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Smith EA, McDaniel PA, Malone RE. Should tobacco sales be restricted to state-run alcohol outlets? Perspectives from 10 US alcohol control states. Addiction 2024; 119:1048-1058. [PMID: 38454636 PMCID: PMC11131590 DOI: 10.1111/add.16467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIMS The ubiquity of tobacco retailers helps to sustain the tobacco epidemic. A tobacco retail reduction approach that has not been tried is transitioning tobacco sales to state-controlled alcohol stores (TTS), which are limited in number and operate under some restrictions, e.g. regarding opening hours or marketing materials. This study summarizes policy experts' and advocates' views of TTS, including (1) advantages and disadvantages; (2) feasibility; and (3) potential implementation obstacles. DESIGN This study was a qualitative content analysis of semi-structured interviews. SETTING Ten US states with alcoholic beverage control systems were included. PARTICIPANTS The participants comprised a total of 103 tobacco control advocates and professionals, public health officials, alcohol policy experts and alcohol control system representatives, including two tribal community representatives. MEASUREMENTS Interviewees' perspectives on their state's alcoholic beverage control agency (ABC, the agency that oversees or operates a state alcohol monopoly) and on TTS were assessed. FINDINGS Interviewees thought TTS offered potential advantages, including reduced access to tobacco products, less exposure to tobacco advertising and a greater likelihood of successful smoking cessation. Some saw potential long-term health benefits for communities of color, due to the smaller number of state alcohol stores in those communities. Interviewees also raised concerns regarding TTS, including ABCs' limited focus on public health and emphasis on revenue generation, which could conflict with tobacco use reduction efforts. Some interviewees thought TTS could enhance the power of the tobacco and alcohol industries, increase calls for alcohol system privatization or create difficulties for those in recovery. CONCLUSIONS In the United States, transitioning tobacco sales to state-controlled alcohol stores (TTS) could have a positive public health impact by reducing tobacco availability, marketing exposure and, ultimately, tobacco use. However, tensions exist between alcohol control system goals of providing revenue to the state and protecting public health. Should a state decide to pursue TTS, several guardrails should be established, including building into the legislation an explicit goal of reducing tobacco consumption.
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Affiliation(s)
- Elizabeth A Smith
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA
| | - Patricia A McDaniel
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA
| | - Ruth E Malone
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, USA
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Karriker-Jaffe KJ, Henriksen L, Smith EA, McDaniel PA, Malone RE, Kerr WC. Relapse to problem drinking or trading up to spirits? Using U.S. national cross-sectional survey data to highlight possible negative impacts of potential tobacco retail changes. Subst Abuse Treat Prev Policy 2022; 17:72. [PMID: 36320048 PMCID: PMC9623940 DOI: 10.1186/s13011-022-00498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND According to the National Alcohol Beverage Control Association, twelve states in the United States (U.S.) have government retail monopolies on spirits/liquor sales. With a new federal minimum legal sales age for tobacco (raised from 18 to 21, the minimum legal sales age for alcohol), we examine possible unintended consequences of a hypothetical policy change restricting retail tobacco sales to state-run spirits/liquor stores in alcohol control states, which has been proposed as a tobacco endgame strategy. METHODS We used cross-sectional survey data from 14,821 randomly-selected adults ages 21 and older who responded to the 2015 or 2020 U.S. National Alcohol Survey (51.8% female; 65.8% identified as non-Hispanic White, 12.4% as Black or African American, 14.2% as Hispanic or Latinx; 34.0% had a low level of education), including 2,274 respondents (18.9%) residing in one of the alcohol control states (representing 42.2 million (M) adults ages 21+). We estimated associations between tobacco measures (lifetime smoking status, lifetime daily smoking, past-year daily smoking) and alcohol measures (drinking status, beverage choices, lifetime alcohol use disorder (AUD) status, recovery status) overall and for specific subgroups. RESULTS In control states, 55.1% of people who smoked daily in the past year also reported lifetime AUD, including an estimated 3.56 M adults ages 21 + who reported prior (but not current) AUD. The association of daily smoking with lifetime AUD was stronger among those with low education compared to those with higher education. Further, 58.8% of people in recovery from an alcohol and/or drug problem (1.49 M adults ages 21+) smoked daily, and this was more marked among women than men in control states. CONCLUSION There could be negative consequences of an endgame strategy to restructure tobacco retail sales, including increased risk for relapse to drinking among people who smoke daily, especially among women and people with low levels of education. Strategies to mitigate unintended harms would be needed if such a policy were implemented.
