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      Tobacco regulatory compliance with STAKE Act age-of-sale signage among licensed tobacco retailers across diverse neighborhoods in Southern California

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          Abstract

          INTRODUCTION

          The California Stop Tobacco Access to Kids Enforcement (STAKE) Act requires licensed tobacco retailers to post minimum age-of-sale signage at the point of sale. This study investigated STAKE Act compliance in licensed tobacco retailers across four racial/ethnic communities in Southern California.

          METHODS

          The sample consisted of 675 licensed tobacco retailers (excluding chain store supermarkets and pharmacies) randomly selected based on zip codes from predominantly non-Hispanic White (n=196), African American (n=193), Hispanic/Latino (n=186), and Korean American (n=100) communities. A protocol for assessing signage was completed at each store by community health workers ( promotoras de salud). The law changed from a minimum age of 18 to 21 years (Tobacco 21) during data collection, as of 9 June 2016. Differences in signage compliance were evaluated before and after changes in the State law.

          RESULTS

          Overall, 45% of the stores were compliant with posting the required age-of-sale signage (which varied in minimum age by date of collection); 14% of stores did not have any store interior age-of-sale signs, and 41% of stores had some type of age-of-sale sign but were not compliant with the STAKE Act (e.g. 29.5% of the stores had non-compliant tobacco industry We Card signs but not STAKE Act signs). Stores observed after the 2016 implementation of Tobacco 21 had significantly lower STAKE Act signage compliance rates (38.6%) compared to stores observed before the change in the State law (70.9%) (z=6.8623, p<0.001). The difference in STAKE Act sign compliance between stores located in AA communities (16.9%) and stores located in NHW communities (41.5%) observed within the first three months after the change in law was statistically significant (χ 2(1)=20.098, p<0.001).

          CONCLUSIONS

          Findings suggest the need for prompt, educational outreach to licensed tobacco retailers on age-of-sale signage changes, multiple compliance checks, and enforcement.

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          Most cited references17

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          A Systematic Review of Neighborhood Disparities in Point-of-Sale Tobacco Marketing.

          Joseph G L Lee, Lisa Henriksen, Shyanika W. Rose … (2015)
          We systematically reviewed evidence of disparities in tobacco marketing at tobacco retailers by sociodemographic neighborhood characteristics. We identified 43 relevant articles from 893 results of a systematic search in 10 databases updated May 28, 2014. We found 148 associations of marketing (price, placement, promotion, or product availability) with a neighborhood demographic of interest (socioeconomic disadvantage, race, ethnicity, and urbanicity). Neighborhoods with lower income have more tobacco marketing. There is more menthol marketing targeting urban neighborhoods and neighborhoods with more Black residents. Smokeless tobacco products are targeted more toward rural neighborhoods and neighborhoods with more White residents. Differences in store type partially explain these disparities. There are more inducements to start and continue smoking in lower-income neighborhoods and in neighborhoods with more Black residents. Retailer marketing may contribute to disparities in tobacco use. Clinicians should be aware of the pervasiveness of these environmental cues.
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            Standardized Tobacco Assessment for Retail Settings (STARS): dissemination and implementation research

            Lisa Henriksen, Kurt M. Ribisl, Todd Rogers … (2016)
            Objective The Standardized Tobacco Assessment for Retail Settings (STARS) was designed to characterise the availability, placement, promotion and price of tobacco products, with items chosen for relevance to regulating the retail tobacco environment. This study describes the process to develop the STARS instrument and protocol employed by a collaboration of US government agencies, US state tobacco control programmes (TCPs), advocacy organisations, public health attorneys and researchers from the National Cancer Institute's State and Community Tobacco Control (SCTC) Research Initiative. Methods To evaluate dissemination and early implementation experiences, we conducted telephone surveys with state TCP leaders (n=50, response rate=100%), and with individuals recruited via a STARS download registry on the SCTC website. Website registrants were surveyed within 6 months of the STARS release (n=105, response rate=66%) and again after ∼5 months (retention rate=62%). Results Among the state TCPs, 42 reported conducting any retail marketing surveillance, with actual or planned STARS use in 34 of these states and in 12 of the 17 states where marketing surveillance was not previously reported. Within 6 months of the STARS release, 21% of surveyed registrants reported using STARS and 35% were likely/very likely to use it in the next 6 months. To investigate implementation fidelity, we compared data collected by self-trained volunteers and by trained professionals, the latter method being more typically in retail marketing surveillance studies. Results suggest high or moderate reliability for most STARS measures. Conclusion The study concludes with examples of states that used STARS to inform policy change.
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              Cigarette advertising and promotional strategies in retail outlets: results of a statewide survey in California.

              N Schleicher, Kurt M. Ribisl, E Feighery … (2001)
              To examine the extent and types of cigarette advertising materials in stores and to assess tobacco company compliance with the 1998 Master Settlement Agreement (MSA). A cross-sectional analysis of a random sample of 586 stores that sold cigarettes. US state of California. Trained data collectors classified cigarette advertising materials by type (signs, displays, functional items), location (interior or exterior), and placement (below 3 feet (1 m) or near candy). California retail outlets featured 17.2 (SD 16.1) tobacco advertising materials on average, and 94% of stores featured at least some advertising. About 85% of these were within 4 feet (1.3 m) of the counter. About 50% of the stores had ads at or below 3 feet, and 23% had cigarette product displays next to candy. In violation of the MSA, 3% of stores featured signs with cartoons and 11% had large exterior signs. Tobacco companies are aggressively using stores to market cigarettes. Moreover, the spirit of the MSA-to protect children from cigarette advertising-has not been realised. Future studies should monitor industry use of this venue and assess the impact of exposure to cigarette advertising materials in stores on adult smokers and youth.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 101201591
                Journal ID (pubmed-jr-id): 34456
                Journal ID (nlm-ta): Tob Induc Dis
                Journal ID (iso-abbrev): Tob Induc Dis
                Title: Tobacco induced diseases
                ISSN (Print): 2070-7266
                ISSN (Electronic): 1617-9625
                Publication date Nihms-submitted: 25 June 2019
                Publication date (Print): June 2018
                Publication date PMC-release: 18 July 2019
                Volume: 16
                Electronic Location Identifier: 30
                Affiliations
                [1 ]USC Tobacco Center for Regulatory Sciences in Vulnerable Populations, Keck School of Medicine, University of Southern California, United States
                [2 ]Colorado School of Public Health, University of Colorado, Aurora, United States
                Author notes
                CORRESPONDENCE TO: Steve Sussman. USC Tobacco Center for Regulatory Sciences in Vulnerable Populations, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA 90032, United States., ssussma@ 123456usc.edu
                Article
                Manuscript ID: NIHMS1037329
                DOI: 10.18332/tid/91846
                PMC ID: 6637954
                PubMed ID: 31321095
                SO-VID: d83cc808-5fd3-46ec-aa37-64d9596469fc
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License. ( https://creativecommons.org/licenses/by/4.0/)

                History
                Categories
                Subject: Article

                ScienceOpen disciplines: Respiratory medicine
                Keywords: tobacco,age-of-sale signs,compliance,licensed tobacco retailers,race/ethnicity
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: tobacco, age-of-sale signs, compliance, licensed tobacco retailers, race/ethnicity

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