Point-of-Purchase Alcohol Ads in One Low-Income Community in Central California : Occurrence and Women ’ s Perceptions

This study explores the occurrence of point-of-purchase (POP) alcohol ads in one low-income community Central California, identifies their target audience and themes, and obtains their perspective on how the ads influence women’s alcohol consumption. Methods included observation of POP alcohol ads in local supermarket and convenience stores that sell alcohol products, content analysis of a selection of these POP alcohol ads, and focus group discussions with young women who are mostly in their twenties from both Latina and non-Latina backgrounds. A total of 2,021 POP alcohol ads were observed in 164 retail establishments that sell alcohol. Of these ads, we took photos of 64 different ads for content analysis. Our content analysis indicated that most POP alcohol poster ads appealed both to men and women, with themes mainly related to sex and sports. Focus group interviews indicated that sex and sports-themed alcohol ads, coupled with the presence of peers and family members that drink alcohol, are influential in women’s decisions to drink. The influence of alcohol ads on norms regarding alcohol consumption warrant stronger anti-alcohol policies, such as the banning alcohol ads in places frequented by minors, and the implementation of anti-alcohol marketing campaigns with a health consequences focus. © 2012 Californian Journal of Health Promotion. All rights reserved.


Point-of-Purchase Alcohol Ads in One Low-Income Community in Central California: Occurrence and Women's Perceptions
Media is an important source of information in people's lives (Bryant, 2002), and one important use of the media is advertisements to shape consumers' purchasing and consumption behavior.Marketing communication theory suggests that saturating the market with advertisements of a particular product influences consumers' acquisition and consumption of that product (Stewart, Pavlou, & Ward, 2002).Each year, the alcohol beverage industry spends billions of dollars in advertising (Jernigan, 2009).Alcohol is advertised in several media outlets, including television, radio, the Internet, promotional events, billboards, and at the pointof-purchase (POP).Considering all the media channels in which alcohol is advertised, POP print ads strongly influence consumer behavior.One study estimates that alcohol POP advertising alone increases total beer sales by 17% (Beverage Industry, 2001).
While males tend to have higher alcohol consumption rates than females, recent trends suggest that females are closing the gap in both current alcohol use and binge drinking rates (National Center for Chronic Disease Prevention & Health Promotion, 2009a, 2009b).Studies also show that those with lower incomes are more likely to drink alcohol compared to their counterparts (U.S.Department of Health and Human Services, 2000).Given the potential influence of alcohol print ads on alcohol consumption among women and those from lower socioeconomic backgrounds, we addressed the following two research questions: (1) What quantity and types of alcohol ads are found in stores selling alcohol in low-income communities?(2) How do women, particularly, perceive these advertisements?Rather than examining alcohol ads in television, radio, and internet, as several studies have done to date (Aitken et al., 1988; The Center on Alcohol Marketing and Youth [CAMY], 2002[CAMY], , 2003a[CAMY], , 2003b[CAMY], , 2003c[CAMY], , 2004a[CAMY], , 2004b[CAMY], , 2005[CAMY], , 2006)), this study focuses on POP alcohol ads-a form of advertising rarely studied, yet have a significant influence on consumer purchases (Beverage Industry, 2001).This study uses quantitative and qualitative methods to explore the occurrence of POP alcohol ads in one lowincome community in the Central Valley of California and identify women's perceptions regarding alcohol print ads and alcohol consumption.

Study Design
Our study used a cross-sectional study design, using a mixed methods approach.The quantitative portion involved researchers' observation of POP alcohol ads in all supermarket and convenience stores in the study community.The qualitative portion involved focus group interviews with women in the community, assessing their perceptions of alcohol ads and alcohol consumption Data collection occurred in three phases from January 2005 to June 2005.The first phase involved our community-based research assistant visiting all supermarket and convenience stores in the community, noting the number, type, and placement of POP alcohol ads.The second phase involved the research assistant going back to the same places, to take photos of alcohol posters ads for content analysis.Finally, the third phase consisted of focus group interviews with women in the community.
This study was a small portion of the evaluation of Fetal Alcohol Spectrum Disorders Prevention Narrowcast Campaign, funded by Centers for Disease Control and Prevention.Thus, in putting together our focus groups, we worked mainly with organizations that serve childbearing women and young mothers, mainly in their twenties.The UCLA Institutional Review Board approved this study before its implementation.

