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SCTC February 2016 Digest (archived)




February 10, 2016


Dear NCI SCTC Research Initiative partners,


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

Also, we welcome feedback on ways we can improve its format, content, and delivery to make it easier to use. Please send any feedback to

Thank for your support of the NCI SCTC Research Initiative.




The State and Community Tobacco Control Research Initiative Coordinating Center


PI: Matthew C. Farrelly, PhD

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


New Product


Networks among Tribal Organizations for Clean Air Policies (NATO CAP) recently developed three short educational videos about commercial tobacco smoke-free policy and secondhand smoke. The videos communicate research findings from surveys, interviews, and focus groups with Navajo elected officials and community members.

Value added

The videos can be used to stimulate conversations about secondhand smoke and commercial tobacco smoke-free policies in Navajo Nation and among other Tribes. 

Video highlights

  • Video 1 describes the evidence base for smoke-free policies and details the provisions of the 2014 Navajo Nation Executive Order, which creates commercial tobacco smoke-free environments in Navajo government facilities. The video also shares key findings from interviews with Navajo elected officials about secondhand smoke and smoke-free policies. Ninety percent of the elected officials who were interviewed believe that smoke-free policy would improve the health of the Navajo people.
  • Video 2 shares results of community focus groups. Most Navajo citizens characterize secondhand smoke as harmful, noting that it creates new and exacerbates existing health conditions. Focus group participants supported policy measures aimed at protecting the health of all Navajo people, especially vulnerable members of the population. Participants believed that smoke-free policies are a fair compromise between protecting the health of nonsmokers and people with health conditions while preserving an individual’s freedom to choose to smoke. Navajo traditional cultural values can help guide the development of policies protective of health.
  • Video 3 is a personal story about the harmful effects of smoking in the home and describes ways to encourage friends and loved ones to keep indoor air smoke-free.


These videos offer important insights into public and policymaker beliefs about secondhand smoke and support for smoke-free environments in Navajo Nation. Practitioners working in Navajo Nation and with other Tribal populations can use these videos to advance their work to promote smoke-free environments.

New Publications

Combs TB, Moreland-Russell S, Roche J. (2015). Evaluation of measurement tools for tobacco product displays: is there an app for that? doi: 10.3934/publichealth.2015.4.810


The tobacco industry spends more than $750 million each year on product placement in the retail environment, and tobacco product displays are pervasive in convenience stores, supermarkets, and other retailers. Research shows that tobacco product displays at the point of sale (POS) influence product purchase, initiation, and use, particularly among youth and other vulnerable populations.

Store audit studies count the number and types of displays, but most do not attempt to measure the size of displays systematically. This study reported on five tools that measure area or distance in photos, specifically looking at how reliable, valid, and feasible they were for measuring tobacco product displays in stores. Three smartphone apps—EasyMeasure, Partometer 3D, and ON 3D CamMeasure—calculated product display dimensions from a photo after leaving the store. A fourth tool, which was a built-in function of Microsoft Office Suite, calculated the relative area of a display using photos taken from any device. The fifth tool, Narrative Clip, used photos from a “life-logging” wearable camera. This study compared the tools’ measurements to observed measurements using a tape measure and assessed reliability between two testers.

Value added

This study reports on the relative accuracy of existing and new technology in measuring tobacco product displays.

Study findings

Accessibility and ease of use

  • Besides the Narrative Clip wearable camera, these instruments are affordable and widely accessible for tobacco control partners and researchers.
  • The Narrative Clip presented challenges for “covert” in-store use. However, this tool was the newest technology tested in this study and holds promise.


  • Most of the differences between the physical measurements of the displays and the tool measurements were small, but the tools typically underestimated display size. The Partometer 3D was the most accurate tool in the trials.
  • Some tools were sensitive to display size. For larger displays, the tools became less accurate and underestimated size.


  • Most of the instruments produced reliable measures. Inter-rater reliability was the highest for Partometer 3D, ON 3D Cam Measure, and Microsoft Office.


Identifying effective tools that measure product displays can help build the evidence base for tobacco control policies at the point of sale. Practitioners can consider using innovative measurement tools in store audits to add to literature on accurate and feasible ways to measure industry marketing in the retail environment.

