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SCTC August 2016 Digest (archived)





August 12, 2016


Dear NCI SCTC Research Initiative partners,


Welcome to the National Cancer Institute State and Community Tobacco Control (SCTC) Research Initiative August 2016 digest.


As a reminder, the purpose of this digest is to inform key tobacco control partners such as yourself of our work so that you can in turn share the information relevant to your constituents through your normal means of communication. If you see any released publications or products that could be useful for your constituents, feel free to share them in your newsletters. Additionally, if you see any upcoming publications or briefs with which you would like to coordinate program activities or news releases, do not hesitate to get in touch with us at the Coordinating Center or the listed authors and principal investigators.


We welcome feedback on ways we can improve the format, content, and delivery of this digest to make it easier to use. Please send any feedback to


Thank for your support of the NCI SCTC Research Initiative. Sincerely,

The State and Community Tobacco Control Research Initiative Coordinating Center


PI: Matthew C. Farrelly, PhD

Co-PIs: Carol Schmitt, PhD, and Todd Rogers, PhD



Ackerman, Amy, et al. "Reducing the density and number of tobacco retailers: Policy solutions and  legal issues." Nicotine & Tobacco Research(2016): ntw124.


Overview              Greater density and higher numbers of tobacco retailers, and their proximity to schools and other places frequented by youth, have been associated with higher rates of smoking among youth, higher rates of cigarettes smoked per day, and lower rates of successful cessation.

Communities can reduce the density and number of tobacco retailers through several policy approaches. These include setting minimum distance requirements between existing retailers, capping the number of retailers in a specific geographic area, establishing a maximum number of retailers proportional to population size,



and prohibiting sales in specific venues (e.g., pharmacies) or within a certain distance of locations serving youth.

To avoid the risk of a successful legal challenge, it is important for communities to consider constitutional, statutory, or regulatory restrictions and requirements prior to adopting or amending such laws. This article provides information about potential legal challenges and encourages communities to seek local legal counsel when developing tobacco retailer reduction policies.

Value added

There are few published legal opinions that address these strategies in the context of tobacco control. This article discusses the relevant legal challenges communities may face when adopting or amending laws or policies to reduce tobacco retailer density.


Implementation Strategies

Local governments can use three legal mechanisms to enact tobacco retailer reduction policies:

  • Licensing requires all retailers that wish to lawfully sell tobacco products to obtain a license from the jurisdiction. Retailers must comply with conditions of operation to avoid having the license suspended or revoked.
  • Zoning regulates the use of property and categorizes the potential uses of a property into permissible, prohibited, or permitted subject to certain conditions. Direct regulation involves standalone laws (i.e., neither licensing nor zoning) to reduce tobacco retailer density.


Potential constitutional challenges include violations of the Takings Clause of the Fifth Amendment, which protects property owners from onerous government regulations, and under the Fourteenth Amendment’s Equal Protection and Due Process Clauses, which protect business owners from arbitrary or unreasonable regulations that do not further a legitimate government interest.

  • To minimize the risk of successful takings claims, communities should require licenses to be renewed periodically, apply changes to tobacco retailer licensing laws prospectively, and consider property interest in zoning laws.
  • As long as implied classifications are reasonable and further a valid government interest (for example, making tobacco products less available to reduce smoking and promote public health), tobacco retailer reduction policies should survive an Equal Protection challenge.
  • To survive procedural due process challenges, governments should ensure adequate notice and hearing procedures before suspending or revoking licenses for violations of new standards. To avoid successful substantive due process claim, governments should ensure that zoning regulations further a legitimate governmental purpose, such as protecting health, safety, or welfare.


Local governments have the authority to use laws and policies to reduce the density and number of tobacco retailers in their communities, given existing public health data. Communities should carefully review state constitutions, statutes, and municipal codes and seek local counsel to understand potential legal issues and assess the most viable policy solutions to reduce retailer density.



 D’Angelo, Heather, et al. "Sociodemographic Disparities in Proximity of Schools to Tobacco Outlets  and Fast-Food Restaurants." American Journal of Public Health (2016): e1-e7.


