Assessing tobacco retailer compliance with flavoured tobacco product sales restrictions: a cross-sectional study of four California cities
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Abstract
Background Governments are passing laws to restrict the sale of flavoured tobacco products (FTPs), but retailer compliance with such policies may vary. This study compared tobacco retailer compliance with local ordinances restricting the sale of FTPs across various localities in Southern California.
Methods Attempts to purchase FTPs from a random sample of tobacco retailers in a convenience sample of four cities in Southern California with FTP sales restrictions were made from June to August 2022. Trained shoppers of legal tobacco purchasing age entered tobacco retailers and purchased prohibited FTPs if they were on display or asked salespersons for menthol cigarettes or a flavoured e-cigarette, completing purchases if they were made available.
Results Among 141 stores, 39.9% of stores were non-compliant with local ordinances. Non-compliance varied by city, occurring in 49.3%, 43.8%, 15.4% and 0% of stores across four cities. The highest proportion of non-compliance was among vape or tobacco shops (91.2%) followed by convenience and liquor stores (36.4%), grocery stores and pharmacies (15.4%), and gas stations (13.5%).
Conclusion Prior to California’s statewide sales restriction on flavoured tobacco, compliance with local sales restrictions was variable across cities and store types.
What is already known on this topic
Flavoured tobacco product sales restrictions can be effective measures in limiting sales and accessibility of tobacco products.
What this study adds
Retailer compliance is highly variable across localities and store types, suggesting ordinances restricting the sale flavoured tobacco products sales alone are insufficient to elicit compliance among retailers.
How this study might affect research, practice or policy
Greater understanding of factors that promote retailer compliance with flavoured tobacco product sales prohibitions is needed, as are more concerted educational and enforcement efforts in policy implementation.
Introduction
Increasing numbers of youth and adolescents are using tobacco and nicotine products, driven largely by the use of flavoured tobacco products (FTPs) such as flavoured electronic nicotine delivery systems (ENDS).1 2 High rates of FTP use place adolescents at greater risk for harm from nicotine exposure, adverse physiological effects and cigarette smoking.3–5 Additionally, menthol cigarettes continue to be widely available, reinforcing tobacco-related health disparities among priority populations such as women, Blacks and youth.6–8 Among adults in California in 2021, 12.7% of adults used tobacco products, 51.0% of whom used FTPs and 5.3% used ENDS, 80.9% of whom used flavoured ENDS. Among high school students, 6.6% of 12th and 10th grade students use tobacco and 5.6% used ENDS, with 86.3% of high school students reporting use of flavoured tobacco and 91.7% use of flavoured ENDS.9 10
Governmental action has been taken to reduce accessibility of FTPs. All flavoured cigarettes except menthol were banned in the USA in 2009, and a federal ban on certain cartridge-based flavoured ENDS was enacted in 2020. California and Massachusetts have broadly restricted FTP sales, and Rhode Island, New Jersey and New York have statewide restrictions on flavoured ENDS sales.11 Nationally, over 360 localities passed restrictions of FTP sales by the end of 2022, though the strength and scope of policies vary.12 Evidence suggests that FTP sales restrictions can reduce sales and availability of FTPs,13–16 though low compliance has also been observed.17 18
Previous compliance studies typically focused on one jurisdiction or aggregated multiple jurisdictions, obfuscating variation among localities. Additionally, studies tend to use observation of products to assess compliance, which may lead to undercounting non-compliance. The purpose of this study was to assess tobacco retailer compliance with local ordinances restricting the sale of FTPs across four local Southern California jurisdictions using attempted purchases as a direct measure of compliance.
Methods
Sampling
A convenience sample of four cities in Southern California with FTP sales restrictions was selected for this study based on geographical proximity to the research team. An FTP sales ordinance in Buena Park, California (city 1) came into effect in March 2022 after adoption in July 2021, exempting the sale of flavoured shisha tobacco for use in a hookah under certain conditions. In Santa Ana, California (city 2), an ordinance was adopted in March 2022, entered into force after 30 days, and included no product exemptions. Encinitas, California (city 3) passed its ordinance in August 2020, which entered into force in January 2021, exempting sale of shisha tobacco products for use in a hookah. Solana Beach, California (city 4) passed its local ordinance in April 2020, which entered into force 30 days after adoption and included no product exemptions. Tobacco retailers in each city were identified from the California Department of Tax and Franchise Administration database, Yelp, and Google Maps as of May 2022 (prior to the statewide FTP sales restriction). Retailers were divided into four store types: vape or tobacco specialty shops, gas stations, grocery stores and pharmacies, and convenience and liquor stores using a licensure and retail characteristics matching approach as used in prior studies.19 20 For each city, a sample of retailers was selected to include all specialty vape or tobacco retailers and a random sample of 50% of retailers from the other three store categories if the total number of stores in a city was greater than 30 (cities 1 and 2); all remaining licensed retailers were included in the sample if the total number in a city was 30 or less (cities 3 and 4).
