption neighborhoods were significantly
more likely to advertise sugary drinks (97 vs. 89 % of
stores, p \ .001) and 100 % juice (56 vs. 35 %, p \ .001),
and significantly less likely to advertise water and/or selt-
zer (20 vs. 38 %, p \ .001) (Table 4). The magnitude of
advertising also differed by neighborhood. Stores in
higher-consumption neighborhoods were more likely to
feature ads for sugary drinks (78 vs. 57 %, p \ .001) and
100 % juice (10 vs. 4, p = .002) at two or more of the four
locations assessed for advertising (outside, on the refrig-
erator, at the checkout counter, and other indoor locations),
and less likely post ads for water and/or seltzer (5 vs. 11 %,
p \ .001) (Fig. 2). Within higher- and lower-consumption
neighborhoods, there was variation in stores advertising
water/seltzer, with Central Harlem advertising water/selt-
zer substantially more than other higher-consumption
neighborhoods and Astoria advertising water/seltzer less
than other lower-consumption neighborhoods (Table 3).
There were no significant differences for low-calorie drink
advertisements by neighborhood consumption category.
Sales and Placement
We collected data on temporary price reductions, or ‘‘sales,’’
and promotional placement of beverages throughout the
store. Overall, 18 % of stores offered sales for sugary drinks,
11 % for low-calorie drinks, 8 % for water/seltzer, and 12 %
for 100 % juice. Very few bodegas (7 % overall) offered any
sales promotions. Excluding bodegas, almost two thirds
(64 %) of the remaining stores (supermarkets and chain
pharmacies) featured sales for sugary drinks, while fewer
than half featured sales for low-calorie drinks (45 %), water/
seltzer (37 %), or 100 % juice (49 %). No discernible pat-
tern was found within higher- and lower-consumption
neighborhoods for sales promotions.
Almost half of stores overall (45 %) featured sugary
drinks at one or more of the three promotional locations
Table 3 Mean number of varietiesa of refrigerated beverages, by UHF neighborhood and sugary drink consumption, sugary drink retail audit,
New York City, 2011
Beverage
type
Higher-consumption neighborhoods Lower-consumption neighborhoods p value (Higher
vs. Lower total)South
Bronx
(N = 189)
Central
Harlem
(N = 63)
East New
York
(N = 266)
Total
(N = 518)
Greenpoint
(N = 174)
Astoria
(N = 84)
Upper West
Side
(N = 107)
Total
(N = 365)
Sugary drinks 11.43 11.73 11.37 11.43 10.13 10.44 10.95 10.44 \.001
Low-calorie
drinks
4.35 5.76 3.51 4.09 4.91 4.88 7.17 5.56 \.001
Water/seltzer 2.30 2.59 2.19 2.28 2.55 2.20 2.55 2.47 \.001
100 % Juice .97 1.00 .96 .97 .95 .95 .96 .95 .236
a 13 varieties of sugary drinks, 13 varieties of low-calorie drinks, 3 varieties of water/seltzer, and yes/no availability of 100 % juice were
assessed. Mean availability was calculated by finding the average number of these refrigerated beverage varieties per store
J Community Health (2014) 39:327–335 331
123
assessed (end caps of aisles, special displays, and refrig-
erator at checkout). Far fewer stores promoted low-calorie
drinks (30 %), water/seltzer (27 %), or 100 % juice (15 %)
in any of these locations.
Promotional placement of sugary drinks was much more
common among pharmacies and grocery stores than in
bodegas, with 78 % of pharmacies and grocery stores
featuring sugary drinks at one or more promotional loca-
tions, versus only 36 % of bodegas. Among pharmacies
and grocery stores, end caps of aisles were the most
common promotional location for sugary drinks (68 % of
stores), followed by special displays (56 % of stores) and
refrigerator at checkout (15 % of stores). No pattern was
found by neighborhood sugary drink consumption category
for promotional placement of beverages.
Pricing of Sugary Drinks Versus Other Drinks
Data collectors recorded the prices for several brands and
sizes of beverages at stores where prices were displayed.
