Neighborhood Inequalities in Retailers' Compliance With the Family Smoking Prevention and Tobacco Control Act of 2009, January 2014-July 2014 (original) (raw)
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Concentration of Tobacco Advertisements at SNAP and WIC Stores, Philadelphia, Pennsylvania, 2012
Preventing Chronic Disease, 2015
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2018
BACKGROUND Menthol cigarette use in the United States has remained stable or increased across demographic groups. Menthol cigarettes are associated with greater likelihood of initiation and decreased likelihood of cessation. In 2009, the Family Smoking Prevention and Tobacco Control Act banned the sale of cigarettes with a characterizing flavor but excluded menthol. Without national regulation, local retail policies have become a pathway to regulate access and reduce associated health disparities. Chicago, IL was the first major American city to ban the sale of menthol cigarettes as part of its partial ban on flavored tobacco sales in stores within 500 feet of high schools. This dissertation explored compliance with Chicago's ban on menthol cigarette sales and explored the implementation experience from the point of view of retailers, including how this key group of implementation actors navigated the implementation process and framed the purpose and intended effect of Chicago's partial ban. METHODS This dissertation used a multi-method approach. First, a quantitative study was conducted to assess compliance with Chicago's ban on menthol cigarette sales within a sample of 100 of 154 stores within 500 feet of a high school. Compliance was determined by whether a menthol cigarette pack was purchased and multivariable logistic regression modeled compliance by store type, school, and neighborhood-level factors. Next, semistructured interviews were conducted with retailers in 31 stores not included in the compliance assessment. An inductive approach to disassembling and reassembling the iii data was used to develop the codebook and code data. Coded transcripts were compared to identify patterns and major themes. RESULTS: Overall, the rate of compliance with Chicago's partial menthol cigarette sales ban was 57% (weighted, n=53). Gas stations had 81% lower odds (OR=0.19, 95%CI:0.06-0.58) of complying with the menthol cigarette ban compared to larger/chain stores (e.g. liquor stores, grocery stores). Interviews found that retailers in smaller convenience stores and gas stations were concerned over perceived profit losses and the loss of their "one stop shop" appeal. Stores managed these concerns by changing products offered, appealing whether the ban affected their store, or not complying with the ban on menthol cigarette sales. Generally, retailers saw the government as their main source of information about the ban and the threat of a fine was a motivating factor to comply. However, many felt that enforcement visits were invasive and a mechanism to make money for the city. Many also felt that the government's communication about the ban and existing guidelines on what was considered a flavored tobacco product was one-sided and ambiguous, sometime leading to non-compliance. Finally, retailers largely framed Chicago's partial ban as an effort to protect kids but felt it was redundant with the existing minimum age of sale rule. Many challenged whether the 500 feet buffer zone changed access to menthol cigarettes and suggested that there were more equitable approaches to prevent access, such as a comprehensive, city-wide ban. DISCUSSION: Results from the compliance assessment and interview studies suggest that a partial ban on menthol cigarette sales is a less preferred policy option for local jurisdiction. The iv compliance rate with a partial menthol cigarette sales ban was poor and interviews with retailers suggest that a partial ban may disproportionately impact the financial viability of affected retail stores while making limited gains in reducing access to menthol cigarettes, which were still widely available in affected stores and unaffected stores beyond 500 feet of high schools. Findings from this study suggest that local policymakers should actively engage retailers in the design and implementation of menthol cigarette bans and other tobacco control regulatory efforts. This active partnership can incorporate the unique perspective of retailers as implementation actors into the design of ordinances, capitalize on their potential support for comprehensive efforts, and enhance compliance by addressing retailers' implementation needs.
Tobacco Induced Diseases
of tobacco product retailers have led to a decrease in the prevalence of youth buying cigarettes in a store 3-5. However, social access to cigarettes has been increasing, with strong evidence indicating that youth aged <18 years can obtain their cigarettes from friends and young adults aged 18-20 years 6-8. In 2015, the Institute of Medicine (IOM) examined existing literature on tobacco use initiation and ABSTRACT INTRODUCTION Tobacco control laws that raise the minimum age of tobacco sales to 21 years (T21) play a pivotal role in youth tobacco prevention, yet empirical data are sorely needed to inform enforcement, compliance efforts, and future legislation. METHODS Spatial analysis was conducted at the zip code level by geocoding the states and localities that adopted T21 ordinances from 2015 to 2019. A multi-level logistic regression model was conducted to examine disparities in neighborhood socioeconomic status (SES), FDA retail inspection, and state-level tobacco control policies associated with T21 adoption. RESULTS T21 adoption at the state and local level increased considerably from 1.4% of zip codes in 2015 to 40.2% in 2019. However, the T21 ordinances were disproportionally adopted in New England (82.6%) and Pacific (73.6%) regions with scarce coverage in East South Central (<0.1%), Mountain (1.6%), and West North Central regions (6.1%). The T21 policies were more likely to be adopted in areas with stronger tobacco control policies, urban areas (vs rural, adjusted odds ratio, AOR=1.25, p=0.005), areas with a larger Hispanic (AOR=1.19, p<0.0001) or Asian population (AOR=1.12, p<0.0001), and in areas where the population had higher levels of education (AOR=1.05, p<0.0001). It was less likely to be adopted in areas with larger proportions of American Indians, youths, and young adults. Nearly 40% of zip codes with tobacco retailers did not receive annual FDA tobacco retail inspections for underage sales in 2019. The average retail violation rate of underage sales of tobacco products in T21 regions was lower than in non-T21 regions. CONCLUSIONS Disparities in T21 adoption, retail inspections, and retail compliance may limit the policy impact. Unified enforcement of youth tobacco access restrictions with resources and interventions in vulnerable communities is needed to reduce tobacco-related health disparities.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2016
Population-level research on the implications of retail pharmacy policies to end the sale of tobacco products is scant, and the impact of such policies on racial/ethnic and socioeconomic disparities across neighborhoods in access to tobacco products remains unexplored. We investigated the association between neighborhood sociodemographic characteristics and tobacco retail density in Rhode Island (RI) (N=240 census tracts). We also investigated whether the CVS Health (N=60) policy to end the sale of tobacco products reduces the disparity in the density of tobacco retail across neighborhoods, and we conducted a prospective policy analysis to determine if a similar policy change in all pharmacies in RI (N=135) would reduce the disparity in tobacco retail density. The results revealed statistically significant associations between neighborhood sociodemographic characteristics and tobacco retail outlet density across RI neighborhoods. The results when excluding the CVS Health locations, ...