The Federal Trade Commission (FTC) has reported on tobacco companies’ marketing expenditures for cigarettes and smokeless tobacco for decades. In October 2019, the FTC issued orders to 6 major e-cigarette companies (Fontem US, Inc.; JUUL Labs, Inc.; Logic Technology Department LLC; NJOY, LLC; Nu Mark LLC; and R.J. Reynolds Vapor Company) seeking information on their sales, advertising, and promotional activities from 2015-2018. This month, the FTC published their first report on e-cigarettes using that data.

The data show that most e-cigarette sales are happening at retail stores – total e-cigarette sales, including both disposable units and those using changeable cartridges, increased more than six-fold from 2015-2018. It also makes evident the rise in popularity of sweet, fruity flavors that have helped drive youth e-cigarette use. The sales of fruit and other flavored e-cigarette cartridges preferred by youth increased seven-fold during the three year period. These sales numbers are prior to any federal regulations on flavored e-cigarettes, and we expect to see a new report on 2019-2020 sales at some point, since the FTC issued another order in September 2021.

The retail setting is where e-cigarette companies are spending the vast majority of their money. The FTC found that the e-cigarette companies more than tripled their spending on advertising and promotion in three years. Research shows that exposure to tobacco marketing can cause youth to start smoking, keep people who currently smoke hooked, and make it harder for people to quit and stay quit. Point-of-sale marketing often disproportionately targets minority and low-income neighborhoods, and research shows this targeted marketing works, with higher rates of smoking among individuals of lower socioeconomic status and education level.

The expenditure from e-cigarette companies include pricing strategies such as free or deeply discounted e-cigarette products and price discounts paid to retailers or wholesalers, so they can reduce the price of e-cigarettes to consumers. While research on the impacts of e-cigarette pricing is less extensive than on the impacts of cigarette pricing, the existing data show that both disposable and reusable e-cigarette sales are responsive to price changes. When e-cigarette prices increase, sales decrease, particularly among price-sensitive groups like youth. We know that lower prices, along with coupons and price discounts, encourage youth to start smoking and move them along from experimentation to regular cigarette use.

E-cigarette companies engage in these practices because the same thing is likely to happen with e-cigarettes. These FTC reports emphasize the critical need to monitor and address tobacco industry activity in the retail environment. Policies that raise the price of tobacco products, such as increasing excise taxes, banning coupons, or setting minimum price floors, are just a few examples of effective strategies for addressing significant spending on tobacco marketing and promotion at the point-of-sale.

Read a more in-depth analysis on CounterTobacco.org, read the press release from the FTC or download the full report.

The Tobacco Point of Sale Preemption Playbook, a new resource from Counter Tools and ChangeLab Solutions, equips tobacco prevention staff and their partners with the knowledge, context, and resources needed to understand how preemption influences their work.

Learn more about the different forms preemption can take, key steps and legal considerations for determining local authority, and strategies communities across the country are using to make progress despite preemption at the point of sale.

Download the Playbook here

Download Materials

• Summary report: Surveying How the Tobacco Industry Markets Flavors in Five Midwestern Cities 
• Full report and fSTARS form: Retail Store Assessments for Flavored Tobacco Products: Pilots in Tobacco Nation 
• fSTARS form

Counter Tools and Truth Initiative initially partnered in 2018 to develop a set of retail tobacco store assessment questions specifically focused on menthol and other flavored commercial tobacco products. These questions were added to the Standardized Tobacco Assessment for Retail Settings (STARS) form. The new form fSTARS was piloted in two cities within Tobacco Nation in order to field-test the questions and to facilitate the cities’ consideration of flavor-based policies and other point-of-sale tobacco control policies.

The pilot study “Colorful and Close to Candy: Surveying how the tobacco industry markets flavored products in stores” examined marketing in stores in Ohio (Dayton and Cleveland) from 2018 to 2019. The data showed that tobacco prices were cheaper in neighborhoods that had more youth, and almost every tobacco retailer located near schools displayed ads for flavored tobacco products outside.

Following the initial pilot, the form was revised to reflect the evolving market for flavored e-cigarette products, to be able to better compare flavored and non-flavored products, and to compare local data with national trends in disparities in the availability and marketing of flavored products. The most recent study “Surveying How the Tobacco Industry Markets Flavors in Five Midwestern Cities” spans from 2019 to 2020 and examines marketing in cities in Missouri (Columbia and Lee’s Summit) and Illinois (Evanston). E-cigarette products were more widely available in the cities where stores were assessed in 2020 than in those assessed in 2018-2019.

