Monitoring the retail environments for vape products Lisa Henriksen, PhD Senior Research Scientist Waltham, MA, Sept 6, 2018
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