Sample, Measures, and Data Collection
Survey of POP alcohol ads.For the content analysis portion of the study, we first drew boundaries around the study community using the 2000 Census zip code designation.Once boundaries were defined, a research assistant went to the community to identify supermarket and convenience stores that sold alcohol in the area.If a store had POP alcohol ads, the research assistant noted its name, address, and type (i.e., convenience store or mini-mart, grocery, or liquor store).Then, he recorded how many POP alcohol ads there were, what alcohol types and brands were advertised, and whether the alcohol ads were inside or outside of the business establishment.
Due to time and resource limitations, we did not collect data on the length of time the advertisement was posted to measure saturation in a target setting.

Sample of Alcohol Ads for Content Analysis.
In establishing our sampling guidelines, our goal was not to assess the content of all the alcohol ads that we observed, because that would involve the analysis of over 2,000 alcohol ads (see Table 1), with many of the same ads being placed in several places.Our goal, rather, was to examine a variety of POP alcohol ads and assess their common themes and target audience.
Since there were several types of POP alcohol ads (i.e., logos, banners, and posters), we only sampled the posters with images and symbols because they provide a richer and more meaningful content than other ad types, lending themselves well for content analysis.Moreover, studies also suggest that such thematic and engaging ads are more effective in influencing individual attitudes and behavioral intentions (Beverage Industry, 2001;Weinrich, 2010).Given that we were only interested in assessing what POP alcohol poster ads the public generally see in many of the stores in the community, we decided to sample up to three different POP alcohol poster ads from stores with three or more alcohol poster ads.Our rationale for sampling only three per store was to avoid having to assess disproportionately more alcohol poster ads from a few stores with an unusually large number of alcohol poster ads.We instructed our research assistant to choose the top three alcohol poster ads that exemplified a more comprehensive marketing strategy (i.e., posters that included brand names, slogans, pictures, models, representations, and symbols) than others.This provided us with greater opportunity to understand how messages of alcohol ads promote drinking.In total, our research assistant went back and visited 138 stores with POP alcohol ads, taking photos of 64 unique POP alcohol poster ads to assess for content analysis.Before any POP alcohol poster ads were photographed, permission from the store manager was sought.
All of the 64 POP alcohol poster ads were printed and reviewed by one of the investigators.Based on his initial review, he developed a coding protocol and codebook for the coders to follow.Codes were based on the type (e.g., beer, liquor, wine, etc…) and brand (e.g., Budweiser, Coors, etc…) of alcohol advertised, the ads' major themes (e.g., sex appeal, sports, etc…), and the alcohol ads' target audience (whether they appeal to men, women, or both; and whether they appeal to a particular racial group-Latino, Black, or others).
Coding for the type and brand of alcohol advertised was simpler than coding for the ads' themes and target audience, because the types and brand of alcohol were explicitly displayed on the ads, while the ads' themes and target audience required close attention to the implicit message of the ad.In assessing the ads' themes, the coders asked themselves of the collective meaning of the ads' image, design, symbols, language, and content.In assessing the ads' target audience, the coders were asked to pay attention to the sex and race of the ads' models, and put that within the context of the ads' themes.For example, a male dominated sportsthemed ad (i.e., football, car racing) that had a woman in a bikini was coded as targeting men.An ad that used Spanish language and cultural themes and symbols (i.e., Cinco de Mayo), was coded as targeting Latinos.Our coders were two trained female undergraduate students.Both coders independently analyzed the content of all the 64 POP poster alcohol ads.In a few cases where there were disagreements in coding, the coders resolved their disagreements with each other and the investigator.
Focus group interviews.We conducted three focus group interviews to investigate how alcohol ads influence alcohol consumption among young women residing in the study community.Our selection criteria for the focus group participants were: women ages 18 to 45 years residing in the study community.A community liaison recruited our participants from maternal and child clinics and community centers in low-income areas of the study community.When we received the list of participants, we purposely divided them into three approximately equal sized groups-the first group included Latinas only, the second group included Caucasians only, and the third group included Latinas, Caucasians, Blacks and others.The purpose of dividing the groups into these categories was to capture both unique and common ethnic or cultural perceptions and values regarding alcohol ads and alcohol consumption.
The focus group interviews covered three main topics: alcohol experience with family and peers, exposure to alcohol advertisements, and general perceptions of alcohol print ads.In discussing general perceptions of alcohol print ads, the focus group participants were shown photos of seven alcohol print ads that we randomly chose from our 64 POP alcohol ads.
As the participants were shown the photos, we asked them to comment on the themes, explicit and implicit messages, and presumed target audience of the ads.
The moderator used an interview guide, and a community liaison took observational notes.Each of the focus group interviews lasted approximately 90 minutes, and all were taperecorded.A professional transcriptionist then transcribed the tape recordings verbatim.
Analyses POP Alcohol Ads Survey Analysis.Data for the alcohol ads survey were entered in Microsoft Excel spreadsheet, and later transferred to SPSS for statistical analyses.Analysis for the alcohol ads survey mainly involved descriptive statistics.We counted the number of grocery and convenience stores with POP alcohol ads, the number of POP alcohol ads in each of the stores, the location of the POP alcohol ads (i.e., outside and/or inside the business establishment), and the type of alcohol advertised on the ads.

