Evaluation of California's 'Tobacco 21' law.

IntroductionCalifornia's law raising the minimum tobacco sales age to 21 went into effect on 9 June 2016. This law, known as 'Tobacco 21' or 'T21', also expanded the definition of tobacco to include electronic smoking devices. This paper describes the T21 evaluation plan and initial evaluation results.MethodsAn evaluation plan and logic model were created to evaluate T21. A tobacco retailer poll was conducted 7 months after the law went into effect to assess awareness, support and implementation; an online survey of California adults was fielded to provide data on tobacco use and attitudinal changes before and after T21 implementation; and tobacco purchase surveys were conducted to assess the retailer violation rate (RVR). Multivariate models estimated the odds of RVR and odds of being aware, agreeing with and observing advertisements related to T21.ResultsSeven months after the T21 effective date, 98.6% of retailers were aware of the law and 60.6% supported the law. Furthermore, 66.2% of retailers agreed that people who start smoking before 21 would become addicted to tobacco products. The RVR using youth decoys under age 18 statistically decreased from 10.3% before T21 to 5.7% after T21 (P=0.002). Furthermore, the RVR using young adult decoys ages 18-19 was 14.2% (95% CI 9.3% to 19.1%) for traditional tobacco and 13.1% (95% CI 10.2% to 16.1%) for electronic smoking devices.ConclusionsSurvey findings suggest that the high awareness and support for the law may have contributed to reducing illegal tobacco sales to youth under 18 and achieving widespread retailer conformity with the new law disallowing sales to young adults under 21

Evaluating the Impact of Strong and Weak California Flavored Tobacco Sales Restriction Policies on the Tobacco Retail Environment

Purpose Evaluate success of local flavored tobacco (FT) policies in reducing availability of FT products in California. Design Matched-jurisdiction cross-sectional design compared availability of FT at licensed tobacco retailers (LTR) in jurisdictions with and without such policies in 2013 and 2019. Flavor policy jurisdictions were split into strong and weak groups using Flavored Tobacco Policy Rating Rubric. Setting 32 local California jurisdictions Subjects Final sample included 306 LTR in 2013 and 1441 LTR in 2019. LTR were classified as convenience store, liquor store, pharmacy, small market, supermarket, gas station booth, tobacco/vape product store, or other. Measures Retail availability of menthol cigarettes and flavored non-cigarette tobacco. Analysis Logistic regression analysis including covariate (store type) determined whether differences existed in availability of FT in jurisdictions with and without FT policies. Percentage change assessed difference in proportion of retailers that sold FT in 2013 (i.e. before-policies-passed) and in 2019 (i.e. after-policies-became-effective). Results Strong flavor-policy jurisdictions significantly differed from matched no-policy jurisdictions in availability of menthol cigarettes (OR = .04, 95% CI: .02–.08) and flavored non-cigarette tobacco (OR = .07, 95% CI: .05–.11). From 2013 to 2019, these jurisdictions experienced significant declines in menthol cigarettes (87.9% to 35.4%) and flavored non-cigarette tobacco sales (63.8% to 37.0%). Conclusion Strong FT sales restriction policies appear to be effective in reducing availability of FT, thereby creating a healthier retail environment in California. </jats:sec

Evaluation of California’s ‘Tobacco 21’ law

IntroductionCalifornia's law raising the minimum tobacco sales age to 21 went into effect on 9 June 2016. This law, known as 'Tobacco 21' or 'T21', also expanded the definition of tobacco to include electronic smoking devices. This paper describes the T21 evaluation plan and initial evaluation results.MethodsAn evaluation plan and logic model were created to evaluate T21. A tobacco retailer poll was conducted 7 months after the law went into effect to assess awareness, support and implementation; an online survey of California adults was fielded to provide data on tobacco use and attitudinal changes before and after T21 implementation; and tobacco purchase surveys were conducted to assess the retailer violation rate (RVR). Multivariate models estimated the odds of RVR and odds of being aware, agreeing with and observing advertisements related to T21.ResultsSeven months after the T21 effective date, 98.6% of retailers were aware of the law and 60.6% supported the law. Furthermore, 66.2% of retailers agreed that people who start smoking before 21 would become addicted to tobacco products. The RVR using youth decoys under age 18 statistically decreased from 10.3% before T21 to 5.7% after T21 (P=0.002). Furthermore, the RVR using young adult decoys ages 18-19 was 14.2% (95% CI 9.3% to 19.1%) for traditional tobacco and 13.1% (95% CI 10.2% to 16.1%) for electronic smoking devices.ConclusionsSurvey findings suggest that the high awareness and support for the law may have contributed to reducing illegal tobacco sales to youth under 18 and achieving widespread retailer conformity with the new law disallowing sales to young adults under 21

