1.  Tobacco 21 continues to gain momentum and spread across the country

The minimum legal sale age (MLSA) prohibits retailers from selling tobacco products to anyone under a set age. In most places across the country, that age is 18. Four states (Alaska, Alabama, New Jersey, and Utah) have a minimum age of 19.  However, momentum is building across the country to raise the MLSA to 21 to prevent more youth from initiating tobacco use. Over 100 municipalities and the state of Hawaii have already passed so-called “Tobacco 21” policies raising the MLSA for tobacco products to 21. Initiatives have been proposed in many other states as well, and federal legislation to raise the age to 21 was introduced on September 30, 2015. Find a full list of places that have raised the MLSA to 21 or proposed legislation to do so at Tobacco21.org.

Why institute Tobacco 21 policies? The ultimate goal is to prevent youth from ever picking up the habit and to reduce tobacco use overall. A recent report by the Institute of Medicine suggests that smoking prevalence would decrease by an additional 12% if the MLSA were raised to 21. A higher MLSA limits social channels through which youth can get enough cigarettes to develop a regular smoking habit. Youth frequently rely on getting cigarettes from the 18-20 year olds in their social circles. ^[1] Raising the MLSA reduces access to legal buyers in their daily routine (especially at school) and limits successful store purchases. ^[2]

Tobacco21 also enjoys broad public support. In fact, 75% of nationally surveyed adults, including current smokers and individuals aged 18-21, who would be most impacted by the law, all support Tobacco 21. ^[5, 6] In addition, the policy has been endorsed by the American Academy of Pediatrics and a number of other health groups.

Read more about this policy solution, and look for it in headlines across the nation!

2. The Rise of Vape Shops & Vaping

E-cigarettes first entered the US market in 2007 and have since surged in popularity.  According to a recent CDC survey in 2014, 12.6% of U.S. adults had ever tried an e-cigarette, and 3.7% were current users. Of current adult cigarette smokers,15.9% also used e-cigarettes, and of current e-cigarette users, 76.8% also concurrently smoked cigarette, called “dual use”.^[7]  The tobacco industry has begun to channel vast sums of money into the marketing of e-cigarettes. In fact, a 2013 study found that of noncombustible tobacco products, advertisements for e-cigarettes are the most widely circulated.^[8]Across the top 10 major brands, e-cigarette advertising expenditures grew by 52% between 2013 and 2014, rising to a combined total of $115.3 million in 2014. The brand MarkTen alone spent $54 million just on advertising in 2014.

The products are also currently largely unregulated. In April, 2011, the FDA announced its intention to expand its definition of tobacco products to include e-cigarettes  so that they would be regulated under the 2009 Tobacco Control Act, but has not yet done so. Meanwhile, the industry is rapidly evolving, and many variations and categories of these products now exist, including vaporizers, disposable e-cigarettes, heat-not-burn cigarettes, and non-nicotine e-cigarettes. Use of any of these devices is referred to as “vaping” and there are even vaping competitions to see who can blow the biggest “vape clouds”.

We expect most of the industry’s money to go towards advanced systems (vaporizers with “mods”, tanks, and e-liquids) and less of it to “cig-a-likes,” which mimic the look and feel of traditional combustible cigarettes.  This follows the popularity of “vaping,” which uses electronic devices to heat nicotine e-liquid in a refillable cartridge or tank, and the proliferation of “vape shops” that sell these types of devices. The vaping industry advances its technology daily, and the most recent generation of vaporizers allow users to take them apart, customize the temperature, increase the battery power, or change the coils. There are now over 15,000 vape shops nationwide, averaging $300,000 in annual sales. Also look for new innovations from major Big Tobacco companies in products such as Vuse’s Pro, Connect, and Fob

Recently, there has been concern about the use of these products to vape marijuana or other psychoactive substances, in addition to nicotine. Most cannabis users prefer to use dry-chamber “herbal vaporizers”, which heats the leaves to a temperature high enough to release THC, but not so hot as to burn them. To the outside observer, it can be difficult to distinguish between herbal vaporizers and other traditional models that deliver nicotine, which could pose potential problems for law enforcement in the future. Look for vaping and marijuana to be a rising issue as more states consider legalization of medical or recreational marijuana.

Learn more about e-cigarettes at the point of sale.