The participating cities received training and technical assistance from Counter Tools and Truth Initiative, and data analysis was completed by Counter Tools.

The Census Bureau has released data summary files from the 2020 census that show population changes as the nation becomes more racially and ethnically diverse.

The Census Bureau has provided an interactive map viewer as well as helpful data visualizations to explore population sizes, racial and ethnic diversity, housing data, and more.

The overall racial and ethnic diversity of the country has increased since 2010. The Hispanic or Latino population grew by 23%, the Asian alone population by 35%, and the Black population by 5.6%. The number of people who identify as multiracial (two or more races) increased by 276%. The White alone population declined by 8.6%.

The Census Bureau updated the race question in 2020 by allowing respondents to write additional details about their race, so someone who selected “Black” could also write “African American” or “Jamaican.” New codes were added while analyzing the data to account for a wider variety of how people self-identify.

The significant changes in race and ethnicity is clearly a sign that our country is becoming more diverse. It may also be partially explained by the way we talk about race and ethnicity. There is less stigma around being multiracial, and younger people may be more open to describing themselves as multiracial. Some people who chose White only on the 2010 census may have felt more comfortable choosing multiple races in 2020. As DNA testing becomes more popular, it may also be changing the way people think about themselves. A Stanford study found that people who have taken ancestry tests are more likely to identify as multiracial.

The census is taken every 10 years to count the number of residents in each county. Census data is used primarily to determine the distribution of Congressional seats and define districts, but it is also used to help determine how to distribute billions of dollars in federal funding to support public health initiatives, build roads and schools, improve transportation, and more.

At Counter Tools, we use census data in our data collection and mapping tools to help states identify disparities in tobacco and alcohol retailer density and advertising. Evidence shows there are more tobacco outlets in communities with higher Black and Hispanic populations. Just as these industries use census data to target their marketing and product availability, those who work in public health can use it to keep an eye on disparities and inform policy decisions.

The data summary files can be downloaded here and the complete data toolkit will be available by Sept. 30, 2021.

The COVID-19 pandemic highlighted how the social determinants of health directly impact the health of communities. Unsafe or unstable housing, income insecurity, lack of transportation, and underlying health inequities put some populations at higher risk during the pandemic. Systemic inequities resulted in a higher burden on racial and ethnic minority communities, especially during the first wave of the pandemic.

The Social Vulnerability Index (SVI) was initially developed by the CDC in 2011 to help government officials identify communities that may need support during public health emergencies. The standard SVI incorporates 15 social factors based on census data such as socioeconomic status, minority and language status, disability status, housing type and transportation.

The new Minority Health SVI launched in 2021 adds additional factors known to be associated with COVID-19 outcomes and include two new themes. Health care infrastructure and access now also consider the number of hospitals and urgent care clinics per 100,000 residents. Medical vulnerability now includes variables such as the obesity rate and cardiovascular disease mortality per 100,000 residents. The dataset is also broken down into specific race and ethnicity categories and languages. Data is included for five racial and ethnic minority groups: American Indian and Alaska Native, Asian, African American or Black, Native Hawaiian/Pacific Islander, and Hispanic or Latino/a. The data also include the top five languages spoken by populations with limited English proficiency (LEP) at the county level, described in variables such as “Spanish speakers who speak English less than ‘very well’ ”.

We all have a responsibility in public health to address the inequities that persist across the social determinants of health. In order to understand and address racial and ethnic health disparities, we need quality disaggregated data. We are excited to see the new Minority Health SVI offer greater disaggregation of its data by factoring in more languages and racial and ethnic minority groups.

Short term, the data and dashboards can help with planning COVID-19 testing, and improving access to treatment and vaccine distribution for specific communities. The data can also be used to help identify communities that need improved health care infrastructure and access, language assistance, and other community-level efforts to address systemic factors related to the social determinants of health.

The Minority Health SVI is a critical tool for applying a health equity lens to public health. We look forward to exploring the data and incorporating it into our work.

Read the Minority Health Social Vulnerability Index Fact Sheet and search the data using the Minority Health Social Vulnerability Index Explorer.

