In partnership with University of North Texas Health Science Center, Counter Tools facilitated the Retail Alcohol Data (RAD) collaborative as a free opportunity for coalitions to gather important data about the alcohol retail environment. From January-March 2025, more than 30 coalitions and agencies across 15 states visited 2,368 off-premise licensed alcohol outlets to collect local data on the availability, pricing, and marketing of 7 ready-to-drink alcoholic beverages that are especially dangerous and/or appeal to young people. Some of the products of interest included Four Loko, Natty Daddy, and Steel Reserve. Of the 2,368 outlets visited, 2,017 contained at least one product of interest. Participants received training and technical support, enabling them to use a standardized survey in software developed by Counter Tools. 

To support local and state policy advocacy, researchers at the University of North Texas Health Science Center provided statistical analyses including average price per product and average price per standard drink. Across all 15 participating states, the price for one standard alcoholic drink averaged 80 cents. Findings indicated that for less than $11, you can buy 3 Four Lokos, or the equivalent of 17 standard alcoholic drinks. In comparison, for the same price you could only buy 4 Coca-Colas. 

View the RAD collaborative’s national data snapshot for more findings.

Contact Counter Tools to learn more about how you can assess the alcohol retail environment in your community.

In a recently published study, researchers examined the DPCP types, brands, and intoxicating compounds sold by the three top-trafficked U.S.-based DPCP retail websites. Researchers identified over 800 DPCPs from 118 brands, primarily available in the form of disposable vapes or edibles. Among these products, there were 26 distinct intoxicating compounds, with over half of the products including two or more intoxicating compounds. Some of the most prevalent intoxicating products identified included Delta-8 tetrahydrocannabinol (THC), THC-P, Delta-9 THC, HHC, THC-A, and Delta-10 THC. This study highlights the expansive nature of this rapidly evolving market. Researchers point to the availability of at least 26 distinct intoxicating compounds as evidence of the industry’s adaptability, including their ability to quickly shift focus or find legal loopholes as regulatory challenges arise. 

DPCPs are often available in locations selling tobacco, such as gas stations or convenience stores. For decades, public health professionals have been engaged in surveillance efforts examining the availability of different types of tobacco products and how they are priced and promoted within the retail environment. These data have been key to making progress towards evidence-based policies that limit the availability and marketing of tobacco products at the point-of-sale. The referenced study offers a foundational understanding of the current online retail market for DPCPs. There is still much to be learned about the availability, marketing and promotion of these types of products at brick-and-mortar establishments to inform public health practice and policy efforts. 

Counter Tools can help with monitoring and tracking the sale of DPCPs in the retail environment. Contact us at hello@countertools.org to learn more. 

Learn more about DPCPs on our upcoming Healthy Point-of-Sale Webinar featuring Dr. Matt Rossheim from the University of North Texas. Register here to attend this webinar on April 3 from 12-1 PM ET.

Unfortunately, access can differ drastically depending on where someone lives. Because of this, the health behaviors that reduce cancer risk are much harder to implement for some than others. In many cases, rural communities and neighborhoods with low-income individuals or racial and ethnic minorities face added barriers to health. For example, rural residents often live miles from the nearest source of fresh, healthy food. This lack of access is one of several reasons why rural households face food insecurity at a higher rate than urban households. According to Feeding America, 9 out of 10 high food insecure counties are rural, and 8 out of 10 counties are located in the South. In comparison to neighborhoods with higher household income residents, neighborhoods with lower income residents feature fewer sports areas, parks, greenways, well-maintained sidewalks or bike paths. Rural communities lack the availability of public transit or close proximity of residential areas to everyday destinations, such as retail stores and schools, that help promote more daily physical activity in urban areas. The places people live can also impact their tobacco and alcohol use. Research shows that neighborhoods featuring an overabundance of convenience or liquor stores, and thus more advertising for alcohol and tobacco products, contribute to disparities in use rates. These retailers tend to cluster in neighborhoods with a high percentage of low-income residents or residents of color.  

While there is no one-size-fits all solution, there are a number of ways state and local governments, along with community partners, can work to reduce these disparities so everyone has the opportunity to be healthy, regardless of where they live. A few examples include: 

1. Providing support and resources for existing food retailers by assisting with food distribution challenges and establishing healthy retail programs 
2. Developing affordable and efficient transportation services for neighborhoods without convenient access to healthy food retail venues and adopting Complete Street policies to ensure streets are designed to be safely used by all
3. Supporting shared use agreements so that existing facilities, such as schools, can be used for physical activity by the broader community 
4. Decreasing the density of alcohol and tobacco outlets through licensing or zoning restrictions

By building healthier communities for all, we have the potential to make a profound impact on the health behaviors that are proven to reduce cancer risks.

