Healthy Stores, Healthy Communities

Tobacco products are predominantly sold at convenience stores, gas stations and supermarkets, which also sell food, especially junk food. Under a new U.S. Food and Drug Administration (FDA) Act, stores will be more tightly regulated and will feature fewer ads for tobacco products. New graphic health warnings will appear on cigarette packs and displays, and many retailers will opt to take down some advertising. This presents a prime opportunity to promote healthy foods and beverages in these stores, to increase purchase and consumption of healthier food options, and even to facilitate physical activity.

The project aim is to design an integrated community assessment approach to address major behavioral cancer risk factors of tobacco use, diet, and physical activity in Buncombe, New Hanover and Wake counties. Project activities include:

  • mapping the tobacco retailers, parks, physical activity facilities, and schools
  • examining the density of stores and their proximity to schools and parks
  • examining any racial/ethnic and socioeconomic disparities
  • assessing the amount of tobacco and food marketing and products at stores in each county
  • identifying locations with high concentrations of tobacco marketing, junk food, and street locations that fail to support physical activity
Study findings will be disseminated to policy advocates and local community groups.

This study conducted the first comprehensive assessment of FDA policies at point-of-sale. There was a least one FDA point-of-sale provision violation in 15% of stores; provisions most violated were continued sales of 'light' cigarettes (13%) and self-service of cigarettes or smokeless tobacco (2%). There were significant differences in violation rates across counties, and odds of violation were significantly higher for pharmacies vs. grocery.  Additionally, the store lists used by NC ALE are very inaccurate compared to the 'ground-truthing' methods used in this study. 

The study also looked at the relationship between food and tobacco sales at tobacco retail outlets, such as gas stations, convenience stores, and supermarkets. They examined the potential to ?transition? tobacco retailers to businesses that promote health food options. Their analyses showed that tobacco retailers, on average, now make more revenue selling food and beverages than tobacco products, and tobacco sales have declined while food sales have increased. Their team is developing a number of strategies to help promote this trend through healthy corner stores initiatives. They are also one of the first research teams to look at the relationship between amount of tobacco marketing and availability of health foods. Surprisingly, stores with more interior tobacco marketing sold more healthy foods, after controlling for store type and neighborhood characteristics. Therefore, even supermarkets, typically regarded as a place to get affordable, healthy foods, may expose customers to high amounts of interior tobacco marketing. 

The research team used an off-the-shelf mobile data collection program and discovered many limitations. This inspired Dr. Ribisl to develop a better mobile data collection system - and then launch a new non-profit agency (, to provide its software tools and technical assistance to clients across the country.

Geographic area(s) served: Buncombe, New Hanover & Wake Counties and Statewide

Research team:
Kurt Ribisl, PhD, professor of health behavior, and Kelly Evenson, PhD, research professor of epidemiology (co-principal investigators); Heather D'Angelo and Shyanika Rose, health behavior (HB) doctoral students; Jane Laping, Sandy Diehl; Sheila Fleischhacker, former postdoctoral fellow in Nutrition; and HB alumna Lisa Isgett.

For more information about the Healthy Stores, Healthy Communities pilot study, contact Heather D'Angelo, research assistant, at