Tobacco is the leading preventable cause of death in the U.S., with 90% of adult smokers initiating smoking by age 18. This makes youth smoking initiation a vital lever for curbing overall rates of smoking. Due to staff limitations and funding decline, compliance checks for sale to minors in King County went from a census of retailers (before 2004) to a convenience-based sample. By analyzing 10 years of compliance check data, this study aims to identify risk factors associated with sale to minors, as well as optimize sampling of retailers by developing a geography-based risk-score that can be used to categorize tobacco and e-cigarette product retailers.
METHODS:
Checks are conducted by the King County (KC) tobacco compliance staff with the help of student volunteers from KC schools. While geographical spread of checks is attempted, retailers are chosen based on convenience of location. A cross-sectional descriptive analysis was performed on 10 years of data (2006-2015), totaling ~10,000 checks. Descriptive statistics on checks, rate of sales, and trends over time were conducted. Bivariate analysis determined if sale to minors was significantly associated with specific individual factors. ArcGIS was used to construct maps of sale rates. A ‘risk-score’, based on proximity to schools, type of business, and other criteria, was developed and assigned to retailers.
RESULTS:
The overall rate of sale to minors was 7.7% and ranged from 3.6% in 2009 to 12.2% in 2011. Sale of e-cigarette products was higher (8.7%) than conventional tobacco products (7.6%). Vapor juice was found to have the highest sale rate (35%), and smokeless tobacco the lowest (0%). Across each of the 10 years of data, clerk asking for youth’s ID was significantly associated with sale to minors (p value<0.05). Most recently (2015), the following factors were significantly associated with sale to minors: youth’s age, clerk’s age, whether youth’s ID was asked, and whether youth’s age was asked. Maps demonstrated specific regions of King County where re-allocation of compliance efforts should be explored. The risk-score provided further specificity.
CONCLUSIONS:
Our findings are especially timely given local health jurisdictions’ recent focus on regulating the burgeoning e-cigarette market, and point to training and education needs that emphasize the importance of checking ID. Given budget and staffing constraints, the risk-score is vital to checking retailers in an efficient manner. This score can be re-assessed incorporating stakeholder input, extended to all tobacco/e-cigarette retailers in KC, and customized for specific products.