As cannabis products become more widely available in retail settings across the United States, communities are increasingly committed to ensuring that public health is not compromised by commercial interests.

The retail environment shapes how cannabis products are marketed, who is exposed to them, what products are easiest to access, and ultimately how communities experience the impacts of cannabis commercialization.

For public health practitioners, policymakers, researchers, and community advocates, understanding cannabis sales at the point of sale is critical for developing effective, evidence-based policies that protect public health while responding to a rapidly changing marketplace.

That is why Counter Tools developed the resource Cannabis at the Point of Sale: Products, Policies, and the Retail Environment — a one-pager designed to help communities begin to understand, assess, and respond to the evolving cannabis retail landscape.

What Does “Point of Sale” Mean for Cannabis Products?

The “point of sale” refers to the places where cannabis products are sold and promoted. This includes licensed cannabis dispensaries – but also includes the many all-age stores that sell cannabis-derived (hemp) intoxicating products, such as convenience stores, gas stations, smoke and vape shops, and grocery stores.

Just as tobacco and alcohol research has shown that retail environments influence public health outcomes, cannabis retail environments can also affect initiation, patterns of use, social perception, and health risks.

Why Cannabis Retail Environments Matter

Cannabis products today are very different from those available decades ago. Retail markets now include high-potency concentrates, flavored vape products, infused beverages, gummies, candies, snacks, and products designed with branding and packaging that can strongly appeal to youth.

Communities often focus on legalization policies themselves, but retail conditions are equally important because they determine how cannabis products are introduced into everyday environments.

The point of sale matters because it influences:

• Youth exposure and appeal
• Product accessibility
• Consumer understanding of risks
• Use patterns and dependence
• Community density of retailers
• Perceptions of safety and normalization

Understanding these factors allows communities to identify gaps in regulation and opportunities for prevention.

One of the biggest public health concerns related to cannabis retail environments is youth exposure. Research has shown that colorful packaging, candy-like products, sweet flavors, cartoon imagery, and food-based branding can increase youth appeal. Cannabis gummies, chocolates, beverages, and snacks are often packaged in ways that resemble conventional consumer products familiar to children and adolescents.

What Can Communities Do?

Local governments, coalitions, researchers, and advocates can take meaningful action by gathering local data. Conducting retail assessments provides valuable information to best inform policy decisions. 

Communities can visit local retailers and systematically document:

• Product types
• Product potency
• Packaging features
• Advertising and promotions
• Pricing practices
• Product placement
• Exterior and interior signage
• Health warnings and labeling
• Store location, proximity, and density
• Other micro and macro-level factors

Many cannabis policies evolve rapidly, and local assessments help determine whether regulations are keeping pace with the marketplace, and whether there is compliance with the regulations. 

Point-of-sale assessments transform abstract policy conversations into concrete evidence about what is happening on the ground. Furthermore, local data is often more compelling than national statistics because it reflects conditions residents can directly observe in their own neighborhoods. 

Looking Ahead

Cannabis markets continue to evolve rapidly. New products, new marketing strategies, and new retail models are constantly emerging. At the same time, states and localities are still determining how best to regulate. The point of sale will remain one of the most important places where these tensions play out.

By paying attention to the retail environment, communities can move beyond broad debates about legalization and focus on practical, evidence-informed strategies that protect public health and reduce harm.

Collecting local data, evaluating retail conditions, and developing evidence-based policies can help communities better respond to emerging cannabis-related challenges while supporting informed decision-making for residents and policymakers alike.

Community support for this change was fueled by growing concerns about the health effects and rising use of electronic nicotine products among youth. One of the biggest drivers of youth tobacco use is the retail environment, where harmful substances such as tobacco and nicotine products are marketed and sold, often in appealing flavors directly targeted towards youth.

To strengthen the case for change, Counter Tools partnered with The Coalition to support their advocacy work by providing tobacco retailer density and proximity maps of Lufkin, Texas.

Tobacco retailer density refers to how concentrated tobacco outlets are in a neighborhood, often measured as retailers per 1,000 people. High density increases exposure to advertising and makes tobacco more accessible, leading to higher rates of use among both youth and adults. Proximity measures the distance to the nearest retailer, in feet or miles. The closer the store, the easier it is for young people to be exposed to products and marketing. Research shows that high density and close proximity fuel disparities: youth initiation rises, people who smoke consume more, and quit attempts are less likely to succeed. Reducing density and proximity is key to protecting community health.

