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Monitoring the retail environments for vape products
Lisa Henriksen, PhDSenior Research ScientistWaltham, MA, Sept 6, 2018
Acknowledgments
� American Cancer Society Cancer Action Network
� Research sponsored by California Tobacco Control Program and the National Cancer Institute (5R01-CA067850, PI: Henriksen) and (1R01-CA215155, PI: Berg, Co-I: Henriksen)
� My expert team: Nina Schleicher, PhD, Trent Johnson, MPH, Lindsey Winn, MS, Amna Ali, MPH
Overview
� Importance of monitoring/regulating the retail environment
� Marketing in CA licensed tobacco retailers
� Marketing in MA vape shops
� Implications for policy/practice
Median household income
$12,628 - $46,592
$46,593 - $64,855
$64,856 - $79,659
$79,660 - $99,792
Past-year prevalence of tobacco, marijuana use: CA Student Tobacco Survey, AY 2015-16
0
5
10
15
20
25
30
E-cigarettes Hookah Cigarettes Small cigars Large cigars Any tobacco Marijuana
Middle School High School
%
Source: California Tobacco Control Program, CDPH
Estimated 378,000 tobacco retailers in US (2012)
• 32 times as many tobacco
retailers as Starbucks
• 79% of tobacco retailers sold
e-cigarettes in 2015
• Excludes vape shops
(est. 9943 in 2016)
11,817 Starbucks US locations (2013)
Sources: Center for Public Health Systems Science; POS Report to the Nation, 2014; Image credit James Davenport, ifweassume.com
Dai et al., Tob Control, 2016
Built
Environment• Retailer density
• Type
• Location
Consumer
Environment
• Product availability
• Placement
• Promotion
• Price
Retail environment
Source: Henriksen, Tob Control, 2016
Built
Environment• Retailer density
• Type
• Location
Consumer
Environment
• Product availability
• Placement
• Promotion
• Price
Retail environment
Source: Henriksen, Tob Control, 2016
Built environment for tobacco
�44% of US teens (ages 13-16) attend school
within 1000 feet of at least one tobacco retailer
�41% live within walking distance
(0.5 mi) of at least one tobaccoretailer
1.39
1.94
2.31
2.07
1 1.5 2 2.5 3
Hispanic
Other race
African American
Low income
Adjusted ORs
(Schleicher et al., Prev Medicine, 2017)
Built environment and youth vaping
Sources: Giovenco DP, et al. (2016). J Adol Health.; Perez et al., (2018). J Biostat.
Students more likely to report past-
month vaping if they attended schools
with more retailers nearby:
�vape retailers in New Jersey (AOR=1.06, 95% 1.01, 1.10)
�tobacco retailers in hotspots for
Dallas/Tarrant/Harris counties in TX (Risk ratio not specified)
Consumer environment and youth vaping
Consumer environment and youth vaping
� Dose-response relationship between retail advertising exposure at baseline and past-month vaping among middle/high school students in Texas(Nicksic et al., Tob Reg Sci, 2018)
� Among college students, exposure to vape product displays at baseline associated lower odds of cigarette abstinence at follow-up(Mantey et al., N&TR, 2018)
Sales to minors
• 13.1% to decoys (ages 18-19) in CA tobacco
retailers (Zhang et al., Tob Control, 2018)
• 6.5% to same-age decoys in CA
gas/convenience stores (Henriksen et al., 2018)
Parts 2 & 3: Monitoring retail environment for vape products in CA and MA
CA Tobacco Retail Surveillance System
• Random sample of licensed tobacco retailers
• Trained professional data collectors
• Qualtrics survey on iPads
• Product, placement, promotion, price
2008
2011
2014
2017
Price
Product Menthol
Price
Product
Other flavors
Other flavors
73%
65%
98%
38%41%
96%100% 100%
11%
67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Convenience Liquor Pharmacy Small market Supermarket Tobacco shop Vape shop Head shop Other Total
Retail availability of vape products, by store type: CA, 2017
Vape retailers, by store type: CA, 2017
46.7%
13.1%
5.9% 6.6% 5.1%8.9% 9.8%
2.7% 1.2%
100.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Convenience Liquor Pharmacy Small market Supermarket Tobacco shop Vape shop Head shop Other Total