Figures from the Federal Trade Commission (FTC) Reports on Cigarettes and Smokeless Tobacco Sales and Marketing Expenditures in 2019, released in March 2021, document a continued concentration of tobacco industry expenditures in the retail environment. These numbers are for cigarettes and smokeless tobacco alone – they do not include any marketing expenditures for cigarillos, little cigars, e-cigarettes, or any other tobacco products.

The spending reports show that tobacco companies spend the majority of their marketing dollars on two categories: price discounts and promotional allowances to keep products cheap and visible at the point of sale.

When factoring in price discounts and promotional allowances paid to wholesalers, which ultimately reduce the price of products to consumers, the amount spent rises to nearly $8 billion, over 97% of the tobacco industry’s total marketing budget.

The retail environment has an impact on the health of the community as a whole. Research shows that tobacco marketing can cause youth to start smoking, keep current smokers hooked, and make it harder for current and former users to quit and stay quit. Point-of-sale marketing often disproportionately targets minority and low-income neighborhoods, and research shows this targeted marketing works, with higher rates of smoking among individuals of lower socioeconomic status and education level.

These FTC reports emphasize the critical need to monitor and address tobacco industry activity in the retail environment. Price discounts counteract the impact of effective tobacco control policies and target price sensitive smokers. Policies that raise the price of tobacco products, such as increasing excise taxes, banning coupons, or setting minimum price floors, are just a couple examples of effective strategies for addressing significant spending on tobacco marketing and promotion at the point-of-sale.

Read a more in-depth analysis of these reports on CounterTobacco.org, and check out more information about tobacco at the point of sale.

University of North Carolina’s Vaping Prevention Resource and Public Health Law Center recently released the Policy Playbook for E-cigarettes. The Playbook provides state and local stakeholders with a framework of policies and practices to pursue, guidelines on policy implementation, case studies, and examples.

As a supplement, Public Health Law Center is hosting a webinar this week, “Changing the Game: A Playbook for E-cigarette Regulation at the State and Local Level” on December 10 at 12 PM CST. This webinar will provide an overview of policies that states and local jurisdictions can adopt to regulate e-cigarettes, including an introduction to the new Policy Playbook for E-cigarettes. Register for the webinar here.

For more on e-cigarettes at the point-of-sale, take a look at Counter Tobacco’s evidence summary E-cigarettes at the Point of Sale.

The fight against tobacco is far from over.

According to the report, cigarettes and other tobacco products account for 35 percent of all in-store sales in convenience stores. Although the report indicates a slight decline of sales for cigarettes and cigars, there was a major increase in the sale of electronic cigarettes as well as a moderate increase in smokeless tobacco. Unfortunately, these figures align with the rapidly increasing numbers of middle and high school students using e-cigarettes, with numbers rising from 3.6 million in 2018 to 5.4 million in 2019—a difference of about 1.8 million youth.

Density and proximity of tobacco retailers play a role in smoking behaviors.

The report points to convenient store location as the top factor influencing cigarette purchases in c-stores. Public health research also confirms that store location matters. Evidence confirms that a greater availability of tobacco products is associated with higher smoking rates for both youth and adults. From a health equity standpoint, this is particularly concerning since tobacco retailer density is higher in low-income and minority communities. Retailer licensing and zoning are two of the most lasting strategies to impact the density of tobacco retailers, the types of retailers that can sell tobacco, and the location of tobacco retailers.

Increasing the price of tobacco has the potential to influence sales.

Another top factor influencing cigarette purchases in c-stores was price. Again, this comes as no surprise. 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. Over the years, public health has identified several successful strategies for raising the price of tobacco products, including raising excise taxes. There are also non-tax approaches  for states and communities facing political barriers to excise tax increases and that can complement excise taxes to keep prices high.

But who really benefits from tobacco sales at c-stores? The tobacco industry.

The three concepts above reinforce the need for comprehensive efforts to counteract commercial tobacco product sales and marketing at the point of sale. Reports like this one are often used to support economic arguments against point of sale policies. However, it’s important to note that tobacco is actually a relatively low-margin product for c-stores. In 2016, while 34.1% of in-store sales were from tobacco, only 18.2% of profits were from tobacco. In comparison, prepared foods were 22% of sales, but 35% of profits, and packaged beverages were 15% of sales but 19% of profits. At the same time, the tobacco industry is well aware of the value of the retail environment on their bottom line. In 2018, the tobacco industry spent over $7.2 billion to advertise and promote their products at the point of sale, with a majority of this money directed towards price promotions and promotional allowances paid to retailers. Unsurprisingly, this spending pays off, with over ⅓ of c-store shoppers purchasing cigarettes in a month. Not only do these incentives paid to retailers help keep people hooked on tobacco, but they also keep the retailers dependent on tobacco companies through detailed contracts dictating sale price and product placement.