These maps visually demonstrated how 61% of tobacco retailers were clustering close to schools and parks within a 2,000-foot radius, raising the risk of youth exposure to marketing and easy access to nicotine. By presenting data in a clear and compelling way, The Coalition was able to strengthen its case and mobilize community support. Data visualizations that highlight the need for change are often the turning point in advocacy, transforming abstract data into a persuasive story to influence policy and create healthier environments.

“The tobacco retailer maps from Counter Tools were a powerful tool in our advocacy
efforts. A quick glance at our map shows the high number of vape shops in our rural
town of only 35,000 people. This was tangible proof that it was time for our community
to act and protect our youth from further exposure to these harmful products.”
Sharon Kruk, Executive Director | The Coalition

With the passing of this ordinance, new e-cigarette and vape retail shops require a special use permit and are zoned to light and heavy manufacturing districts, which are mostly on the outskirts of town and away from residential zones. Importantly, the ordinance sets a 1,000-foot buffer zone around schools and churches, safeguarding youth by preventing vape retailers from clustering near places they frequent. Existing vape shops will not be impacted by this ordinance unless they are closed for more than six months, in which case they would have to apply for a special use permit. Additionally, the ordinance does not apply to stores with vape products bringing in less than 50% of the store’s revenue.

Counter Tools celebrates this milestone alongside The Coalition and community leaders in Lufkin, Texas. Their work sets a positive example for other cities looking to address youth tobacco use at the point of sale. With each local victory, we move closer to a healthier future where all youth can grow up free from the influence of commercial tobacco.

Research by Dr. Matthew Rossheim, which was considered during this policy discussion, found that some of the biggest retail stores in Texas are selling dangerous and often illegal cannabis products. These include items that break state and federal laws or have been deemed unsafe by the FDA, such as certain THC edibles and vapes that are too strong, imported edibles with banned ingredients, and unapproved drugs like tianeptine and kratom extracts. Some retailers are using risky sales tactics like giving out free samples, not checking IDs, and selling near schools—methods that increase the chances of young people using these products.

CBD and CBG products would remain legal under the bill, but would no longer be legal to be sold within 1000 feet of a school.

The bill also introduces new criminal penalties for possessing as well as selling intoxicating hemp products, which unfortunately could contribute to additional incarceration related to hemp as well as marijuana. Public health laws can support social justice, but they can also contribute to inequities. It is imperative for public health professionals and decision makers to consider the role of structural racism and discrimination in policy work and enforcement and to continually take meaningful steps toward equitable cannabis policy change.

Intoxicating “hemp” and THC products, sometimes referred to as derived psychoactive cannabis products (DPCPs), are currently available in nearly every state, including those states that have banned certain DPCPs like Delta-8 THC. This is due to a loophole created by the 2018 Farm Bill which allows for the continuous development and sale of new types of DPCPs. The Texas bill has the potential to significantly reduce the availability of harmful cannabis products for Texans, particularly youth.

Nearly two years ago, the FDA announced a proposed rule to prohibit menthol as a characterizing flavor in cigarettes, as well as prohibit menthol and all other characterizing flavors in cigars. The FDA has studied prohibiting menthol through policy change for more than 12 years. The policy is supported by overwhelming scientific evidence, and it will save hundreds of thousands of lives.

Menthol makes tobacco products easier to start and harder to quit. Tobacco companies have targeted its marketing to African Americans and other marginalized groups across the country for decades, contributing to disparities in tobacco product use and subsequent harm. Recent research has found that between 1980 and 2018, menthol cigarettes were responsible for 10.1 million extra smokers, 3 million life years lost, and 378,000 premature deaths. With the tobacco industry’s relentless targeted marketing of menthol cigarettes to the African American community, a disproportionate amount of the harm from menthol has fallen on African Americans. While 12% of the US population is African American, African Americans account for 41% of the premature deaths and 50% of the life-years lost during this same time period.

The latest delay in action is unacceptable and prolongs the 45,000 Black lives lost to tobacco-related illness each year. Counter Tools urges the Office of Information and Management Affairs (OIRA) to complete its review of the Tobacco Product Standard for Menthol in Cigarettes (menthol cigarette rule) and to allow it to be finalized without delay. Prohibiting menthol as a characterizing flavor in cigarettes will reduce youth smoking, save lives, and advance health equity.

The tobacco industry spends the large majority of all of their marketing dollars in the retail environment – to the tune of over $7 billion dollars in 2020 alone, amounting to nearly $1 million per hour. And they’re spending it there for good reason – because they know exposure to tobacco marketing in retail stores leads kids to start using tobacco products and makes it harder for adults who currently use tobacco to quit. Now they must use the retail environment to also tell the harsh truth about the deadly products they aggressively market and sell and how they have lied about their health impacts for decades.

