Impact and Equity of New York City's Tobacco Retail Reduction Initiative.

INTRODUCTION: High levels of tobacco retailer density in communities is associated with a range of tobacco use behaviors and is a key structural driver of tobacco-related disparities. This study evaluates the impacts of New York City's (NYC) novel policy intervention to cap tobacco retail licenses on tobacco retailer density levels and neighborhood inequities in tobacco access. METHODS: Using geocoded tobacco retail licensing data from 2010 to 2022, Bayesian conditional autoregressive Poisson panel models estimated the association between policy implementation in 2018 and retailer density per 1,000 population, controlling for neighborhood-level sociodemographic factors. Data were analyzed in 2023. RESULTS: The number of tobacco retail licenses decreased from 9,304 in 2010 to 5,107 in 2022, with the rate of decline significantly accelerating post-policy (-14·2% versus -34·2%). Policy effects were stronger in districts with lower income and greater proportions of non-Hispanic Black residents. CONCLUSIONS: NYC's policy substantially reduced tobacco retailer density and appeared to close longstanding patterns of inequity in tobacco access, serving as a rare example of a tobacco control policy that may effectively reduce tobacco-related disparities. This emergent approach to restructure tobacco retail in communities may reach populations that have not benefitted from traditional tobacco control policies and should be considered by other localities.

Tobacco companies' creation of additional communication space: a content analysis of cigarette pack inserts and onserts.

OBJECTIVES: Pack inserts and onserts-removable items placed inside or on the outside of packs-are a communicative strategy used by tobacco companies that provide them with additional marketing space. A content analysis of these items was conducted across several years, countries and brands to assess how these items are used to communicate with consumers. METHODS: Between 2013 and 2020, cigarette packs were systematically collected using the Tobacco Pack Surveillance System protocol. Packs with inserts or onserts (n=178) were identified from 11 low and middle-income countries. Packs were coded for tobacco company strategies, physical pack characteristics and imagery and lexical marketing appeals. RESULTS: Of the 5903 packs, 3% (n=178) had an insert or onsert. 171 of these (96%) were inserts. While most (78%) pack exteriors were entirely in English, over half (51%) of the inserts/onserts were entirely in the local (non-English) language from where the pack was collected. The most common appeals on the inserts/onserts were product dependability (64%), luxury/aspirational (55%) and machinery/technology (37%). Product images were prevalent as well as images or words mentioning filters (22%). The most used appeals involved featuring aspects of a product (66%), addressing customers directly (52%) and informing customers about new aspects of a product (31%). CONCLUSIONS: Cigarette pack inserts/onserts are unregulated in many countries and provide additional space for tobacco companies to extend and innovate their advertising. Tobacco advertising and packaging policies such as plain and standardised packaging should expand to address inserts/onserts to protect consumers more fully from industry promotion of deadly products.

Changes in Pack Features Among Top-Selling Cigarettes in the U.S., 2018 and 2021.

INTRODUCTION: Cigarette packaging is designed to increase consumer appeal and remains a primary promotional tool in many countries, including the U.S. This study documented changes in the prevalence of pack characteristics among the top-selling cigarette products in the U.S. in 2018 and 2021. METHODS: The 50 cigarette packs with the highest national unit sales in U.S. convenience stores in 2018 and 2021 were identified using Nielsen's Scantrack data and subsequently purchased. Packs were coded for features such as dominant color(s), descriptive text, and promotional language. Descriptive analyses conducted in 2022 weighted by total annual unit sales compared the prevalence of pack characteristics between years. RESULTS: Three brands-Marlboro, Newport, and Camel-constituted over 80% of pack sales among the top-selling products. Packs with red as a dominant color grew less popular between years (33.3% vs 29.5%), whereas those with green became more prevalent (25.2% vs 28.9%), consistent with a rise in the proportion of menthol sales. The prevalence of descriptors such as flavor and fresh decreased from 46.0% to 39.4% and 9.7% to 5.2%, respectively. Meanwhile, the prevalence of promotional language (e.g., rewards programs) increased from 60.9% to 69.0%. CONCLUSIONS: The use of visual and named colors remains common, which can implicitly communicate sensory or health-related attributes. Moreover, promotions may help recruit and retain consumers in the context of more restrictive tobacco control policies and price increases. Given the strong influence that cigarette packaging exerts on consumers, packaging-focused policies, such as plain packaging laws, may reduce appeal and accelerate declines in cigarette use.