Read the Submission from 208 organizations from 61 countries in response to the current draft and their recommendations here.

The joint submission includes key recommendations for the UN Committee to consider to:

1. Strengthen the implementation of the WHO Framework Convention on Tobacco Control;
2. Support culturally competent cessation support;
3. Combat targeted advertising by tobacco companies and flavored tobacco products;
4. Protect indigenous peoples from the tobacco industry; and
5. Affirm the connection between the right to health and the UN Sustainable Development Goals.

A strong General Recommendation from CERD is essential because the UN human rights treaty has been ratified by 182 countries, meaning CERD is law where ratified. General Recommendation 37 will be a global legal recommendation to strengthen tobacco control at the national level.

Learn more about the treaty process by watching ASH’s webinar here.

Oral nicotine pouches are similar to the spitless, smokeless tobacco product “snus,” except that the pre-filled pouches, designed to be placed between a user’s lip and gum, contain nicotine powder rather than tobacco leaf. This nicotine is still generally derived from tobacco, though there are some companies claiming that the nicotine they use is synthetic. These products are sometimes marketed as tobacco-free, which may imply lower risk even though they have not been proven. However, it’s important to note that they are not approved as nicotine replacement therapy or cessation products. 

Data on youth use remains limited since the CDC’s National Tobacco Youth Survey began capturing data on nicotine pouches for the first time in 2021. As of 2022, use rates among youth were fairly low (1.1%), but concerns about increasing popularity among youth remain. Modern oral nicotine products are available in a wide variety of flavors, including menthol, flavors like mango or black cherry, as well as “concept flavors” like “smooth” and “chill”. Since 80% of middle or high school students who currently use any tobacco product report using a flavored product, these products have the potential to provide additional flavored options for youth. The pouches are small, smokeless, and spitless, allowing for discreet use. It’s easy to see how these products could pose an additional challenge for teachers and administrators already struggling to prevent the use and possession of tobacco products in schools. Lastly, nicotine pouches are often available at relatively low prices, which is often an important factor for price-sensitive groups like youth. 

While non-combustible products like these may be less dangerous than cigarettes, they still have their own health risks, including addiction to nicotine, which can harm the developing brains of adolescents. In an attempt to take advantage of the harm reduction potential, Big Tobacco makes big claims about working toward a smoke-free world. Meanwhile, the industry spends more than 8 billion dollars a year marketing and promoting traditional combustible cigarettes while continuing to introduce new combustible products to the market. As always, we’ll be keeping a close eye on these products to see how tobacco at the point of sale continues to evolve. 

Want to learn more about modern oral nicotine pouches? Listen to our Counter Tobacco podcast! And check out this GQ article that cites Counter Tools: Why are Zyn Nicotine Patches Suddenly Everywhere?

The alcohol industry is quite transparent in their goals to recruit new drinkers, including women, Hispanic consumers and “beer rejectors”. One strategy that has seen growing success over the course of the last 20 years is offering new products that are sweeter and easier to drink than traditional beer or distilled spirits. These flavored malt beverages, sometimes referred to as alcopops or ready-to-drink beverages, feature low prices, a variety of flavors, high alcohol content and are widely available. Product packaging often features bright colors and eye-catching designs. In recent years, a number of new beverage options have hit the market. Brands popular for non-alcoholic products already familiar to children and youth, like Mountain Dew, are developing these new beverages. This strategy of using flavors to make a product more appealing and palatable for youth or other new consumers comes straight from Big Tobacco’s playbook.  

These types of products are increasingly available in convenience stores, grocery stores and mass merchandisers across the country. These places are all easily accessible to youth under the age of 21 – leaving plenty of opportunities for regular exposure to alcohol marketing and promotions. Research shows alcohol advertising has a meaningful impact on youth, including associations with heavier drinking, brand recognition or brand preference and the perception that alcohol consumption is more prevalent among peers. In fact, one study calculated that for each dollar spent on advertising, young people drank 3% more each month. All youth are exposed to alcohol advertising on an almost daily basis, but African American and Hispanic youth are exposed to more alcohol advertising than white youth.  