The good news is that we have plenty of strategies for counteracting commercial tobacco product sales and marketing at the retail store. These strategies include those mentioned above, like retailer licensing and zoning or raising excise taxes, as well as others such as, minimum pack sizes and restrictions on the sale of flavored tobacco products. Check out countertobacco.org for a full menu of evidence-based, flexible strategies to help local, state, and federal practitioners select the best and most effective solutions for their communities.

Recently, our partners at ASPiRE and Campaign for Tobacco Free Kids shared their latest findings on tobacco retailer density from a study that mapped tobacco retailers in 30 cities. The study was conducted by researchers from the Stanford University School of Medicine, the University of North Carolina at Chapel Hill, and Washington University in St. Louis.

The research team found that across 30 major US cities, an average of 63% of public schools are located within 1,000 feet – about two city blocks – of a tobacco retailer. In eight of the cities surveyed, at least 80% of public schools are within 1,000 feet of a tobacco retailer – Baltimore (87%), Boston (87.5%), Miami (90%), New York City (94%), Philadelphia (90%), Providence (80%), San Francisco (81.5%) and Washington, D.C. (82%).

The findings also tell us that tobacco retailers are concentrated in low-income areas. On average, there are nearly five times more tobacco retailers per square mile in the lowest-income neighborhoods than in the highest-income neighborhoods, as defined by data from the U.S. Census.

When we consider how many tobacco retailers exist–31 times more than McDonald’s restaurants and 16 times more than Starbucks–it is staggering to realize the density of tobacco retailers, particularly in low-income neighborhoods. This is of course no coincidence. (Read more about the disparities in point-of-sale advertising and retailer density on CounterTobacco.org.) The need for tobacco policy change at the point of sale is still painfully clear. Mapping tobacco retailers in our communities is one of many powerful tools needed to counteract this industry influence and strengthen healthy communities.

Many advocates in tobacco prevention and control are capturing data down to the neighborhood level and using GIS mapping to examine where tobacco retailers are clustered. States such as Florida, Minnesota, South Carolina and Virginia are working with Counter Tools to map tobacco retailers (among other variables) to examine their proximity to schools and disparities in density and using similar calculations to those used in this study. Philadelphia and San Francisco are two examples of places that have taken action to reduce disparities in density and stores near schools revealed by mapping.

If you live in one of the 30 cities represented in the ASPiRE study, there are fact sheets, maps and infographics to help us all support the increasing number of local tobacco control interventions that address the retail environment. How does your community capture and tell its story about your built environment?

We’re pleased to announce that we have updated the infographics we shared at NCTOH last fall!

The orange themed maps display the “FDA Violation Rate of Tobacco Product Sales to Minors” and includes Fiscal Year (FY) 2019 and 2018 data. Now you can easily compare how your state sale to minor violation rate has changed from FY2018 to FY2019. The FDA might conduct repeat inspections at the same retailer, however in this instance, each of those reported visits would be counted as a separate enforcement check. The maps are looking at the violation rate across visits, not across retailers.

The blue-grey themed maps display the “Percent of Retailers that had Violations Reported as Selling E-Cigarette Products to Youth” during FY2018 and FY2019. Review these changes to understand the tendency of your state retailers to sell e-cigarette products to youth. The total number of “sale to minor” violations for each state was used when calculating the percentage of e-cigarette products sold in comparison to the other products the FDA now provides in the fiscal year exports.

As the FDA states on their website, “Violation data cannot be readily compared across states”, this data is best compared year over year for your own state. We encourage you to know your state’s publicly available FDA data and act locally towards positive change!

Download PDF versions:

FY2019_2018 FDA Violation State Level

FY2019_2018 ECIG Violation State Level

***All data was exported from: FDA Compliance Check Inspections of Tobacco Retailer Products, Fiscal Years 2018 and 2019. See https://www.accessdata.fda.gov/scripts/oce/inspections/oce_insp_searching.cfm***