D’Angelo HD, Evenson KR, Rose S, Fleishhacker S, Myers AE, Ribisl KE. (2016). Examination of community and consumer nutrition, tobacco and physical activity environments at food and tobacco retail stores in three diverse North Carolina communities. doi: 10.1016/j.pmedr.2015.08.018


The kinds of health promoting resources (or lack, thereof) in one’s neighborhood can affect health behavior choices. In the context of nutrition, researchers have described two key components that influence dietary behavior: community environment (i.e., number, type, and location of food outlets in a community) and consumer environment (i.e., availability, price, and promotion of healthy foods within the outlet itself). Similar distinctions can be made for tobacco and physical activity environments.

Separate lines of research have shown that community and consumer environment measures in nutrition, tobacco, and physical activity environments are associated with diet, smoking, and physical activity. However, few studies have examined associations between these three environments and their related health behaviors/health risk factors.

This study examined the following research questions: (1) At the consumer level, do stores with few healthy foods also have high amounts of tobacco marketing and poor environments for physical activity? (2) At the community level, do neighborhoods with low access to supermarkets also have high tobacco retail density and few community places to exercise? (3) Are consumer and community environments related? For example, do stores located in neighborhoods with high tobacco retail density also have fewer healthy foods available?

This study collected data in and around stores that sold food and tobacco products in three geographically diverse North Carolina counties.

Value added

Previous research has investigated nutrition, tobacco, and physical activity environments in isolation. This study examines the relationships between community and consumer factors in all three environments. Findings from this study may provide important information for practitioners and policymakers looking to address multiple health behaviors within their communities.

Study findings

Community factors

  • Higher tobacco density was associated with more physical activity resources and better supermarket access.
  • Areas with more tobacco, physical activity resources has more favorable walking environments.

Consumer factors

  • Stores with higher amounts of interior tobacco marketing had more healthy food availability.
  • Stores with higher amounts of exterior tobacco marking had lower healthy food availability.


This study encourages public health practitioners to think about the intersection of nutrition, tobacco, and physical activity environments and relationships between community and consumer factors. In the community environment, interventions could focus on increasing access to healthier foods and places for exercise while reducing tobacco advertising and number of retailers. In the consumer environment, interventions at the point of sale could aim to encourage healthy food while discouraging tobacco purchases.

Escoffery C, Bundy L, Haardoerfer R, Berg CJ, Savas LS, Williams RS, Kegler MC. (2015). A process evaluation of an intervention to promote home smoking banks among low income households. doi:10.1016/j.evalprogplan.2015.12.008


Most secondhand smoke exposure occurs in the home. Establishing total household smoking bans reduces secondhand smoke exposure for nonsmokers and children and can also reduce associated health conditions, such as asthma, lung cancer, and heart disease.

The study analyzed data from a smoke-free homes intervention. Participants were recruited from United Way of Greater Atlanta 2-1-1 contact center and were randomly assigned to intervention or control groups. The intervention group received three educational mailings and one coaching call to help them establish smoke-free homes, all in 2-week increments. Researchers collected data at baseline and 3 and 6 months after the intervention.

This process evaluation study reported how the intervention was delivered by trained staff and received by the participants, including their use of the materials and reactions to the program. The study also reported on whether having a full ban was associated with greater engagement with the intervention and whether there were differences between nonsmokers and smokers in reactions and engagement.

Value added

Study findings may show the level of receptiveness to minimal interventions promoting smoke-free homes and identify potential change agents in the home for implementing smoke-free home policies.

Study findings

  • Of the 192 participants surveyed at the 3-month follow-up interview, 92.3% reported receiving all intervention components.
  • Most participants (86.7%) reported that the materials were very easy to understand, and 70.0% reported that the materials were very relevant to them personally.
  • Of the key recommended intervention behaviors, 92.8% of participants had a talk with their household about going smoke free; 76.7% came up with a list of reasons for making their home smoke free; 65.6% used the stickers provided in the intervention materials; 60.6% put up signs; and 56.7% signed a pledge.
  • Participants who had full household bans at 3 months were more likely to conduct the above behaviors than those with no/partial ban.
  • Significantly more nonsmokers found the materials more relevant to them personally than smokers.
  • Among those who received the coaching call, more nonsmokers reported that the call was somewhat/very relevant to them personally than smokers.
  • Although most participants found the information in the call useful, significantly more smokers reported that the call was somewhat/very useful than nonsmokers (95.5% vs. 82.0%).
  • Households with two or more smokers indicated higher satisfaction with the coaching call than households with one smoker, and households without children indicated higher satisfaction with the coaching call than households with children (M = 3.93 vs. M = 3.72).