The changing retail landscape for tobacco: dollar stores and the availability of cheap cigarettes among tobacco-related priority populations

IntroductionDollar stores are rapidly altering the retail landscape for tobacco. Two of the three largest chains sell tobacco products in more than 24 000 stores across the USA. We sought to examine whether dollar stores are more likely to be located in disadvantaged neighbourhoods and whether dollar stores charge less for cigarettes than other tobacco retailers.MethodsData were collected from a statewide random sample of licensed tobacco retailers in California (n=7678) in 2019. Logistic regression modelled odds of a census tract containing at least one dollar store as a function of tract demographics. Linear mixed models compared price of the cheapest cigarette pack by store type, controlling for tract demographics.ResultsCensus tracts with lower median household income, rural status and higher proportions of school-age youth were more likely to contain at least one dollar store. The cheapest cigarette pack cost less in dollar stores compared with all store types examined except tobacco shops. Estimated price differences ranged from $0.32 (95$0.39 (95% CI: 0.22 to 0.57) more in convenience stores, to $0.82 (95$1.86 (95% CI: 1.61 to 2.11) more in stores classified as ‘other’.ConclusionsDollar stores may exacerbate smoking-related inequities by contributing to the availability of cheaper cigarettes in neighbourhoods that are lower income, rural and have greater proportions of youth. Pro-equity retail policies, such as minimum price laws and density reduction policies, could mitigate the health consequences of dollar stores’ rapid expansion.</jats:sec

Mind the Gap: Changes in Cigarette Prices after California's Tax Increase

Objective: In this study, we investigated whether California's 2017 cigarette tax increase was passed onto smokers equally. Methods: Auditors recorded 4 cigarette prices in the same random sample of licensed tobacco retailers (N = 1049) before the tax increase (January-March 2017) and after (April-September 2018): Natural American Spirit (ultra-premium), Newport menthol (premium), and Pall Mall (value) all from the same manufacturer, and Marlboro (premium). Ordinary least squares regressions examined how the gap in prices varied by market segment and neighborhood demographics, controlling for store type and months since implementation. Paired t-tests assessed whether industry/retail revenue increased. Results: Over-shifting (increase greater than tax) was evident for all 4 brands and was significantly greater for ultra-premium (Mean = $0.40, SD = 0.75) than premium (Mean =$0.25, SD = 0.78) and greater for premium than value brand (Mean = $0.16, SD = 0.67). However, under-shifting (increase less than tax) was evident for Newport in African-American neighborhoods and Pall Mall in Hispanic neighborhoods. After the tax increase, prices were significantly more likely to be discounted and significantly more stores advertised a discount on cigarettes. Conclusion: California's tax increase was not passed onto consumers equally. Non-tax mechanisms to increase price could support intended effects of tobacco taxes.</jats:p

Sources of flavoured e-cigarettes among California youth and young adults: associations with local flavoured tobacco sales restrictions

PurposeThis study compares access to flavoured JUUL and other e-cigarettes from retail, online and social sources among underage and young adult e-cigarette users who live in California jurisdictions that restrict sales of flavoured tobacco with the rest of the state.MethodsAn online survey used social media advertisements to recruit participants (n=3075, ages 15–29) who lived in one of nine jurisdictions that restrict sales (n=1539) or in the rest of state, and oversampled flavoured tobacco users. Focusing on past-month e-cigarette users (n=908), multilevel models tested whether access to flavoured JUUL and other e-cigarettes from retail, online and social sources differed by local law (yes/no) and age group (15–20 or older), controlling for other individual characteristics.ResultsThe percent of underage users who obtained flavoured JUUL and other e-cigarettes in the past month was 33.6% and 31.2% from retail, 11.6% and 12.7% online, and 76.0% and 70.9% from social sources, respectively. Compared with underage and young adult users in the rest of California, those in localities that restrict the sales of flavoured tobacco were less likely to obtain flavoured JUUL from retail sources (Adjusted OR=0.54, 95% CI 0.36 to 0.80), but more likely to obtain it from social sources (Adjusted OR=1.55, 95% CI 1.02 to 2.35). The same pattern was observed for other brands of flavoured e-cigarettes.ConclusionAlthough local laws may reduce access to flavoured e-cigarettes from retail sources, more comprehensive state or federal restrictions are recommended to close the loopholes for online sources. Dedicated efforts to curtail access from social sources are needed.</jats:sec