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

� lhenriksen@stanford.edu