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Affiliation(s)
- Katherine J Karriker-Jaffe
- Center on Behavioral Health Epidemiology, Implementation & Evaluation Research, RTI International, 2150 Shattuck Avenue, Suite 800, 94704, Berkeley, CA, USA.
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 94305, Stanford, CA, USA
| | - Elizabeth A Smith
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, 94143, San Francisco, CA, USA
| | - Patricia A McDaniel
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, 94143, San Francisco, CA, USA
| | - Ruth E Malone
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, 94143, San Francisco, CA, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 94608, Emeryville, CA, USA
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A Long-Term National Survey of Compliance with the Ban on Selling Tobacco Products to Adolescents of Taiwan’s Tobacco Hazards Prevention Act. Healthcare (Basel) 2022; 10:healthcare10102077. [DOI: 10.3390/healthcare10102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
The data on long-term trends and factors of tobacco retailers’ compliance in Taiwan are limited. The new regulations of the Tobacco Hazards Prevention Act were established in 2009. Now, the government is planning to raise the minimum legal age (MLA) for purchasing tobacco products from 18 to 20, so the results of this study will be an important reference to promote new regulations in the future. We carried out an observational mystery shopping study design and data were collected from 2009 to 2019. In total, 6320 undercover tests were conducted to investigate selling by tobacco retailers to persons aged less than 18 years by an impartial third party annually. Logistic regression was used to analyze the factors influencing compliance by adjusting test variables and independent variables. The compliance rate increased by 8.4% annually and was better among tests conducted during summer vacation (AOR = 1.324), chain convenience stores (AOR = 3.651), supermarkets or hypermarkets (AOR = 1.973), and verifications with age (AOR = 15.345). It is the first study to explore long-term and national tobacco retailers’ enforcement effects by an impartial third party in Asia. The findings suggest that local health agencies should enhance enforcement on those stores which were tested during non-summer holidays and weekends, betel nut stands, and grocery stores.
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Feltmann K, Gripenberg J, Elgán TH. Compliance Checks Decrease Cigarette Sales Rates to Pseudo-Underaged Mystery Shoppers: A Quasi-Experimental Control Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13161. [PMID: 36293737 PMCID: PMC9602829 DOI: 10.3390/ijerph192013161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
To control adherence to age limits regarding sales of tobacco products, Swedish authorities can conduct compliance checks. Compliance checks involve prior information to all retailers, mystery shopping, and subsequent feedback to the retailers. This study investigated whether compliance checks can decrease the rates of cigarette sales to underaged adolescents. Test purchases of cigarettes were conducted using pseudo-underaged mystery shoppers, i.e., 18-year-old adolescents with a younger appearance not carrying ID, to measure the refusal rate and rate of ID checks. Test purchases were conducted at 257 retail outlets in 13 municipalities in Stockholm County at baseline 2017 and follow-up 2019, respectively. In between the measurements, six municipalities (intervention area) conducted compliance checks, and seven municipalities were used as a comparison. Comparing baseline and follow-up, rates of refusal (70.4 to 95.8%) and ID checks (80.3 to 95.8%) improved in the intervention area. In the comparison area, refusal rates increased (80.9 to 85.2%), and ID check rates remained stable (at 86.1%). Significant group × time interaction effects reveal that the rates of refusal and ID checks differently changed in the study areas over time. These results indicate that compliance checks are an effective method to decrease cigarette sales to underaged adolescents.