Content Analysis of POP Alcohol Poster Ads.
Content analysis data were also initially entered in Microsoft Excel for coding purposes, and then transferred to SPSS for statistical analysis.In our analysis, we assessed the proportion POP alcohol poster ads that targeted a specific sex and racial/ethnic group, as well as the proportion of a particular theme that came out of the alcohol poster ads.
Focus Group Data Analysis.Analysis of our focus group data followed a thematic analytic approach.In identifying our final themes, we performed three important steps.First, we read through the focus group transcripts and observation notes to gain some idea of the key issues brought up by our participants.Second, we conducted two rounds of open and selective coding-open coding involved determining codes during our qualitative, grounded data review process, while selective coding involved having predetermined codes based on our hypotheses, research questions, and theoretical framework.In our coding process, we looked for key quotes and phrases that related to alcohol ad perceptions and alcohol experiences.The final step of our analysis involved locating quotes that we had previously coded with similar meaning or context and grouping similar quotes through coding.
These codes were then reviewed and grouped based on overarching themes they represent (Strauss, 1987).
Integrative Analysis.Analyses of our quantitative and qualitative data were performed independently.Once we obtained the results from our quantitative and qualitative analyses, we then reviewed the results together to obtain an integrative understanding of POP alcohol ads and their potential influence to alcohol consumption behavior among women in one low-income community in Central California.

Demographic Characteristics of Study Community
To protect the identity of our focus group participants and to prevent potentially stigmatizing our study community, we chose to keep our study community's name anonymous.However, we present our study community's geographic and demographic characteristics to provide some context to the results of our study.Based on the 2000 U.S. Census (U.S. Bureau of the Census, 2000), our study community had a total area of close to 115 square miles.Its population totaled approximately 247,000, with a population density of 2,185 people per square mile.Our study community had 51% Whites, 32% Latinos, and 9% Blacks.The age distribution of the community was fairly young, as persons aged 18 to 49 years comprised 46% of the population, and persons aged 17 years and under comprised 38% of the population.While approximately 14% of people lived in poverty in the entire state of California, approximately 18% of people lived in poverty in this community.With regards to the population's educational background, only 20% had a bachelor's or an associate's degree.A substantial portion of people in the study community worked in the educational (24%) and retail (12%) industry.Others worked in the agricultural (8%), professional (8%), and arts (8%) industry.

Survey of POP Alcohol Ads
We found a total of 164 supermarket and convenience stores in the study community that sold alcohol products.
Most of these establishments were liquor and convenience stores.Of the 164 alcohol retail businesses, 84% had some type of alcohol advertisement.Among those with alcohol advertisements, 28% put their alcohol ads only inside of their establishment, 35% only put their ads outside of their establishment, and 36% put their ads both inside and outside of their establishment.On average, a total of about 15 POP alcohol ads were observed in each of the alcohol business establishments.This totals 2,021 POP alcohol ads observed among all visited businesses that sold alcohol, with some of the ads repeated several times.Approximately 95% of POP alcohol ads were for beer.Almost half (47%) of the POP beer ads (data not shown) were from Budweiser.