It should be noted that the majority of stores in both
higher- and lower-consumption neighborhoods did not
post prices for the beverages assessed. Of the 883 total
stores, 524 did not have prices posted for any of the
beverages assessed for price, and at another 40 stores, no
pricing data were recorded for any beverage, leaving us
Fig. 2 Percentage of stores featuring beverage advertising in 2 or
more locations (4 advertising locations were assessed: checkout
counter, refrigerator, other unspecified indoor location, and outdoors),
overall and by store type, sugary drink retail audit, New York City,
2011. Asterisk represents significant at .05 alpha level
Table 4 Percent of stores overall featuring any beverage advertising, by UHF neighborhood and sugary drink consumption, sugary drink retail
audit, New York City, 2011
Beverage
type
Higher-consumption neighborhoods Lower-consumption neighborhoods p value (Higher
vs. Lower total)South
Bronx
(N = 189)
Central
Harlem
(N = 63)
East New
York
(N = 266)
Total
(N = 518)
Greenpoint
(N = 174)
Astoria
(N = 84)
Upper West
Side
(N = 107)
Total
(N = 365)
Sugary drinks 95.8 98.4 96.6 96.5 87.4 90.5 89.7 88.8 \.001
Low-calorie drinks 29.6 27.0 35.5 32.3 30.5 26.2 41.1 32.6 .925
Water/seltzer 18.0 31.7 18.0 19.7 35.1 25.0 51.4 37.5 \.001
100 % Juice 50.8 74.6 55.6 56.2 36.2 33.3 34.6 35.1 \.001
332 J Community Health (2014) 39:327–335
123
with pricing data for only 319 stores. Because so few
stores had prices posted, Monte Carlo exact significance
tests were used to calculate p values where Ns fell below
30 stores. In general, chain pharmacies and grocery stores
were more likely to display prices and are therefore
overrepresented in these results, while corner stores are
underrepresented. All chain pharmacies and 70 % of
grocery stores posted prices for at least one of the bev-
erages for which we collected pricing data, compared with
just 27 % of corner stores.
At stores in higher-consumption neighborhoods, prices
were significantly lower for all sugary drink types and sizes
assessed. These included 20-oz Coke� or Pepsi� ($1.38 vs.
$1.60, p \ .001), 2 l Coke� or Pepsi� ($2.01 vs. $2.18,
p \ .001), and 16- and 32-oz SnappleTM Iced Tea ($1.33
vs. $1.41, p = .048; $2.08 vs. $2.39, p = .004). These
differences also existed for low-calorie beverages, as the
mean price for each variety of beverage was virtually the
same as for its sugary counterpart. The cost of a 20-oz
seltzer was also significantly lower in higher-consumption
neighborhoods ($1.30 vs. $1.56, p \ .001), while the price
for 20-oz water did not differ significantly by neighborhood
consumption category, and had the lowest percent differ-
ence in price of any of the beverages assessed for price
($1.41 vs. $1.48, p = .31, 4.7 % difference). Although
very few stores posted prices for 20-oz water (8 in higher-
consumption and 19 in lower-consumption neighbor-
hoods), the average price for 20-oz water was more
expensive than a 20-oz soda in higher-consumption
neighborhoods, and less expensive than a 20-oz soda in
lower-consumption neighborhoods (higher-consumption
neighborhoods: $1.41 for water vs. $1.38 for soda; lower-
consumption neighborhoods: $1.48 for water vs. $1.60 for
soda).
Discussion
A growing body of evidence indicates that neighborhood
food availability influences residents’ diets [18–21]. This
assessment aimed to explore the relationships between
consumption of sugary drinks and the retail beverage
environment in NYC by comparing sugary drinks and other
beverages in food retail stores in ‘‘higher’’ sugary drink
consumption neighborhoods, where a greater percentage of
residents report consuming at least one sugary drink per
day, with ‘‘lower’’ sugary drink consumption neighbor-
hoods. To our knowledge, this is the first study to collect
such comprehensive and varied data on sugary drinks in the
food retail environment and to focus on comparing urban
neighborhoods with higher- and lower- sugary drink
consumption.
Our findings show a high level of exposure to sugary
drinks in the food retail environment overall. On average,
stores offered more than twice as many of the sugary drink
varieties we assessed as low-calorie drinks, and far more
stores advertised sugary drinks than low-calorie drinks and
water/seltzer. Additionally, sugary drinks were more
heavily marketed through sales promotions than low-cal-
orie drinks or water/seltzer; almost two thirds of super-
markets and chain pharmacies offered sales on sugary
drinks, compared with fewer than half offering sales on
low-calorie drinks or water/seltzer. This evaluation also
documents significant differences based on neighborhood
consumption of sugary drinks. We found that collectively,
in neighborhoods with higher reported sugary drink con-
sumption, a wider variety of sugary drinks were available
in store refrigerators and a greater percentage of stores
advertised sugary drinks than in lower-consumption
neighborhoods. Conversely, fewer refrigerated varieties of
low-calorie drinks were available and fewer stores adver-
tised water/seltzer in higher-consumption neighborhoods.