Data collection
From June to August 2022, eight trained research staff of legal tobacco purchase age attempted to purchase prohibited FTPs from retailers in the store sample. Research staff were assigned to attempt purchases in specific cities. If prohibited FTPs were on display, purchases were attempted and completed, if possible. If prohibited items were not on display, shoppers asked salespersons for prohibited products and completed purchases if they were made available. Research staff asked for FTPs as novel tobacco users, first requesting ‘menthol cigarettes’ then any ‘flavoured vapes’ if menthol cigarettes were not available. Store transactions were recorded after exiting the retail establishment as ‘transaction completed’ or ‘transaction not completed’ along with informal field notes. From October to December 2022, a second wave of data collection was carried out in cities 1 and 2 stores to assess changes over time as wave 1 data collection occurred soon after both cities’ policies entered into force. The study protocol was exempted from human subjects review by the Institutional Review Board at California State University, Fullerton.
Data analysis
The final dataset included variables for city, store type, wave and non-compliant retailers. Descriptive statistics were applied to ascertain the percentage of non-compliant retailers by city, store type and wave. Given low cell sizes, a Fisher’s exact test was used to analyse different rates of retailer non-compliance between cities. Following this, a generalised linear mixed model (GLMM) was employed to compare across store types. Leveraging a binomial distribution paired with a logit link function, city was used as a fixed effect to account for the nested structure of the data. A longitudinal linear model with wave and store type interaction terms was established to probe changes in non-compliance across waves for cities 1 and 2 and whether these shifts were influenced by store type.
Results
Twelve stores from the store sample were permanently closed. Among the remaining 141 stores, 39.9% (n=56) of all stores were non-compliant with local FTP sales restrictions. Retailer non-compliance varied by city, ranging from 49.3% (n=38) to 43.8% (n=14), 15.4% (n=4), and 0% of stores in cities 2, 3, 1 and 4, respectively (table 1). A Fisher’s exact test indicated that the proportion of non-compliant retailers varied significantly between cities (p<0.01).
Twelve stores from the store sample were permanently closed. Among the remaining 141 stores, 39.9% (n=56) of all stores were non-compliant with local FTP sales restrictions. Retailer non-compliance varied by city, ranging from 49.3% (n=38) to 43.8% (n=14), 15.4% (n=4), and 0% of stores in cities 2, 3, 1 and 4, respectively (table 1). A Fisher’s exact text indicated that the proportion of non-compliant retailers varied significantly between cities (p<0.01).
Table 1
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Percentage of tobacco retailors who sold flavoured tobacco products in four select cities in Southern California with flavoured tobacco product restrictions by store type, June–August 2022, with 95% CIs denoted in parentheses
Non-compliance among gas stations was 13.5%, grocery stores 15.4%, liquor stores 36.4%, and vape or tobacco shops 91.2%. According to the GLMM analysis, when controlling for variations across cities and the impact of waves, the odds of retailer non-compliance were higher among liquor stores by about 3.91 times compared with gas stations (estimate=1.3636, p<0.01). Vape or tobacco shops had odds 88.57 times higher than gas stations (estimate=4.4828, p<0.01). The wave variable showed no significant effect on retailer non-compliance (estimate=−0.2023, p=0.61). The random effect for cities indicates variability in retailer non-compliance across different cities, suggesting differing baseline non-compliance probabilities among them.
In the longitudinal analysis of cities 1 and 2, the retailer non-compliance rate during wave 1 was 41.1%, while wave 2 registered a rate of 38.1%, a difference that was not statistically significant. An estimated rise of 27.1% in retailer non-compliance rates among grocery and pharmacies was observed across the two waves; however, this was not statistically significant (p=0.08).
Discussion
Our retail audit of tobacco retailers in four cities with local ordinances restricting the sale of FTPs found variable rates of retailer non-compliance between cities, ranging from 49.3% of stores to no stores (0%), indicating total compliance. Variable rates of non-compliance were also observed by store type, with higher rates of non-compliance in vape or tobacco specialty stores and lowest in gas stations. In two cities where longitudinal data were collected, retailer non-compliance did not change appreciably over an approximately 6-month period.
The results of this study suggest that the existence of ordinances that restrict the sale of FTPs alone do not ensure compliance among retailers. In this study, there is no clear pattern in policy factors that affect retailer compliance including date of policy passage, length of time the ordinance has been in force, or exemptions. Thus, there may be unaccounted factors affecting retailer compliance such as retailer knowledge of local FTP sales ordinances, resistance to the policy by retailers, or lack of political will or governmental resources to enforce FTP sales restrictions. With the expansion of FTP sales restrictions across local and state governments and a potential federal ban of menthol cigarettes, enforcement actions will be central to ensuring retailers adhere to such policies to maximise their public health impact. This includes explicit statements regarding and commitment to enforcement which, as California’s statewide policy shows, may not always be specified in the authorising policy.
This study has limitations. The cities in this study were selected using a convenience sample with a relatively small sample size, limiting generalisability to other cities or regions. The products requested for purchase did not include other FTPs such as cigars which may have affected study outcomes and should be included in future studies. Local enforcement efforts may be an important factor in eliciting retailer compliance, but information regarding such efforts was not collected in this study. Furthermore, research staff were designated to collect data from specified cities, confounding data collectors with cities.
In four Southern California cities, retailer compliance with local FTP sales restrictions was highly variable. Though policies restricting the sale of FTPs are spreading, retailer compliance will require concerted educational and enforcement efforts to realise such policies’ intended public health benefit.