Content Analysis of POP Poster Alcohol Ads
A total of 64 POP alcohol poster ads were photographed for content analysis.
Of the 64 photographed POP alcohol poster ads, 61 ads were for beer, two were for malt liquor, and one was for hard liquor.Results of the alcohol ads' content analysis are shown on Table 2.
Of these ads, approximately 52% targeted both males and females based on our interpretation, and 48% targeted only males.With regards to the ads' targeted racial/ethnic group, 67% could appeal to any race or ethnic group, while 28% and 5% specifically targeted Latinos and Blacks, respectively.
The most predominant themes among the alcohol ads were sex appeal (42%), sports (28%), culture and tradition (6%), and diet (6%).Ads using sex appeal generally show attractive women in tightfitting clothes or swimwear, with taglines usually located on the level of the woman's chest or buttocks area.Ads with sports themes generally showed race car drivers endorsing a particular alcohol brand, racing cars with a logo from a particular alcohol brand, and football or baseball teams or team members endorsing a particular alcohol brand.Ads using the theme of culture and tradition generally used the color scheme of a particular Latin American flag, the use of Spanish

Table 2
Content Analysis of POP Alcohol Poster Ads,N=64 language, or significant historic or cultural events in a particular country in Latin America.Dietthemed ads either highlighted the amount of calories for a particular brand or showed pictures of sweating, athletic-built, men and women engaging in sports.

Focus Group Interviews
Table 3 summarizes the demographic characteristics of the focus group participants.White women were in the first focus group, while Latina women were in the second focus group.The third focus group consisted of various ethnicities.The mean age for the first, second, and third focus group participants were 28, 22, and 21 years, respectively.
Four major themes related to alcohol ads and alcohol experience emerged from analyzing the focus group interviews.Themes 1 and 4 were based from the key concepts of Social Cognitive Theory (Bandura, 2002), while themes 2 and 3 were inductively determined.All themes were common across all focus groups, and none were specific to a particular ethnic group.The four themes were as follows.
Theme 1: Alcohol ads as positive symbolic representations and fantasies.For many of the participants, the images portrayed on alcohol ads become symbols that serve as cognitive models of how it feels to drink alcohol.When the participants were shown a picture of an alcohol ad that has a cold bottle of Budweiser beer on a red background with a droplet of water falling on the bottle's cap, forming a splash that looks like a king's crown, many perceived Budweiser beer as refreshing: At this point in the focus group interview, three women from the first focus group were observed to get up to get some cold drinks that were provided.When alcohol ads use the image of attractive women, there is a perception that the ads are particularly targeting men.Indeed, when the participants were shown a picture of a Coors Light poster ad with two blonde women in the center, dressed in tight-fitting, attractive outfits with a tagline, "Shift to Silver", some felt that it gives men the message that drinking Coors Light can help them meet women like the ones in the ad: "  Missing (no answer) 1 (6.2%) 0 (0.0%) 0 (0.0%)

Annual Family Income
< $50,000 per year 13 (81.2%)6 (54.5%) 10 (83.3%) ≥ $50,000 per year 2 (12.5%) 0 (0.0%) 1 (9.1%) Missing (no answer) 1 (6.2%) 5 (45.4%) 0 (0.0%) message that drinking this particular beer can help them feel more sexy and beautiful: "My daughter sees these girls on these ads and she wants to be like them.I have an eleven year old daughter and she's in color guard and she looks at things like this and she says, 'I want to be skinny like that.I want to be pretty like that.I want to look like that when I'm older.'""Well, tobacco, they really showed me… They have this woman that has this cigarette coming out of her breathing hole… They really show.They really tell you how, but with beer, they really don't show you.You don't think anything bad is going to happen."Theme 3: Easy Access to Obtaining Alcohol.Another factor contributing to drinking initiation among young girls is the ease of obtaining alcohol in their neighborhood even as a minor.According to one underage participant, for which several agreed: "I can buy beer… without even being carded.Like at the corner market." Even if minors have difficulty purchasing alcohol, according to several underage participants, they are confident they can obtain alcohol because people they know can purchase or give it to them: "My cousin buys it for the family, for me, and he buys hard stuff.If I was to do it, it would be hard.We can't really afford some drinks, but [if] people are [bringing in drinks]… then you can get too wrong." Theme 4: Drinking Alcohol as a Perceived Social Norm.What makes alcohol consumption a reasonable behavior to engage in seems to be influenced by the perceived alcohol prevalence in the individuals' social environment and the society-at-large.In all three focus groups, most of the participants who drink alcohol mentioned that either their peers or family members drink alcohol as well.
"Most of the women in my family, they like to drink cocktails, fruit drinks, alcohol fruit beverages, a lot of beer.My brother-in-law [and I] drink a lot together.Every time we get together.When [my friends] get together, we drink a lot."Many participants perceive that there are more teenagers who drink alcohol currently as compared to more than a decade ago, thereby normalizing drinking behavior among youth.Several agree to the following testimonies: "[Teenagers] don't hide [drinking] anymore.I see 15 year old boys that are walking down the street [drinking alcohol]" Additionally, a few participants claim that even some of the models on alcohol ads do not look like they are of the legal age to drink.
"[The models] look pretty… it seems that [the alcohol companies] are using younger men and women [to promote their product]… a lot of times [the models] look like they are 18 instead of looking 35 or around that age.[The models] sure don't look 21."