The neighborhood differences documented in this
assessment may contribute to disparities sugary drink
consumption levels among residents. In-store beverage
availability may reflect the preferences of customers, the
decisions of store staff, beverage companies, and distrib-
utors, or some combination of factors. What is clear is that,
in-store availability determines what customers are able to
purchase, and several studies have documented correlations
between sales of specific products and the shelf-space
allocated to them [19, 38]. Additionally, researchers have
pointed out that in-store availability of products creates
familiarity with and establishes social norms for con-
sumption of these products [13].
Furthermore, the disparities we observed in advertising
for sugary drinks and water/seltzer in higher- and lower-
consumption neighborhoods may influence consumption
patterns. Advertising has been well-documented to influ-
ence purchasing behavior [39], and studies have identified
efforts to target advertising for unhealthy foods to vulner-
able populations, including minority groups and children
[40, 41]. For example, a review of the literature on mar-
keting to African Americans found that ads for cheap,
calorie-dense and low-nutrition foods and beverages were
found more often in media oriented towards African
American audiences; also noted were associations between
targeted food marketing and disparities in obesity and diet-
related chronic diseases between African American and
white populations [40]. A 2012 study of supermarket
shoppers by the Point-of-Purchase Advertising Institute
found that 55 % of purchases were unplanned [39], and
food companies spend considerable sums on in-store
advertising, indicating the considerable potential of in-store
advertising to influence consumer purchases [41].
J Community Health (2014) 39:327–335 333
123
This assessment has some limitations. It was cross-
sectional, and therefore only provides a snapshot of the
retail environment. Also, other commercial establishments
that sell sugary drinks, such as restaurants and newsstands,
were not captured in the assessment. Additionally, within
our sample, we did not characterize the full breadth of
beverages for sale at each store, only what was included on
our assessment tool; for instance, the varieties of sugary
and low-calorie drinks that were measured were not the
absolute or relative number of sugary or low-calorie vari-
eties available. Further, limited availability of pricing
information in the retail outlets we surveyed prevented us
from exploring variations in pricing among neighborhoods.
The fact that data collectors were aware of higher- and
lower-consumption neighborhood classifications could
have introduced bias, but we do not believe this to be
enough to explain the findings; quality control measures
were taken to ensure accurate, unbiased data collection.
Finally, the Community Health Survey data used to classify
neighborhoods into higher- and lower-consumption cate-
gories was based on self-reported sugary drink consump-
tion, and participating neighborhoods were not randomly
selected.
More research is needed to fully understand the impact
of the retail environment on residents’ diets. Future studies
should explore the impact of pricing on consumer beverage
choices in greater detail, looking particularly at the ques-
tion of whether a lack of clearly-posted pricing information
in retail outlets may affect consumers’ beverage purchasing
behavior. In our study, less than one third of the stores
assessed displayed any pricing information for beverages.
More generally, determining how the interplay of avail-
ability, promotion, placement, and pricing of unhealthy
food items influences consumer purchases remains an
important avenue for study, and was beyond the scope of
the present effort.
The present study provides new information on
availability, promotion, placement, and pricing of sugary
drinks and other beverages in the retail environment in a
densely-populated urban setting. We identified an asso-
ciation between wide availability and promotion of sug-
ary drinks in retail outlets in higher-consumption
neighborhoods, adding to the literature documenting
associations between the food environment and individ-
ual dietary behavior. Our findings corroborate those of
previous studies that have identified neighborhood dis-
parities in the food environment [22–24] and that have
documented the proliferation of sugary drinks and other
unhealthy foods in retail outlets [42]. Additional studies
of this association could identify avenues for focused and
effective public health interventions to prevent and
reduce obesity.
Acknowledgments This project was supported in part by a coop-
erative agreement from CDC’s Communities Putting Prevention to
Work (CPPW) program (3U58DP002418-01S1). The findings and
conclusions are those of the authors and do not necessarily represent
the views of the Centers for Disease Control and Prevention. Special
thanks to Tamara Dumanovsky, Philip Alberti, Carolyn Olson,
Christa Myers, Lynn Silver, and the NYC DOHMH CPPW Research
and Evaluation Workgroup for assistance with research design and
analysis. Thanks to Cathy Nonas for her review of this paper, to
Lillian Dunn and Ryan Ruff for assistance with analysis, and to Pathu
Sriphanlop for performing a data check. Thanks also to our data
collectors: Thao Bui, Christine C. Caruso, Jason Codjoe, Kathleen
Delgado, Devin Madden, Yemisi Okusanya, and Nirav Patel.
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