Read more about the corrective statements requirement on Countertobacco.org.

The racketeering verdict was the result of a lawsuit brought by the US Department of Justice and six intervening public health groups: Tobacco-Free Kids Action Fund (a 501(c)(4) affiliate of the Campaign for Tobacco-Free Kids), American Cancer Society, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights and National African American Tobacco Prevention Network.

We often see innovative policy solutions tested first at the local-level. In this webinar, you’ll learn about alcoholic beverage regulations in Montgomery County, the sole “control” jurisdiction in the state of Maryland and one of very few jurisdictions across the country to use this model. You’ll hear about efforts at the county level in Maryland to advance policies that make the food and beverage options on restaurant kids’ meal menus healthier, with a strategy of spreading these policies throughout the state and an eye towards a state-level law.

We also highlight the City of Berkeley, California, the first city in the nation to levy a tax on sugar-sweetened beverages, as well as the first in the country to pass a healthy checkout policy.

In this third webinar of the Local Control webinar series on August 22, CADCA’s Geographic Health Equity Alliance, in collaboration with Counter Tools share details about these local solutions. The three-part webinar series equips attendees with an understanding of why local policy solutions are important, lessons learned from local policy implementation efforts and innovative policy strategies built at the local-level.

View the recording:

Local Control webinar series

CADCA’s Geographic Health Equity Alliance, in collaboration with Counter Tools hosted a three-part webinar series to equip attendees with an understanding of why local policy solutions are important, lessons learned from local policy implementation efforts and innovative policy strategies built at the local-level.

Webinar 1: Building the Rationale for Local Policy Change. Speakers provided a broad rationale for local-level policy efforts and the implications for public health, as well as insight on strategies that have proven successful for local policy implementation.

Webinar 2: Using Local Momentum to Drive State and Federal Policy Change. This webinar featured leaders from the Tobacco 21 and smokefree air movements to discuss how tobacco control policy strategies at the local level helped drive policy change across the country.

Webinar 3:  Innovative Local Solutions in Public Health. The third webinar in the series covered local-level policy solutions in Maryland and California. These efforts advanced policies relating to alcohol and healthy food.

Health equity means that everyone has a fair and just opportunity to be as healthy as they can be, and this requires reducing and removing structural barriers and obstacles that impact health. Structural elements that disadvantage certain racial groups through institutional racism, along with industry targeting, can impact exposure, availability, and access to both healthy and harmful products.

We know that the Black community has been targeted by the tobacco industry for decades with marketing tactics and point-of-sale strategies such as advertising, product availability and pricing at retail stores. This targeting has resulted in disparities in tobacco product use, such as the prevalence of the use of menthol cigarettes among Black Americans, and caused disproportionate harm.

There has historically been a lack of urgency surrounding policies that would benefit Black communities, and policies that restrict menthol do not seem to have the same publicity and support as other types of policies. Policies to protect youth from e-cigarette flavors have received considerable support and attention, and while the youth vaping epidemic is critical, these policies disproportionately benefit white youth as they are more likely to use electronic products.

Using an equity viewpoint, we can start to understand how even the best intentioned tobacco product regulation policies may reinforce racism and the inequitable impact on marginalized communities. For example, targeted marketing of Black communities is an ongoing strategy of the tobacco industry, menthol was exempted from the 2009 Family Smoking Prevention and Tobacco Control Act flavored cigarette ban, and there is a lack of flavor tobacco product restrictions on cigars. While 274 localities across the United States have placed restrictions on flavored tobacco products since 2019, the majority of these flavor restrictions have excluded menthol. In April this year a long overdue announcement was made by the FDA that they are proposing product standards to prohibit menthol as a characterizing flavor in cigarettes and prohibit all characterizing flavors in cigars.