Discussion
A number of studies on alcohol consumption behavior and the media have either documented the occurrence of alcohol in the media (CAMY, 2002(CAMY, , 2003c(CAMY, , 2004b;;Christenson, Henriksen, & Roberts, 2000;Roberts et al., 2002;Terry-McElrath et al., 2003;Wallack et al., 1990), the content of the media messages related to alcohol consumption (CAMY 2003a(CAMY , 2003b(CAMY , 2004a(CAMY , 2006;;Wallack et al., 1990;Grube, 2004;Jernigan, Ostroff, & Ross, 2004) or the individual cognitive effects of alcohol media messages (CAMY, 2003a;Grube, 2004;Collins et al., 2003;Hankin et al., 1993;Robinson, 1998;Saffer, 1996;Stacy et al., 2004).This is perhaps one of the first studies that used a mixed methods approach to give an integrated account of the occurrence, content, and potential effect of alcohol print ads in a low-income community.By integrating the quantitative and qualitative study findings, a more complete understanding of the impact of POP advertising on the target audience can be realized.We report three key conclusions from the integration of our quantitative and qualitative data.
First, alcohol print ads were common in our study community, as we had initially hypothesized.We found that approximately 84% of supermarket and convenience stores that sell alcohol in our study community have some type of POP alcohol ad.This is close to the nationwide figure, which is about 90% (Terry-McElrath et al., 2001).Having several stores with POP alcohol ad can potentially reinforce a culture of drinking, particularly among youth and young adults.With approximately 15 alcohol ads per store in the study community, anyone who goes there, including youth, will be exposed to alcohol advertisements.One study estimates that there are approximately 2,300 to 8,000 shoppers per week in supermarkets alone, which means that POP ads in these establishments can be viewed by shoppers about 5,916 times per week (Beverage Industry, 2001).Thus, while youth cannot legally purchase alcohol, they are constantly exposed to cues encouraging alcohol consumption when they go to these retail establishments.
Unfortunately, as our focus group results suggests, several of these alcohol ads appeal to young girls and teenagers.Studies show that exposure to media that portray alcohol in a positive light, is associated with a positive attitude toward the alcohol product and its use, which then increases the probability of alcohol consumption especially among youth (CAMY, 2003a;Grube, 2004;Anderson et al., 2009;Austin & Knaus, 2000;Neuendorf, 1985).As in all brand exposure advertising, brand identification begins during youth and develops into actual purchasing and consumption behaviors by adulthood.Interestingly, many of our focus group participants portrayed attitudes toward drinking and alcohol ads from a young girl's perspective, and not their own as adult women, suggesting that this may be how they felt when they were younger or that they see this attitude in their own children.
Second, alcohol print ads are both innovative and effective in reaching their intended target audience and in communicating their messages, both explicitly and implicitly.Both quantitative and qualitative data collected in this study showed that most alcohol print ads appealed to both men and women regardless of their racial/ethnic background, disconfirming our hypothesis that alcohol ads predominantly target men.While a case has been made that ethnic minorities are often disproportionately targeted by alcohol industries in television and radio media (CAMY, 2003a(CAMY, , 2003b)), our findings suggest that the majority of these ads in the community appealed across ethnic, racial and gender groups.Despite our efforts to identify unique ethnic or cultural perceptions and values related to alcohol ads in our focus groups, we did not find any.Hence, the alcohol advertisers are effectively targeting a broad audience.
Third, results of our content analysis showed that the most predominant themes among these alcohol ads included sex, sports, culture, and diet.All of these themes, based on qualitative data, have the potential to create both emotional, cognitive, and sensory responses that can result in individuals visualizing how drinking makes them feel good.Moreover, these themes also provide entertainment and fantasy to individuals, making alcohol consumption attractive, easily recalled, and motivating.The images presented on alcohol ads are further reinforced by the family members' drinking behaviors, as well as the lack of antialcohol media campaigns.