Obesity and tobacco use are risk factors for cardiovascular disease and many forms of cancer, and disparities in both risk factors exist by socioeconomic status and race/ethnicity. Youth are exposed to retail outlets in school neighborhoods when walking to and from school or during a lunch break. Both fast food and tobacco companies target low-income, minority, and youth populations with promotions and advertising.

This national study included 18,379 public schools across 97 counties and 40 states. The study examined the number of fast food restaurants and tobacco outlets within 800 meters (approximately a 10-minute walk) of a school and whether a school had both a fast food restaurant and a tobacco outlet nearby.

Value added

This is the first study examining the availability of both fast food restaurants and tobacco outlets near schools and the extent to which the availability differs according to race/ethnicity and student socioeconomic status.

Study findings

  • Overall, approximately 40% of schools had at least one fast food restaurant within 800 meters, and about 77% had at least one tobacco retail outlet. Approximately 38% of schools had both a fast food restaurant and a tobacco retail outlet within 800 meters.
  • The average number of fast food restaurants and tobacco retail outlets near schools and the percentage of schools with both types of outlets nearby increased with each increasing quartile of Hispanic, Black, and low-income students. In models that adjusted for school enrollment, school level, school urban locale, and county population size, schools with higher proportions of Hispanic and low-income students were more likely to have both a fast food restaurant and a tobacco retail outlet nearby.

-          Each 10% increase in the percentage of low-income students enrolled in a school led to a 3% increase in the odds of having both a fast food restaurant and a tobacco outlet nearby.

-          Each 10% increase in the percentage of Hispanic students enrolled in a school led to a 5% increase in the odds of the school having both a fast food restaurant and a tobacco outlet nearby.

-          There was a slight positive but nonsignificant association between the percentage of Black students enrolled in a school and the school’s odds of having both types of outlets nearby.

  • High schools had 40% more fast food restaurants and 24% more tobacco retailers within 800 feet than primary schools and had nearly 1.5 times greater odds of having both nearby.


This study found that low-income and Hispanic students are disproportionately exposed to both tobacco outlets and fast food restaurants near their schools. Public health policy makers may consider licensing or zoning policies to restrict the location of fast food and tobacco retail outlets in school neighborhoods as a strategy to reduce youth access to fast food and tobacco products and advertising, especially among these populations.



DeLong, Hillary, et al. "Common state mechanisms regulating tribal tobacco taxation and sales, the  USA, 2015." Tobacco Control (2016): tobaccocontrol-2016.


As sovereign nations, Native American tribes self-govern reservation activity and are exempt from state tobacco excise taxation in the United States. Only tribal members are exempt from state excise taxation, and tribes are obligated to apply state excise taxes to purchases made by nontribal members. States face challenges in the enforcement and collection of taxes, and differences in cigarette prices along state-tribal borders is a main incentive for tax avoidance/evasion.

This study aimed to (1) identify the types of regulatory mechanisms states use to collect excise tax on tobacco sold on tribal lands to nontribal consumers, (2) analyze the nature of state-level regulatory response, and (3) identify examples of comprehensive anti-evasion regulatory schemes at the state level.

Value added

Other studies have examined state efforts to regulate tribal tobacco sales, but this is the first to examine the issue comprehensively across all states.

Study findings

  • Two strategies exist for regulating tribal tobacco sales: (1) regulating the actual sales of tobacco on tribal lands through the use of intergovernmental compacts negotiated between states and tribal officials, and (2) using codified laws to minimize availability of tax-free cigarettes (e.g., tax stamps, tax prepayment on cigarettes sold to tribes, and tax-free quotas).
  • Only 20 of the 34 states with tribal lands address tribal tobacco sales. Fourteen states with a tribal presence have no formal strategies for nonmembers purchasing tobacco on tribal lands. Compact formation is the most commonly used strategy. Fourteen states address intergovernmental compacts, and 11 of these are tobacco-specific.
  • Within codified law, strategic use of tax stamps is the most popular strategy. Fifteen states address tribal tax stamps: two explicitly prohibit stamping tribally sold products, nine stamp all products, and four stamp some products.
  • Twelve states require prepayment of excise tax prior to any ultimate sale: six on all products, four on products in excess of quota, and two on products sold by nontribal retailers.
  • Six states use quotes to limit tax-free tobacco available to tribes.