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Bar-Zeev Y, Berg CJ, Khayat A, Romm KF, Wysota CN, Abroms LC, Elbaz D, Levine H. IQOS marketing strategies at point-of-sales: a cross-sectional survey with retailers. Tob Control 2022:tobaccocontrol-2021-057083. [PMID: 35140170 DOI: 10.1136/tobaccocontrol-2021-057083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The point-of-sale (POS) is adapting to marketing restrictions, societal changes and the inclusion of new products, such as heated tobacco products (eg, Philip Morris International's (PMI) IQOS device and HEETS sticks). We aimed to assess (1) PMI's influences on IQOS/HEETS POS marketing and (2) the implications of the new legislation (POS display ban and plain packaging) for retailers. METHODS A cross-sectional survey of 43 IQOS/HEETS POS owners/managers in five Israeli cities assessed POS and participant characteristics, marketing strategies, attitudes towards IQOS, and POS implications of the legislation and COVID-19, including industry reactions. Bivariate analysis explored differences between POS selling of the IQOS device versus POS selling of HEETS only. RESULTS A higher proportion of those carrying IQOS (n=15) (vs HEETS only) had special displays (100% vs 17.9%, p<0.001) and interacted with specific IQOS salespersons (73.3% vs 28.6%, p=0.013). Common promotions were financial incentives based on HEETS sales for retailers (37.5%) and price discounts on HEETS for customers (48.7%). Most indicated positive attitudes towards IQOS (72.1%; eg, 'less harmful'), opposition to the legislation (62.7%), limited government assistance to implement the legislation (62.8%), and industry provision of display cases and/or signage to comply with the legislation (67.4%). CONCLUSION PMI uses similar tactics to promote IQOS at POS as they previously used for combustible products, including direct promotional activities with retailers, and circumvented legislation by using special displays and signage. Governments need to ban these measures and support retailers with clear practical guidance regarding the implementation of marketing restrictions at POS.
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Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Katelyn F Romm
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Chritina N Wysota
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
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Staudacher P, Brugger C, Winkler MS, Stamm C, Farnham A, Mubeezi R, Eggen RIL, Günther I. What agro-input dealers know, sell and say to smallholder farmers about pesticides: a mystery shopping and KAP analysis in Uganda. Environ Health 2021; 20:100. [PMID: 34470641 PMCID: PMC8411546 DOI: 10.1186/s12940-021-00775-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pesticides can have negative effects on human and environmental health, especially when not handled as intended. In many countries, agro-input dealers sell pesticides to smallholder farmers and are supposed to provide recommendations on application and handling. This study investigates the role of agro-input dealers in transmitting safety information from chemical manufacturers to smallholder farmers, assesses the safety of their shops, what products they sell, and how agro-input dealers abide by laws and recommendations on best practices for preventing pesticide risk situations. METHODS Applying a mixed-methods approach, we studied agro-input dealers in Central and Western Uganda. Structured questionnaires were applied to understand agro-input dealers' knowledge, attitude and practices on pesticides (n = 402). Shop layout (n = 392) and sales interaction (n = 236) were assessed through observations. Actual behavior of agro-input dealers when selling pesticides was revealed through mystery shopping with local farmers buying pesticides (n = 94). RESULTS While 97.0% of agro-input dealers considered advising customers their responsibility, only 26.6% of mystery shoppers received any advice from agro-input dealers when buying pesticides. 53.2% of products purchased were officially recommended. Sales interactions focused mainly on product choice and price. Agro-input dealers showed limited understanding of labels and active ingredients. Moreover, 25.0% of shops were selling repackaged products, while 10.5% sold unmarked or unlabeled products. 90.1% of shops were lacking safety equipment. Pesticides of World Health Organization toxicity class I and II were sold most frequently. Awareness of health effects seemed to be high, although agro-input dealers showed incomplete hygiene practices and were lacking infrastructure. One reason for these findings might be that only 55.7% of agro-input dealers held a certificate of competency on safe handling of pesticides and even fewer (5.7%) were able to provide a government-approved up-to-date license. CONCLUSION The combination of interviews, mystery shopping and observations proved to be useful, allowing the comparison of stated and actual behavior. While agro-input dealers want to sell pesticides and provide the corresponding risk advice, their customers might receive neither the appropriate product nor sufficient advice on proper handling. In light of the expected increase in pesticide use, affordable, accessible and repeated pesticide training and shop inspections are indispensable.
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Affiliation(s)
- Philipp Staudacher
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600 Dübendorf, Switzerland
- Institute of Biogeochemistry and Pollutant Dynamics, CHN, Universitätsstrasse 16, ETH Zürich, 8092 Zürich, Switzerland
| | - Curdin Brugger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirko S. Winkler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Stamm
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600 Dübendorf, Switzerland
| | - Andrea Farnham
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ruth Mubeezi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Rik I. L. Eggen
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600 Dübendorf, Switzerland
- Institute of Biogeochemistry and Pollutant Dynamics, CHN, Universitätsstrasse 16, ETH Zürich, 8092 Zürich, Switzerland
| | - Isabel Günther
- Development Economics Group & Center for Development and Cooperation (NADEL), ETH Zürich, Clausiusstrasse 37, 8092 Zürich, Switzerland
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