Assessing the Effectiveness of Tobacco 21 Laws to Reduce Underage Access to Tobacco: Protocol for a Repeated Multi-Site Study.

Prior to the federal law passed in December 2019, many states passed an increased age of sale law prohibiting youth under age 21 (or Tobacco 21) from purchasing tobacco products, including e-cigarettes. Although previous research has documented tobacco retail sale violations, fewer studies have examined age verification and illegal tobacco sales in the context of Tobacco 21 or repeated purchase attempts in various settings. In this study conducted between 2019 and 2022, buyers aged 18 to 20 years made repeated unsupervised purchase attempts of cigarettes, cigars, e-cigarettes, tobacco-free nicotine pouches, and smokeless tobacco at over 180 tobacco or e-cigarette retailers in New Jersey, New York City, and Pitt County (North Carolina). Buyers documented whether they were asked for identification and whether they were able to successfully purchase a tobacco or nicotine product at each visit. The primary outcome will be the percent of retailers that checked the buyers' identification at store visits and the percent of visits that resulted in a successful underage tobacco product purchase. We will compare the results across time periods, study sites, products, and buyer characteristics (i.e., gender, minoritized racial/ethnic identity) while controlling for repeated visits. These results will inform improvements to current compliance check inspection programs as well as interventions that reduce youth access to tobacco.

Neighborhood distribution of availability of newer tobacco products: A US four-site study, 2021.

Audits of tobacco retailers can identify marketing patterns as newer tobacco products are introduced in the US. Our study examined store and neighborhood correlates of availability of nicotine pouches and disposable e-cigarettes in four US sites. We conducted standardized store audits of n = 242 tobacco retailers in 2021 in different states: New Jersey, Kentucky, North Carolina, and New York. We geocoded stores linking them with census tract demographics. We conducted unadjusted and adjusted Poisson regression of availability of each product with correlates of the proportion of Non-Hispanic White residents, households under poverty, proximity to schools, site, and store type. Nicotine pouches and disposable e-cigarettes were each available in around half the stores overall, but availability differed across sites (range: 76 %-32 %). In adjusted analyses, nicotine pouches were less likely to be available in each store type vs chain convenience (IRR range 0.2-0.6) and more likely in stores in census tracts with a greater percentage of non-Hispanic White residents (IRR range 1.8-2.3). In contrast, disposable e-cigarettes were more likely to be available in tobacco/vape shops (IRR 1.9 (1.4-2.5) than convenience stores and less likely in non-specialty store types like groceries (IRR 0.2 (0.1-0.4). Newer tobacco products like nicotine pouches and disposable e-cigarettes were widely available in stores across sites, but retail marketing patterns appear to differ. As these product types become subject to increased regulation as they go through the FDA pre-market authorization process, understanding patterns and changes in the retail environment is critical to inform potential policies regulating their sale and marketing.

Packaging Characteristics of Top-Selling Cigars in the United States, 2018.

INTRODUCTION: Tobacco product packaging is an influential industry marketing tool, but research on cigar packaging characteristics is limited. This study leveraged a pack archive of the top-selling, mass-market cigar products in the US and their corresponding sales data to assess the prevalence of common pack features in the marketplace. METHODS: The 50 cigar products with the highest national unit sales in 2018 were identified using Nielsen's Scantrack data. A content analysis captured common packaging features within four domains: physical, textual, graphical, and promotional elements. Descriptive statistics, weighted by each pack's 2018 unit sales, documented the market share of pack characteristics overall and by brand. RESULTS: Products in the sample constituted 62% of all convenience store cigar sales in 2018. Black & Mild, the most popular brand, did not display warning labels on its single stick, cellophane-wrapped products, which constituted nearly all of its sales (96.3%). Resealable foil pouches were the most common packaging style across other brands, and were most often sold in predominantly red, green, or silver packaging. Common flavor categories included concept (eg, "Jazz", 32.4%), fruit (15.7%), and sweet (14.5%). Prepricing (eg, "2 for 99 cents") was a popular promotional strategy, appearing on 74% of all packs sold. CONCLUSIONS: Cigar packaging features such as small pack sizes, innovative materials, flavor names, bright colors, and cost-saving promotions are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help reduce appeal and potentially curb cigar use. IMPLICATIONS: Sales of mass-market cigars in the US have remained strong over the past decade, propelled by lax product regulations. This study demonstrated that cigar packaging features that may enhance consumer appeal, such as small pack sizes, flavor names, sensory descriptors, bright colors, and cost-saving promotions, are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help curb cigar use, reduce youth appeal, and potentially minimize existing disparities in cigar use.

Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 "lockdown": A qualitative study in the United States.

BACKGROUND: The COVID-19 pandemic and associated public health prevention measures (e.g., "stay at home" orders) may impact tobacco supply and demand among consumers. This qualitative study identified multi-level drivers of shifts in inhaled tobacco product use and access patterns during the initial COVID-19 "lockdown" period in the United States. METHODS: Between April and May 2020, we conducted semi-structured telephone interviews (n = 44) with adults who use cigarettes and/or electronic nicotine delivery systems (ENDS). Transcripts were thematically analyzed using a socioecological framework. RESULTS: Nearly all participants reported changes in their product use during lockdown, though patterns varied. Increased use was most common and was predominantly driven by individual-level factors: pandemic-related anxiety, boredom, and irregular routines. Decreased use was common among social users who cited fewer interpersonal interactions and fear of sharing products. At the community level, retail access impacted cigarette and ENDS use differently. While cigarettes were universally accessible, ENDS access was more limited, driving some to purchase products online. Delayed deliveries led some ENDS users to compensate with readily-available cigarettes. CONCLUSION: To mitigate ways that the COVID-19 pandemic may exacerbate an existing public health crisis, multi-level policy strategies, such as expanded virtual cessation services and implementation and enforcement of smoke-free home rules, can better support population health during this critical period. Policies that facilitate access to lower risk products can help minimize harm among those who cannot or do not want to quit smoking.

Content analysis of instagram posts by leading cannabis vaporizer brands.

BACKGROUND: Cannabis vaporizer companies leverage social media to market their products, but little is known about the content of the messages being delivered to consumers. This study describes characteristics of Instagram posts from three popular cannabis vaporizer brands in the U.S. METHODS: A content analysis was performed on posts uploaded between October 2017 and October 2018 by the brands Kandypens (n = 731), G Pen (n = 454), and Pax (n = 71). Posts were coded for: characteristics of individuals pictured, health and risk statements, references to cannabis, co-marketing activities, cartoon images, and product price. Descriptive statistics highlight the prevalence of these characteristics and between-brand differences. RESULTS: Posts had a wide reach, with a total of 467,700 followers across brands. Two-thirds (68.0 %) of posts depicted someone using the product. Among posts featuring a person, (83.9 %) depicted female users. Overall, cannabis was rarely mentioned (8.9 %) or depicted (10.0 %) in posts. "Tagging" social media influencers (34.3 % of posts) and other companies or their products (31.9 % of posts) were popular promotional strategies. Few posts mentioned age restrictions (0.3 %), health risks (5.2 %), or health benefits (0.2 %). CONCLUSIONS: Cannabis vaporizer companies reach thousands of consumers through brand-owned social media accounts. Strategies to promote their products on these channels include posts that may appeal to sociodemographic groups and leveraging social media influencers and other companies to increase overall reach. As legalized recreational cannabis expands and a range of consumption methods become popular, an understanding of brands' social media marketing practices is needed to inform policies and interventions that promote population health.

Demographic and psychological moderators of the relationship between neighborhood cigarette advertising and current smoking in New York City.

BACKGROUND: Tobacco advertising in retailers influences smoking, but little research has examined how this relationship differs among population subgroups. This study merged data on neighborhood cigarette advertising with geocoded survey data to assess the association between advertising prevalence and current smoking among New York City (NYC) residents, and whether demographic and psychological characteristics moderate this relationship. METHODS: Audit data from a stratified, random sample of 796 NYC tobacco retailers generated neighborhood prevalence estimates of cigarette advertising, which were linked with unweighted 2017 NYC Community Health Survey data (n = 7837 adult respondents with residential geocodes). Multilevel regression estimated adjusted odds ratios (aOR) of current smoking by level of neighborhood cigarette advertising (quartiles). Interactions assessed differences in this relationship by demographic characteristics and current depression (analyses conducted in 2019). RESULTS: There was no main effect of advertising on smoking status or significant interactions with demographic variables, but current depression was an effect modifier (p = 0.045). Cigarette advertising was associated with current smoking among those with current depression (p = 0.023), not those without (p = 0.920). Specifically, respondents with depression who resided in neighborhoods in the highest quartile for cigarette advertising prevalence had higher odds of current smoking, compared to those living in the lowest advertising quartile [aOR: 1.72 (1.04, 2.86)]. CONCLUSION: Retail cigarette advertising may serve as an environmental cue to smoke among adults with depression. Efforts to restrict or counteract this practice, such as the development of community-level public health interventions and counter-marketing programs, may particularly benefit those with depression and, perhaps, other mental health disorders.

