Using place-based characteristics to inform FDA tobacco sales inspections: results from a multilevel propensity score model

Abstract

BackgroundConducting routine inspections for compliance with age-of-sale laws is essential to reducing underage access to tobacco. We seek to develop a multilevel propensity score model (PSM) to predict retail violation of sales to minors (RVSM).MethodsThe Food and Drug Administration compliance check of tobacco retailers with minor-involved inspections from 2015 to 2019 (n=683 741) was linked with multilevel data for demographics and policies. Generalised estimating equation was used to develop the PSM using 2015–2016 data to predict the 2017 RVSM. The prediction accuracy of the PSM was validated by contrasting PSM deciles against 2018–2019 actual violation data.ResultsIn 2017, 44.3% of 26 150 zip codes with ≥1 tobacco retailer had 0 FDA underage sales inspections, 11.0% had 1 inspection, 13.5% had 2–3, 15.3% had 4–9, and 15.9% had 10 or more. The likelihood of having an RVSM in 2017 was higher in zip codes with a lower number of inspections (adjusted OR (aOR)=0.988, 95% CI (0.987 to 0.990)) and penalties (aOR=0.97, 95% CI (0.95 to 0.99)) and a higher number of violations (aOR=1.07, 95% CI (1.06 to 1.08)) in the previous 2 years. Urbanicity, socioeconomic status, smoking prevalence and tobacco control policies at multilevels also predicted retail violations. Prediction accuracy was validated with zip codes with the highest 10% of the PSM 3.4 times more likely to have retail violations in 2019 than zip codes in the bottom decile.ConclusionThe multilevel PSM predicts the RVSM with a good rank order of retail violations. The model-based approach can be used to identify hot spots of retail violations and improve the sampling plan for future inspections.

The Impact of Recent Tobacco Regulations and COVID-19 Restrictions and Implications for Future E-Cigarette Retail: Perspectives from Vape and Vape-and-Smoke Shop Merchants

“…Impacting tobacco retail more broadly, federal legislation raised the minimum legal sales age for e-cigarette sales from 18 to 21 (i.e., Tobacco 21 [T21]) in December 2019 [ 15 ]. Despite evidence of the public health benefits from T21 (e.g., youth prevention) [ 16 , 17 ], and the potential to increase awareness and support for tobacco control efforts among retailers and consumers [ 18 ], there are high noncompliance rates in some states [ 19 , 20 ], noncompliance may be underestimated [ 19 ], and gaps in FDA enforcement protocols have been identified [ 20 , 21 ]. In addition, there is growing concern about noncompliance rates for e-cigarette sales, especially among tobacco specialty shops [ 22 , 23 ], and online retailers [ 22 , 24 ].…”

State T21, Restrictions on Flavored E-Cigarette Products, and Non-Medical Cannabis Sales Legalization in Relation to Young Adult Reports of Vape Shop Age Verification and Product Offerings: A Multilevel Analysis

“…Multilevel modeling also examined the associations between relevant state-level policies (e.g., T21, e-cigarette flavor restrictions, non-medical cannabis sales) and participant experiences of vape shop practices. Notably, findings from these analyses indicated that state T21 was not significantly associated with age verification upon entering vape shops or purchasing e-cigarettes at vape shops among participants under age 27, suggesting potential variations in the implementation and enforcement of T21 laws across states [ 23 , 24 ]. This may also be partially explained by the fact that state T21 laws varied in terms of guidance on the minimum age for verification [ 45 , 46 ].…”

“…As a result, the US government implemented the federal T21 law on 20 December 2019 [ 21 ], and prior to then, many US states and localities had implemented T21 laws. Although federal T21 declares no exemption of the minimum age requirement [ 21 ], there are gaps in enforcement protocols [ 22 , 23 ] and underestimates of noncompliance [ 24 ]. Particularly relevant to the current study, T21 implementation varies in relation to whether states previously had a T21 law in place [ 23 , 24 ] and whether state laws previously had required age verification for consumers under 27 years old (as the federal law requires) [ 25 ].…”

“…Although federal T21 declares no exemption of the minimum age requirement [ 21 ], there are gaps in enforcement protocols [ 22 , 23 ] and underestimates of noncompliance [ 24 ]. Particularly relevant to the current study, T21 implementation varies in relation to whether states previously had a T21 law in place [ 23 , 24 ] and whether state laws previously had required age verification for consumers under 27 years old (as the federal law requires) [ 25 ]. In addition, there is growing concern regarding enforcement and compliance for newer tobacco products, particularly e-cigarettes, particularly when they are sold online [ 26 , 27 ] or at specialty retailers like vape shops [ 27 , 28 ].…”

Retail-focused tobacco control: equity and endgame implications

“…Evaluating compliance with policies and effects on tobacco use is a major focus of this e-issue, with 9 of 17 studies examining minimum legal sales age (MLSA), [22][23][24][25] price and flavour restrictions, [26][27][28] or tobacco sales bans. 29 30…”