comparing sugary drinks in the food retail environment in six nyc neighborhoods

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: [email protected]

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

http://nyc.gov/health/epiquery


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,


East New York 43 34 28 18 3 % white, 39 % Hispanic,


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 %


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


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


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].


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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comparing sugary drinks in the food retail environment in six nyc neighborhoods

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