Predictive Validity of Tobacco Product Advertising and Retail Availability.

OBJECTIVES: Measurement properties of key constructs used in tobacco retailer audit studies are infrequently examined. We used diagnostic testing metrics to assess the predictive validity of product advertising and availability. METHODS: In 2017, we documented tobacco product advertising and availability in a sample of New York City and New Jersey retailers (N = 987). We calculated positive predictive values (PPV, ie, probability of availability given advertising is present) and sensitivity scores (ie, probability of advertising given product is available) for cigarettes, cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS). RESULTS: Advertising presence was an imprecise indicator of availability for ENDS (PPV: 82.3%) and smokeless tobacco (PPV: 88.2%), particularly in non-chain convenience stores. Cigars were least likely to be advertised, if available (sensitivity: 27.8%), compared to other product types (sensitivity range: 43.8% - 57.9%). CONCLUSIONS: The suboptimal predictive validity of advertising for certain products suggests that this measure does not necessarily reflect product accessibility in communities. Moreover, differences in sensitivity scores suggest that some product classes rely on strategies other than physical ads to recruit and retain consumers. A better understanding of these constructs and their influence on behavior can help inform more effective retail-based regulatory approaches.

Characteristics of storefront tobacco advertisements and differences by product type: A content analysis of retailers in New York City, USA.

Tobacco companies in the U.S. spend billions of dollars advertising at the point-of-sale. Using photographs of storefront tobacco ads in New York City (NYC), we conducted a content analysis to describe the prevalence of common features across four product categories and illuminate ways in which they may influence behavior. In 2017, data collectors photographed exterior ads from a representative sample of tobacco retailers in NYC (n = 796). We coded each ad (n = 976) for the presence of various characteristics (e.g., brand, price displays, warning labels, menthol/flavors, size, location). Chi-square tests examined differences by product type. Most ads were for cigarettes (40%), followed by electronic nicotine delivery systems (ENDS, 27.9%), cigars (26.9%), and smokeless tobacco (5.2%). Over half of cigarette and smokeless tobacco ads promoted a menthol or flavored style (61% each), compared to about a quarter of cigar (25.9%) and ENDS ads (30.3%, p < .0001). Cigar and ENDS ads, however, were more frequently placed directly on the door of entry (49.4% and 46.7%, respectively, p < .001). Only 5% of ENDS ads displayed a standard warning label. Notably, a quarter of all tobacco ads (23.4%) were for the brand Newport. Cigarette ads still dominate at the point-of-sale with regard to volume and size. Across all products, ad features did not always align with local and federal policies (e.g., flavor bans, warning label mandates). Continued surveillance of advertising strategies and policy compliance can help provide the evidence base needed to inform marketing regulations that reduce the deadly burden of tobacco use.

Evaluating the impact and equity of a tobacco-free pharmacy law on retailer density in New York City neighbourhoods.

BACKGROUND: In 2018, New York City (NYC) implemented a tobacco-free pharmacy law as part of a comprehensive policy approach to curb tobacco use. This study models the reduction in tobacco retailer density following the ban to examine differences in the policy's impact across neighbourhoods. METHODS: Tobacco retailer density per 1000 residents was calculated in July 2017 for each of NYC's Neighborhood Tabulation Areas (NTAs, n=188) before and after removing pharmacies as licensed tobacco retailers. Pearson correlations and linear regression (with predictors scaled to 10 unit increments) measured associations between the projected change in retailer density after the ban and NTA demographic characteristics. RESULTS: On average, retailer density decreased by 6.8% across neighbourhoods (SD: 6.3), with 17 NTAs experiencing reductions over 15%. Density reduction was greater in NTAs with higher median household income (r: 0.41, B: 1.00, p<0.0001) and a higher proportion of non-Hispanic white residents (r: 0.35, B: 0.79, p<0.0001). NTAs with a higher percentage of adults with less than a high school education (r: -0.44, B: -2.60, p<0.0001) and a higher proportion of Hispanic residents (r: -0.36, B: -1.07, p<0.0001) benefited less from the policy. These relationships held after assessing absolute changes in density (vs per cent change). CONCLUSIONS: NYC's tobacco-free pharmacy law substantially reduces tobacco retailer density overall, but the impact is not equal across neighbourhoods. In order to minimise disparities in the tobacco retail environment, local governments considering a similar ban should supplement this strategy with other retailer restrictions to achieve equitable outcomes.

