Monitoring the retail environments for vape products Lisa - PowerPoint PPT Presentation

Monitoring the retail environments for vape products Lisa Henriksen, PhD Senior Research Scientist Waltham, 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 Median household income $12,628 - $46,592 $46,593 - $64,855 $64,856 - $79,659 $79,660 - $99,792 � Implications for policy/practice

Past-year prevalence of tobacco, marijuana use: CA Student Tobacco Survey, AY 2015-16 % 30 Middle School High School 25 20 15 10 5 0 E-cigarettes Hookah Cigarettes Small cigars Large cigars Any tobacco Marijuana 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

Retail environment Built Environment • Retailer density • Type • Location Consumer Environment • Product availability • Placement • Promotion • Price Source: Henriksen, Tob Control, 2016

Retail environment Built Environment • Retailer density • Type • Location Consumer Environment • Product availability • Placement • Promotion • Price 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 Low income 2.07 � 41% live within walking distance African American 2.31 (0.5 mi) of at least one tobacco Other race 1.94 retailer Hispanic 1.39 1 1.5 2 2.5 3 Adjusted ORs (Schleicher et al., Prev Medicine, 2017)

Built environment and youth vaping 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) Sources: Giovenco DP, et al. (2016). J Adol Health.; Perez et al., (2018). J Biostat.

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

Price Other flavors Menthol Product 2008 2014 2011 2017 Price Other flavors Product

Retail availability of vape products, by store type: CA, 2017 100% 100% 98% 100% 96% 90% 80% 73% 67% 70% 65% 60% 50% 41% 38% 40% 30% 20% 11% 10% 0% Convenience Liquor Pharmacy Small market Supermarket Tobacco shop Vape shop Head shop Other Total

Vape retailers, by store type: CA, 2017 100.0% 100% 90% 80% 70% 60% 46.7% 50% 40% 30% 20% 13.1% 9.8% 8.9% 6.6% 10% 5.9% 5.1% 2.7% 1.2% 0% Convenience Liquor Pharmacy Small market Supermarket Tobacco shop Vape shop Head shop Other Total

Retail availability (% stores), by product CA 2017 100% 90% 80% 70% 60% 51.4% 50% 41.3% 40% 32.4% 30% 22.9% 20% 15.3% 12.5% 9.5% 10% 4.4% 0% Disposable Reuseable Other closed Open systems E-hookah E-cigars E-liquid Zero-nicotine e-cigs e-cigs systems e-liquid 0%

Availability of flavored tobacco (% stores) (unambiguous flavors) Texas TCORS slides Vape products

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 100% 90% 80% 70% 61.6% 60% 52.3% 50% 40% 27.1% 27.1% 30% 20% 10% 0% Blunt wraps Blunts "Marijuana flavor" Any co-marketing LCCs

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 n=1,620 n=1,553 n=774 • Metro statistical areas (MSAs) in 6 states: Atlanta, Boston, Minneapolis, Note. Data for 6 states in Dec 2017 Oklahoma City, San Diego, Seattle

“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% 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” (n=142 in 2017) Vape only (n=64) Vape and OTP (n=58) No response (n=20) Ineligible (n=26) Estimate for July, 2018 (n=171) Vape only (n=84) Vape and OTP (n=77)

Massachusetts “vape shops” (n=319, July 2018) • 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) Median household income $12,628 - $46,592 $46,593 - $64,855 $64,856 - $79,659 $79,660 - $99,792 $99,793 - $215,250

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 Non-tax price policies ( cap on quantity, (coupon redemption, proximity to schools, discounts, minimum price) nearest tobacco or mj retailer) Sales restrictions Marketing (flavors, CBD, THC) (zero-nicotine, health/cessation claims)

Tools to improve monitoring (flavors, CBD)

Resource to understand environmental inequity CCHAT • School boundaries • Demography at tract and county levels • Tobacco retailer locations • Vape shops (coming soon) websites.greeninfo.org/stanford/cchat/

Questions � lhenriksen@stanford.edu