When creating policies, it is critical to consider equity issues to achieve equitable outcomes. Policies that focus on equality instead of equity, such as reducing all available tobacco retailer licenses by half, do not address the existing disparity of higher retailer density in certain neighborhoods. Other policies like banning the sale of tobacco products at pharmacies may disproportionately reduce retailers in wealthier neighborhoods, as there are fewer pharmacies in neighborhoods with more Black residents. Mapping tobacco retailers and other locations like schools and parks can be a useful tool to visualize the impact of policies before they are enacted and raise awareness about disparities. (Check out some examples from the six states that participated in the Geographic Surveillance Learning Collaborative for Comprehensive Cancer Control and National Tobacco Control Programs)

In a recent paper on centering equity in flavored tobacco ban policies, the authors recommend examining the entire policy process through an equity lens, including policy formulation, adoption, enforcement, and evaluation. They advocate for partnering and agenda-setting with communities, examining policy language for exemptions, determining the reach of policy on different populations, and assessing the equitable nature of policy implementation and enforcement. The guidelines shared in Tobacco Control Enforcement for Racial Equity: Decriminalizing Commercial Tobacco – Addressing Systemic Racism in the Enforcement of Commercial Tobacco Control may be a starting point for helping advance equitable enforcement practices related to purchase, possession, sale and distribution of tobacco products.

Equity needs to be at the forefront of public health in order to address systemic issues that have gone on for too long. We need to continue to address racism at its roots and understand the history and consequences. With a health equity lens, we can create more effective policies at both the federal and local level that address ongoing disparities, reduce the burden on Black communities, and strive for health equity for all.

Assessing local policy change through case studies helps identify lessons learned and keys to success, which can help set the stage for state or national change. The Tobacco 21 and smokefree air movements are two examples of tobacco control policy strategies that have seen success at the local level in building support for wider initiatives.

In this second webinar of the Local Control webinar series on August 5, CADCA’s Geographic Health Equity Alliance (GHEA) and Counter Tools brought together leaders from these movements to share insights on how steadfast work at the local level helped to drive policy change across the country.

Watch the recording:

Speakers

Onjewel Smith
Southern States Strategist @American Nonsmokers’ Rights Foundation

Onjewel Smith has worked in the nonprofit sector for more than 20 years helping organizations and communities build their capacity for sustainable change. She has provided technical assistance on grassroots advocacy, coalition building, strategic planning, and fundraising. Throughout her career, Onjewel has helped develop strategic alliances between local coalitions, community-based organizations, stakeholders, and decision-makers. She currently serves as the Southern States Strategist to the American Nonsmokers’ Rights Foundation.

Ginny Chadwick
Program Coordinator @University of Missouri

Ginny Chadwick, MPH, MA is Program Coordinator for the Missouri Eliminate Tobacco Use Initiative at the University of Missouri where she works around the state to improve tobacco policy, prevention and cessation services on college campuses and in hospital systems. Since 2013, Chadwick has worked on sales restriction laws for tobacco products. She has written ordinances and statues and contributed to the national model language. Her research includes age of sale, penalty structures, decriminalization of purchase, use and possession, and preemption of local laws. Chadwick was the legislative sponsor for one of the first Tobacco 21 policies to pass locally, and the first in her home state of Missouri. She worked across the nation at a local, state and federal level to help build coalitions, identify legislative champions and successfully pass policy. Chadwick received her MPH and MA in Journalism at the University of Missouri and is currently working on a PhD at at Brandeis University.

Local Control webinar series

CADCA’s Geographic Health Equity Alliance, in collaboration with Counter Tools hosted a three-part webinar series to equip attendees with an understanding of why local policy solutions are important, lessons learned from local policy implementation efforts and innovative policy strategies built at the local-level.

Webinar 1: Building the Rationale for Local Policy Change. Speakers provided a broad rationale for local-level policy efforts and the implications for public health, as well as insight on strategies that have proven successful for local policy implementation.

Webinar 2: Using Local Momentum to Drive State and Federal Policy Change. This webinar featured leaders from the Tobacco 21 and smokefree air movements to discuss how tobacco control policy strategies at the local level helped drive policy change across the country.

Webinar 3:  Innovative Local Solutions in Public Health. The third webinar in the series covered local-level policy solutions in Maryland and California. These efforts advanced policies relating to alcohol and healthy food.

Local governments are on the front lines of adopting laws and policies that have the potential to improve health outcomes and reduce inequities. CADCA’s Geographic Health Equity Alliance, in collaboration with Counter Tools is hosting a three-part webinar series to equip attendees with an understanding of why local policy solutions are important, lessons learned from local policy implementation efforts and innovative policy strategies built at the local-level.

This first webinar, “Building the Rationale for Local Policy Change” was on June 21st. Speakers provided a broad rationale for local-level policy efforts and the implications for public health, as well as insight on strategies that have proven successful for local policy implementation.