Many studies have found that as price increases, alcohol consumption decreases, which is why the alcohol industry has employed a number of strategies to keep alcohol cheap at the point of sale. This includes happy hours or specials at on-premises outlets, and coupons, sales or multi-buy discounts at off-premises retailers. With so many beverage options now available in single-serve containers – including canned wine, cocktails or other flavored malt beverages – shoppers are encouraged to make impulse purchases. Price-sensitive consumers are also able to find something that fits with their budget. In some cases, singles with extremely high alcohol content can be priced cheaper per fluid ounce than regular, nonalcoholic energy drinks or soda. With alcohol so easily available and advertised heavily at so many price points, it is no surprise to see underage alcohol use and other problem drinking behaviors.  

Differences in alcohol availability can help explain why alcohol-related harms impact some communities more heavily than others. One way to measure alcohol availability is to examine alcohol outlet density, or the concentration of retail alcohol establishments in a given geographic area. Research demonstrates that greater alcohol outlet density leads to increased excessive alcohol use and ultimately greater alcohol related harms, such as violence, traffic crashes, and property damage. Alcohol outlet density varies widely among states and communities. An understanding of the differences across geographies and demographics should guide the development of public health interventions for reducing alcohol outlet density. Research shows that neighborhoods with a higher proportion of Black residents or more families living in poverty tend to have a higher alcohol outlet density. Mapping of alcohol outlet density in Durham, North Carolina and Baltimore City, Maryland found areas with a history of redlining to be a strong predictor of where alcohol outlets cluster, even many decades later. There is strong scientific evidence that regulating alcohol outlet density is one of the most effective strategies for reducing excessive alcohol consumption and related harms. Alcohol outlet density can be regulated through licensing or zoning restrictions that cap the number of alcohol outlets or restrict the locations where alcohol can be sold.  

 Learn more:  

• CADCA Webinar Wednesday Recording: Addressing Health Equity with Alcohol Density Regulation 
• Guide for Measuring Alcohol Outlet Density (CDC) 
• Regulating Alcohol Outlet Density: An Action Guide (CADCA) 

This post was originally published as a feature article for The Geographic Health Equity Alliance (GHEA), a CADCA initiative. GHEA is a CDC funded National Network dedicated to reducing geographic health disparities related to tobacco and cancer. 

Title: Better Conversations about Health Equity and Tobacco POS Strategies

Speaker: Dr. Julie Sweetland, PhD (she/hers), Senior Advisor, FrameWorks Institute

Date: Thursday, April 13th at 2:30-3:30pm EST

We write to express our strong support for proposed rules that the Food and Drug Administration has issued to prohibit the manufacture and sale of menthol cigarettes and flavored cigars. FDA’s proposals will substantially improve public health by reducing youth tobacco use, preventing tobacco-caused disease, and saving lives. We urge you to support FDA’s proposed rules and oppose any effort to prevent or delay FDA from finalizing and implementing them. It is time to put an end to the tobacco industry’s targeted efforts to use flavored products to lure youth into a lifetime of deadly addiction.

Tobacco use is the leading preventable cause of death in the U.S., responsible for nearly one in five deaths and more than $241 billion in health care costs each year. While smoking rates have declined, many communities continue to experience high rates of smoking and smoking-caused disease, including people with lower levels of income and education, individuals living in rural areas, Native Americans, people with a behavioral health condition, and the LGBTQ+ community. Congress gave FDA tools to reduce the number of people who die of cancer, heart disease, respiratory disease, and other tobacco-caused diseases. FDA is now proposing to use one of those tools – the ability to set tobacco product standards – to reduce the public health harms caused by menthol cigarettes and flavored cigars. 

Menthol cools and numbs the throat, which helps mask the harshness of tobacco smoke and makes it easier for young people to start smoking. Menthol cigarettes are also more addictive and harder to quit than non-menthol cigarettes. As a result, menthol cigarettes have increased the number of youth who smoke and the number of people who die prematurely from smoking. Black communities, which have been the target of menthol cigarette marketing for decades, have been especially harmed by menthol cigarettes. Removing these products from the market would reduce the number of youth who become addicted to tobacco, save hundreds of thousands of lives, and advance health equity. Researchers estimate that removing menthol cigarettes from the market would prevent up to 654,000 smoking-related deaths over time, including over 255,000 smoking-related deaths among Black Americans. 