It is important for states with a tribal presence to understand the strategies available to address nonmembers purchasing tobacco on tribal lands. Failing to address this issue can undermine state tobacco control efforts.

Kostygina, Ganna, Jidong Huang, and Sherry Emery. "TrendBlendz: how Splitarillos use marijuana  flavours to promote cigarillo use." Tobacco Control (2016): tobaccocontrol-2015.


Trendsettah, Inc., a cigar and cigarillo-producing company, has recently introduced new flavors branded with names drawn from marijuana slang terms, such as Purple K, Loud, Cali Green, and Pineapple Express. This “Ad watch” article presents images of the advertisements and promotional activities for these products and notes that the company is “explicitly embracing the growing trend of tobacco and marijuana co-use in the form of blunts (a blunt is a hollowed-out cigar or cigarillo filled with marijuana).”

The article highlights how tobacco companies are capitalizing on the growing market for marijuana to promote cigarillo use.



Value added

This article addresses the relationship between tobacco and marijuana use, which is becoming an increasing concern for the public health community.


  • Recent research has shown that the relationship between tobacco and marijuana use is much more complicated than the “gateway hypothesis” introduced 40 years ago, which described cigarette smoking as a pathway to marijuana use. For example, research shows that the gateway hypothesis also works in the other direction—that is, marijuana use comes before tobacco smoking and can lead to nicotine dependence. Emerging evidence on co-use also shows that up to 90% of marijuana users are concurrent tobacco smokers.
  • Cigarillo sales increased by 25% from $800 million in 2010 to over $1 billion in 2014. Cigarillo line extensions that feature marijuana flavor references is an emerging trend.
  • Flavors introduced by Trendsettah, Inc. are being promoted at marijuana trade shows, which suggests that the company may be using these flavors to appeal to marijuana users.
  • At the federal level, the U.S. Food and Drug Administration prohibits characterizing flavors in cigarettes, but this prohibition does not include cigar products.


As states continue to pass marijuana legislation, practitioners and policy makers should stay informed about tobacco industry efforts to capitalize on the rising use of marijuana. Whenever possible, programs and policies should address the intersection of marijuana use and tobacco use.

Myers, Allison E., et al. "Setting the agenda for a healthy retail environment: content analysis of US  newspaper coverage of tobacco control policies affecting the point of sale, 2007–2014." Tobacco Control(2016): tobaccocontrol-2016


Mass media coverage can play an important role in shaping public and policy maker attitudes and opinions about point of sale policies that aim to reduce tobacco use.

This study examined overall news coverage of point of sale tobacco control efforts over an 8-year period in U.S. state and national level newspapers.

Value added

Although previous studies have examined mass media coverage around general tobacco issues, smoke-free laws, and tobacco taxes, this study is the first to focus on mass media coverage of point of sale policies.


  • Tobacco retailer licensing was the most common policy point of sale area discussed in news articles (49.1% of articles).
  • A total of 71.3% of articles presented the frame of regulation, while only 45.3% of articles presented a health frame.
  • Nearly one-third of articles (31.4%) contained no statistical evidence at all.
  • Tobacco retailers and the tobacco industry were included as sources in POS articles much more often than public health advocacy groups, health departments, or health care providers.
  • Half of the articles (51.3%) had a mixed, neutral, or antitobacco control slant.
  • The degree of localization was mixed: 40.5% of articles contained neither a local quote, not a local angle, while 41.8% contained both a local quote and local angle.
    • Articles presenting a health frame, greater number of protobacco control sources, and statistical evidence were more likely to also have a protobacco control slant.


Implications         When working with the media, state and local public health practitioners should use strategies that are more likely to generate mass media coverage with a protobacco control slant, such as providing statistical evidence, sharing narrative stories with a local angle, and framing the issue as a health issue.