Watch the recording:

Download the presentation slides (PDF)

Speakers:

• Brooks Rainwater, National League of Cities

Brooks Rainwater is the senior executive and director of the National League of Cities’ (NLC) Center for City Solutions. Rainwater drives the organization’s research agenda, community engagement efforts, and leadership education programming to help city leaders create strong local economies, safe and vibrant neighborhoods, world-class infrastructure, and a sustainable environment. As an advocate for strong local leadership, Rainwater has published numerous reports and articles on innovative solutions that lead to vibrant and successful cities. He also speaks regularly across the country and overseas on issues facing city leaders. Rainwater’s recent research and interests include advancements in technology and city innovation, the sharing economy, and how the rise of state preemption is impacting local authority.

• Nestor Davidson, Fordham University School of Law

Nestor M. Davidson joined the faculty of Fordham Law School in 2011 and was named the Albert A. Walsh Chair in Real Estate, Land Use and Property Law in 2017.  Professor Davidson has published widely in the fields of state and local government law, property, and affordable housing law and policy.  Professor Davidson practiced with the firm of Latham and Watkins, focusing on commercial real estate and affordable housing, and served as Deputy General Counsel at the U.S. Department of Housing and Urban Development. Professor Davidson founded and is the faculty director of the Urban Law Center.

• Sara Bartel, ChangeLab Solutions

Sara Bartel is a senior attorney at ChangeLab Solutions, where her good governance portfolio covers legal authority and preemption, the policymaking process, and cross-sector partnerships for upstream community health improvements. Her work spans issues such as healthy retail, food systems, tobacco use prevention, maternal & child health, shared use, housing, and support for working families. Sara’s legal background is in health, food, and the environment, as well as civil rights litigation. Sara is based in Fort Collins, CO, where she lives with her partner and their two little kids.

Local Control webinar series

CADCA’s Geographic Health Equity Alliance, in collaboration with Counter Tools hosted a three-part webinar series to equip attendees with an understanding of why local policy solutions are important, lessons learned from local policy implementation efforts and innovative policy strategies built at the local-level.

Webinar 1: Building the Rationale for Local Policy Change. Speakers provided a broad rationale for local-level policy efforts and the implications for public health, as well as insight on strategies that have proven successful for local policy implementation.

Webinar 2: Using Local Momentum to Drive State and Federal Policy Change. This webinar featured leaders from the Tobacco 21 and smokefree air movements to discuss how tobacco control policy strategies at the local level helped drive policy change across the country.

Webinar 3:  Innovative Local Solutions in Public Health. The third webinar in the series covered local-level policy solutions in Maryland and California. These efforts advanced policies relating to alcohol and healthy food.

1. Set prices high. According to the Surgeon General, raising the price of tobacco products is one of the most effective strategies for reducing initiation, decreasing consumption, and increasing cessation. Strategies to increase prices include setting minimum price floors or prohibiting coupons and discounts. High cannabis pricing has the potential to similarly decrease initiation, especially among price-sensitive populations, like youth.
2. Reduce availability of flavors. Research shows that youth and young adults associate flavored tobacco products with less perceived harm and have greater interest in experimentation with flavored tobacco. It is reasonable to anticipate similar findings for cannabis-infused foods and beverages or other flavored cannabis products. The tobacco industry has a long history of marketing flavored products to youth. Along with being sold in candy flavors, many flavored tobacco products are packaged similarly to popular candy products. Cannabis products are increasingly available in a wide variety of flavors and flavor-sounding names, with significant marketing and promotion. Restrictions on flavored tobacco products have been successful in decreasing the probability that youth start smoking.
3. Limit retailer density and proximity. Similar to the strong evidence around the impact of tobacco retailer density, researchers have identified an association between higher retail outlet availability and increased cannabis use, including a higher likelihood of experimentation among youth. Analysis also points to a higher concentration of cannabis retailers in already disadvantaged neighborhoods. Several policy strategies that have proven successful for limiting tobacco retailer density could similarly be applied to cannabis retailers, such as capping the number of retailers  based on population size or restricting permits for retailers within a certain distance of schools. These density restrictions are generally implemented through licensing or zoning ordinances.

Now is the time to consider these lessons as states continue to make regulatory decisions around their cannabis marketplace.

Interested in discussing concepts like this with peers across the country? Join our Cannabis Learning Collaborative! Our Cannabis Collaborative features quarterly presentations and resources, while saving space for states with recently adopted or pending adult use cannabis legislation to ask questions, share lessons learned, and prepare for the potential impact on public health issues, especially tobacco prevention and control efforts. Our next meeting is scheduled for August 3rd, 2022 at 2 PM EST. For more information, contact elizabeth@countertools.org.