This study has some limitations.First, although our community liaison attempted to visit all possible grocery and convenience stores in the community based on his knowledge as a longtime resident, there is a possibility that he may have missed smaller stores that are tucked in small and less prominent neighborhoods in the community.Thus, it is possible that we may have underestimated the actual number of alcohol retail establishments and the average number of occurrence of alcohol ads.Second, we did not evaluate all of the possible POP alcohol poster ads encountered in alcohol retail establishments.In alcohol retail establishments with four or more alcohol poster ads, we only chose three because, as previously mentioned, we wanted to avoid assessing disproportionately large number of POP alcohol poster ads from a few select stores with unusually large number of alcohol poster ads.This certainly decreased the study's sample for content analysis and presents potential selection bias.Third, this study focused only on one lowincome community in Central California.Thus, the results of this study may not be representative of other communities in the United States.Finally, we did not ask questions about drinking patterns, behaviors, and intentions to our focus group participants, which could have affected their responses.However, we made the conscious decision not to ask such questions, as some of them were pregnant, and any questioning of their current drinking behavior could be sensitive.Despite the limitations in this study, it is the known first of its kind to investigate the occurrence of POP alcohol ads and how they can potentially influence alcohol consumption behavior.
The findings of this study can be further informed with subsequent studies.First, as this study only focused on a single community, it is important for future research to replicate this study in other communities in different parts of the country to identify possible regional differences.Second, since this study only focused on women's perceptions, mostly of Latino and White backgrounds, future research should also examine perceptions of men and other racial or ethnic groups, such as Blacks, Asians, and Native Americans.Third, future national, state, or local health surveys, especially those that look at alcohol consumption behaviors, such as Behavioral Risk Surveillance Systems Survey and Youth Risk Behavioral Survey, should consider adding questions on perceptions of alcohol ads.
In terms of policy, the study findings suggest capitalizing on the successes of the anti-tobacco campaigns.Several studies have argued to ban alcohol ads that specifically target youth (Anderson et al., 2009;Anderson, 2009;Hollingworth et al., 2006).We would also argue for the prohibition of alcohol advertising in places frequented by minors.However, realizing that an alcohol advertising ban may not be currently feasible, a more practical and immediate approach would be to develop effective counter-marketing campaigns targeted to the audiences of alcohol ads.Many of the study's focus group participants said that there were not enough anti-alcohol media campaigns to counter the current glut of alcohol ads.Increasing ads that focus on the negative health consequences of alcohol consumption, including poor school and job performance, violence, automobile accidents, abusive relationships, Fetal Alcohol Spectrum Disorders, decreased inhibition, and obesity, can help provide people a more balanced view of the impact of drinking, especially among vulnerable populations, such as youth and child-bearing women.Funds for alcohol prevention campaigns, for instance, can come from an increased alcohol tax.
Finally, in terms of practice, our findings suggest that preventive interventions to alcohol consumption should include deconstruction of alcohol advertisements as a means to sensitize target populations to their influence.Research suggests that such media literacy efforts provide promise in terms of preventing risky behaviors among children (Eintraub, Kristine, & Johnson, 1997).
In order for alcohol prevention and control efforts to be effective, community members must have an increased level of knowledge and awareness of the negative health consequences of alcohol consumption, an appreciation of the impact of branded alcohol advertising, and increased skills and motivation to advocate for anti-alcohol policies and campaigns.Our study further illustrates the importance of including media awareness and literacy strategies in health promotion efforts.

"
If you're thirsty, [this beer] is refreshing.""When you live in [this city], and it's 105 degrees outside, you know [you could use a cold beer]."

Table 1
Survey of Point-of-Purchase (POP) Alcohol Ads in Grocery and Convenience Stores in a Central California Community *The frequency of POP alcohol ads include duplicates.

Table 3
Demographic Characteristics of Focus Group Participants