Cigars, which come in hundreds of kid-friendly flavors like Cherry Dynamite and Tropical Fusion, are the second most popular tobacco product among youth. In 2022, half a million youth were current cigar smokers. Every day that passes, more than 800 kids try cigar smoking for the first time, and there is extensive evidence about the role flavors play in attracting youth to cigars. We need to protect kids from flavored cigars because cigar smoke is composed of the same toxic and carcinogenic constituents found in cigarette smoke. According to the National Cancer Institute, cigar smoking can cause cancer of the oral cavity, larynx, esophagus and lung. 

FDA should finalize these proposed rules quickly. All flavors except menthol are already prohibited in cigarettes. Removing other flavored tobacco products from the market, including menthol cigarettes and flavored cigars, is supported by strong scientific evidence and is long overdue. We urge you to discourage any delays in the rulemaking process and reject any legislative efforts to restrict the ability of FDA to move forward with these rules or other efforts to reduce tobacco-caused disease and death. Strong FDA action to reduce tobacco use is critical, as tobacco use continues to claim the lives of nearly half a million Americans every year. 

Sincerely, 

Coalition letter to House on menthol cigs and flavored cigars 2.21.23

Coalition letter to Senate on menthol cigs and flavored cigars 2.21.23

With the industry’s efforts to ensure alcohol is available and marketed everywhere we look, it’s no real surprise to hear of its desirability among underage drinkers. Convenience stores, grocery stores, and mass merchandisers account for a majority of retail sales for beer and malt beverages – all places easily accessible to youth under the age of 21 – leaving plenty of opportunities for regular exposure to alcohol marketing and promotions. The impacts of the exposure to alcohol advertising on youth closely mirror those found for tobacco, including initiation or continuation of use, and brand recognition or brand preference. Additionally, youth who are exposed to alcohol advertisements perceive alcohol consumption to be more common among their peers. With alcohol easily accessible, this advertising is often visible in close proximity to areas with a high concentration of youth, such as schools or parks. Similarly, a high concentration of alcohol retailers, or a high alcohol outlet density, has associations with increased alcohol consumption leading to a number of public health and safety concerns, such as violence, traffic crashes, and property damage. 

What can we do to protect the youth in our communities? According to the CDC, there are several evidence-based strategies that has the potential to reduce underage consumption by directly targeting the retail environment: 

1. Regulate alcohol outlet density. Licensing and zoning restrictions can be used to limit the number or concentration of alcohol retailers in an area. 
2. Increase alcohol taxes. Alcohol taxes may include excise, ad valorem, or sales taxes, all of which affect the price of alcohol. Taxes can be levied at the federal, state, or local level on beer, wine or distilled spirits.
3. Enhanced enforcement of laws prohibiting sales to minors. An enhanced enforcement program initiates or increases compliance checks at alcohol retailers (such as bars, restaurants, and liquor stores).

Want to learn more about the alcohol retail environment in your community? Counter Tools can help! Contact help@countertools.org for more information on how to assess the retail environment, map alcohol outlet locations, measure alcohol outlet density, and formulate policy solutions.

Obtaining a comprehensive understanding of the retail environment is a key first step to implementing successful point-of-sale policy changes. Store assessments (also referred to as store audits or observations) allow communities to collect data about what is happening in the retail environment. This information is important for educating the public, policymakers, and youth about the deceptive marketing tactics that are used by the tobacco and alcohol industries. Using store assessments, public health practitioners can get insight into the types of products available and how these products are advertised, information that can be instrumental in formulating policy solutions to address a community’s specific problems. 

Along with providing useful evidence for guiding policy goals, store assessments have several additional benefits: 

1. Conducting store assessments can be a great opportunity to engage community members and educate decision makers, allowing them a firsthand look at the ways harmful products are being promoted near the places they live, work and play. 
2. Using a standardized store assessment allows for comparison between neighborhoods. Rather than simply comparing differences in tobacco or alcohol use, store assessment data can tell the story of how the retail environment drives these disparities. For example, store assessments might show that one neighborhood has more alcohol or tobacco outlets with lower prices, making it easier for price sensitive groups, like youth, to purchase these products. 
3. Lastly, store assessments are a valuable tool for evaluating changes – Have retailers moved products from children’s eye level following your merchant education campaign? Have prices increased following a ban on coupons? Answering these types of questions would not be possible without the ability to compare the retail environment before and after using store assessments. 

For the past 10 years, Counter Tools has provided training, technology tools, and technical assistance to public health practitioners conducting store assessments all across the country. To find out more about how we can support your store assessment efforts, contact hello@countertools.org.