Retail availability (% stores), by product CA 2017
51.4%
41.3%
15.3%
22.9%
12.5%
4.4%
32.4%
9.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Disposable
e-cigs
Reuseable
e-cigs
Other closed
systems
Open systems E-hookah E-cigars E-liquid Zero-nicotine
e-liquid
0%
Availability of flavored tobacco (% stores)
Texas TCORS slides
Vape products
(unambiguous flavors)
Marijuana as ‘concept flavor’
• Flavor names
• Pack imagery
• Blunt as product category, brand name
• Product design
Presence of marijuana co-marketing in stores (n=531) near schools: CA, 2015
52.3%
27.1% 27.1%
61.6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Blunt wraps Blunts "Marijuana flavor"LCCs
Any co-marketing
Product placement
• front counter displays in 34% of stores; self-service in 6% Schleicher et al. (2015) California Tobacco Control Program
Discounts
• Pre-printed or hand-written discounts in 15.5% of stores
Vape product sales, by brand: CA 2012-17
“Sales didn’t take off until 2017, after Juul had improved its sales and distribution expertise, and, by then, had a more sober online marketing campaign …”
Mr. Matt David, JUUL company spokesman via NYTimes.com
Source: Nielsen Company, xAOC Incl Convenience stores combined
Part 3: Vape shop surveillance in MA
• NCI-funded grant studying impact of regulation
on retail environment for vape products in six
states and metropolitan statistical areas (MSA)
(PI: Carla J. Berg, Emory Univ)
• Tracks a panel of vape shops in Atlanta, Boston,
Minneapolis, Oklahoma City, San Diego, Seattle
• Links data to a panel of young-adult residents
surveyed online
Technical challenge: Identifying "vape shops”
• Every 6 months, Python script accessed
API to retrieve store names/addresses
tagged as “vape shops” by retailers or
customers
• Metro statistical areas (MSAs) in 6
states:
Atlanta, Boston, Minneapolis,
Oklahoma City, San Diego, Seattle
n=774n=1,553n=1,620
Note. Data for 6 states in Dec 2017
Median household income
$12,628 - $46,592
$46,593 - $64,855
$64,856 - $79,659
$79,660 - $99,792
$99,793 - $215,250
“Vape shops” in Boston MSA
Telephone screening
• Do you sell vapes or e-liquids?
• What about cigarettes or cigars,
like Swisher Sweets?
• Response rate=84.2%
Vape only (n=64)
Vape and OTP (n=58)
Ineligible (n=26)
No response (n=20)
“Vape shops” (n=142 in 2017)
Estimate for July, 2018 (n=171)
Vape only (n=84)
Vape and OTP (n=77)
Massachusetts “vape shops” (n=319, July 2018)
Median household income
$12,628 - $46,592
$46,593 - $64,855
$64,856 - $79,659
$79,660 - $99,792
$99,793 - $215,250
• 141 Vape only, 129 Vape+OTP
• Tracts with “vape shops” have
-- lower median household income
-- lower % of African American residents
• Similar to profile for New Jersey(Giovenco et al., NTR, 2017)
Retail marketing surveillance in vape shops
• Trained data collectors (in pairs) assessed randomly
sampled vape shops (Jun-Jul 2018, n=32 in Boston MSA)
• Compliance, product availability, promotion
• “Mystery shopper” task obtained price data
• 98% completion rate, included inter-rater reliability
Part 4: Implications for policy and practice
Objectives for state/local tobacco control
� Make tobacco less attractive, less convenient and more costly
� Reduce disparities in tobacco use (equity-by-design policies)
� Fill the gaps in FDA regulation
Policy implications
Place-based Consumer-focused
Licensing Tax
Retailer reduction
(cap on quantity,
proximity to schools,
nearest tobacco or mj
retailer)
Non-tax price policies
(coupon redemption,
discounts, minimum price)
Sales restrictions
(flavors, CBD, THC)
Marketing
(zero-nicotine,
health/cessation claims)
Tools to improve monitoring (flavors, CBD)
Resource to understand environmental inequity
websites.greeninfo.org/stanford/cchat/
CCHAT
• School boundaries
• Demography at tract and
county levels
• Tobacco retailer locations
• Vape shops (coming soon)
Questions