Neighborhood Differences in Alternative Tobacco Product Availability and Advertising in New York City: Implications for Health Disparities.

INTRODUCTION: Alternative tobacco products (ATPs), such as cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS), have a strong presence in the US retail environment amid declining cigarette consumption. This study documented the promotion of ATPs in tobacco retailers in New York City and examined associations with neighborhood demographics. METHODS: Data on product availability and advertising were collected from a stratified, random sample of tobacco retailers in 2017 (n = 796). Multilevel models estimated adjusted prevalence ratios (aPRs) for each outcome by neighborhood racial/ethnic composition and median household income. RESULTS: Nearly half (49.8%) of retailers carried 99-cent cigarillos, but availability was significantly greater in neighborhoods in the highest (vs. lowest) quartile for the percentage of Black residents [68.2%, aPR: 1.59 (1.19, 2.11)] and in the lowest (vs. highest) income quartile [67.3%, aPR: 1.56 (1.04, 2.35)]. Conversely, retailers in neighborhoods with the highest percentage of White residents were significantly more likely to carry ENDS [66.4%, aPR: 1.71 (1.11, 2.62)]. Advertisements for ENDS were less common in neighborhoods in the highest (vs. lowest) quartiles for the percentage of Black and Hispanic residents [20.3%, aPR: 0.64 (0.41, 0.99); 22.9%, aPR: 0.62 (0.40, 0.98)]. CONCLUSIONS: The marketing of inexpensive, combusted tobacco products disproportionately saturates low-income, minority communities, while potentially lower risk, noncombusted products are more accessible in largely White and higher income neighborhoods. This pattern may exacerbate tobacco-related inequities. Public health policies should prioritize reducing the appeal and affordability of the most harmful tobacco products to help reduce health disparities. IMPLICATIONS: Although cigarette promotion at the point-of-sale is well documented in the literature, questions remain about the ways in which alternative tobacco products (ATPs) are marketed in communities. Importantly, these products fall on a continuum of harm, with combusted tobacco overwhelmingly responsible for tobacco-related death and disease. We found that retailers in minority and low-income communities were more likely to carry and advertise inexpensive ATPs such as cigarillos, while potentially less risky, noncombusted products such as smokeless tobacco and e-cigarettes were more accessible in higher income and predominantly White neighborhoods. Policies aligned with product risk may help reduce health disparities.

Cigarillo sales in legalized marijuana markets in the U.S.

BACKGROUND: Nearly half of marijuana users in the United States also smoke cigarillos, with many using the products as marijuana "blunts." The relationship between marijuana legalization and tobacco retail has not yet been examined. This study uses tobacco sales data to compare the cigarillo marketplace in states with legalized recreational marijuana to the overall U.S. marketplace in 2016. METHODS: Cigarillo sales data from 2016 were obtained from the Nielsen Research Company in the following market regions: Denver, CO; Seattle, WA; Portland, OR; and the overall U.S. Descriptive statistics highlighted differences in the market share of various product features (e.g., flavors, brand, pack size) across regions. RESULTS: Characteristics such as fruit flavors, single sticks, and 2-3 packs were more popular in legal marijuana regions compared to the overall U.S. Black & Mild, a brand not traditionally used for blunts, was the top brand nationally (32.8% market share), but Swisher was the top brand in legal marijuana regions. In Seattle and Portland, for example, over half of cigarillo sales were for Swisher products (59.1% and 52.1%, respectively). Cigarillo wraps (i.e., no tobacco filler) were particularly popular in Denver, constituting 11.4% all cigarillo sales versus 2.8% nationally. CONCLUSIONS: Cigarillo product characteristics traditionally associated with blunt use may shape the tobacco market in legal marijuana regions. As more states continue to legalize recreational marijuana, state and local governments should anticipate the potential impact on the tobacco marketplace and implement tobacco control policies (e.g., flavor bans, minimum pack sizes) that discourage product use.