 3. Expanding STARS – 24 out of the 34 states conducting store audits use STARS

Store assessments (also referred to as store audits or observations) are a great way to collect data on what is happening at the POS of tobacco retailers in your community. This information can then be used to educate the public, policymakers, and youth about the deceptive marketing tactics that are used by the tobacco industry. The Standardized Tobacco Assessment for Retail Settings (STARS) was designed for practitioners to inform state and local tobacco control policies for the point of sale. The STARS form and training materials resulted from a collaboration of SCTC researchers with stakeholders from five state health departments, the CDC, and the Tobacco Control Legal Consortium. This user-friendly survey is now being used by 24 out of the 34 states conducting store assessments, and we expect this number to grow.

In addition, we’re working on creating STARS 2.0, which will include more questions about electronic smoking products and vSTARS, a form that can be used to assess what’s happening in vape shops. With the rise of vape shops and vaping comes the rise of new ways to keep tabs on what’s happening at the point of sale.

4. Healthy Stores – Tobacco + Alcohol + Food + Marijuana +….

Increasingly, communities are interested in finding out what’s happening in retail environments not only with tobacco, but also with alcohol, food, and marijuana as well!  With this focus on healthy communities, and a growing recognition of the effects of place-based issues like tobacco retailer density on smoking rates, municipalities are tracking food deserts and tobacco swamps and collaborating across different departments within public health to determine how to create healthy communities. With the potentially increasing access to recreational and/or medicinal marijuana in several states, the sale of cannabis and its related paraphernalia will become an increasingly important issue at the point of sale.

In addition, recent research suggests  that the environments for nutrition, tobacco, and physical activity at the community level are inter-related, indicating the potential benefit of addressing  multiple issues at the point of sale in a coordinated way rather than addressing each individually in isolation. ^[9]

As noted recently in a paper by ChangeLab  Solutions published in the American Journal of Law &  Medicine, “If we are to reduce chronic disease rates and eliminate health disparities, the public health community needs to look at the whole store and how it affects the surrounding community, with the goal of creating conditions in which the store can thrive by contributing to the health, not the death, of the community.” ^[10]  

For example, check out Healthy Retail San Francisco and “Healthy Retail San Francisco: A Community-Based Solution to Food Swamps,” a case study on a program to redesign corner stores to improve the health of the community that includes goals for food, tobacco, and alcohol.

In 2014, the California Department of Public Health’s Tobacco Control Program conducted over 7,000 store assessments in their Healthy Stores for a Healthy Community campaign, documenting the availability and marketing of tobacco, alcohol, and food. Some communities are looking into offering incentives to stores who change over their product supply to include only those which support healthy lifestyles.

Monitoring of tobacco, e-cigarettes, alcohol, marijuana, food and beverages can also be done with Counter Tools’ Store Audit Center.

For more strategies on interdisciplinary collaboration to shift stores away from tobacco and towards healthier items, review:

• Integrating Tobacco Control and Obesity Prevention Initiatives at Retail Outlets, published in the journal Preventing Chronic Disease.
• ChangeLab Solution’s Healthy Retail: A Set of Tools for Policy and Partnership, which includes a healthy retail Playbook, Conversation Starters, and a Collaboration Workbook.

 5.  Battle over Flavors

While flavored cigarettes (other than menthol) have been banned since the 2009 Family Smoking Prevention and Tobacco Control Act, this is not the case for other tobacco products including little cigars and cigarillos, smokeless tobacco, and e-cigarettes. These can be found in a wide variety of flavors including cotton candy, strawberry, orange cream soda, fruit loop, and hundreds more that appeal to kids. Unfortunately, it doesn’t seem like these flavors are going anywhere.

That means municipalities will be stepping up the fight to keep these sweet, often cheap, but deadly products away from kids. Providence, RI and New York City, NY have both already banned the sale of flavored tobacco products outside of tobacco bars. The City of Chicago passed legislation banning the sale of flavored tobacco products, including menthol, within 500 feet of school, and this policy has withstood the test of various industry lawsuits. More recently, Minneapolis has banned the sale of flavored products, including e-cigarettes anywhere outside of adult-only specialty tobacco shops. Its twin-city of St. Paul shortly followed suit.

As shown in Minneapolis, youth are great advocates for policies restricting flavored products because they understand how the industry is targeting them as replacement smokers – and policymakers listen to them.

Expect there also to be a debate over what constitutes a “characterizing flavor” – from menthol to other tobacco products like these “Blue” cigarillos.

Stay tuned for more flavor fights!