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 Implications for policy/practice

Past-year prevalence of tobacco, marijuana use: CA Student Tobacco Survey, AY 2015-16

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 tobacco retailer

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
• n 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=774 n=1,553 n=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

lhenriksen@stanford.edu