The findings from this study show that participants were receptive to a minimal smoke-free homes intervention and that the intervention may be feasible in reaching low-income smokers and nonsmokers living in homes with secondhand smoke exposure. Practitioners may consider approaching nonsmokers in households where there are smokers as part of their smoke-free home efforts.

Jiang N, Cortese DK, Lewis MJ, Ling PM. (2015). Booze and butts: a content analysis of the presence of alcohol in tobacco industry lifestyle magazines. doi:


Tobacco and alcohol are the leading and third leading causes of preventable disease and death in the United States, respectively. Every year, tobacco and alcohol prematurely claim well over a half a million American lives. The co-use of tobacco and alcohol is common, particularly among young adults.

Exposure to advertising has been shown to influence health behaviors, such as tobacco and alcohol use. However, there is limited research on advertising that portrays tobacco and alcohol together.

This study examined depictions of alcohol in lifestyle magazines, which were produced by the tobacco industry and sent to smokers via direct mail, primarily in the 1990s-2000s. The study analyzed content in 73 issues of six magazines, including magazine covers, articles, tobacco ads, and nontobacco ads. Investigators aimed to identify (1) how often and where alcohol references were made across the magazines; (2) the types of alcohol featured in the magazines; and (3) if the references differed depending on whether the magazine was oriented toward men or women, or if it was unisex.

Value added

Although the tobacco industry no longer produces most of the lifestyle magazines, findings from this study provide historical evidence on the industry’s marketing tactics used to reinforce the links between tobacco and alcohol use.

Study findings

  • Alcohol was frequently portrayed across multiple sections of the magazines:
    • 19% of magazine covers featured alcohol
    • 37% of articles mentioned alcohol
    • 27% of tobacco ads showed alcohol images
    • 8% of nontobacco ads portrayed alcohol
  • Male-oriented magazines contained the most alcohol references, followed by unisex magazines and female-oriented magazines.
    • Male-oriented magazines mostly mentioned beer, mixed drinks, and liquor or spirits, whereas female-oriented magazines made references to wine and mixed drinks. Unisex magazines mostly mentioned mixed drinks over any other type of alcohol.
  • Mixed drinks were commonly seen in tobacco ads, whereas liquor and spirits were more commonly featured in nontobacco ads.


This study suggests that the industry reinforces dual tobacco and alcohol use through its promotional efforts. Practitioners may want to design interventions that reduce the social acceptability of smoking and drinking and address any favorable perceptions of co-use of these substances. The pairing of tobacco and alcohol may target young men in particular. For this reason, practitioners should also consider tailoring anti-tobacco messaging by gender.

Kalkhoran S, Padilla JL, Neilands TB, Ling PM. (2015). Multiple tobacco product use among young adult bar patrons in New Mexico. doi: 10.1016/j.ypmed.2015.11.024


Use of noncigarette tobacco products is common, and e-cigarette use is increasing among young adults. Smoke-free laws and decreased acceptability of cigarette smoking may be contributing to the increased interest in noncigarette tobacco use, particularly among young adults. Promotional activities for noncigarette tobacco products and e-cigarettes, such as messages promoting their use in bars and nightclubs, may also be a factor. Studies have shown that young adults who go to bars and clubs have a higher risk of future smoking than those who do not, and more frequent bar/club attendance has been associated with current smoking.

The goals of this study were to (1) identify what additional tobacco products young adult bar patrons use along with cigarettes; and (2) describe multiple product users. Young adults completed cross-sectional surveys in bars in Albuquerque, New Mexico, as part of an evaluation of a bar-based intervention to reduce cigarette use. Data were collected over two periods (March–December 2011 and December 2012-2013), 2 and 3 years into the intervention. The products included in the survey included cigarettes, snus, dip, cigars and cigarillos, hookah, and e-cigarettes.

Value added

Although research has focused on the young adult population, this study adds to the literature by examining the use of multiple tobacco products among the young adult bar-going population in particular.

Study findings

  • The percentage of cigarette smoking decreased from 43% to 37% among the study population, but other tobacco product use was unchanged.
  • Overall, the two other tobacco products with the highest prevalence of current use were hookah (27%) and e-cigarettes (18%).
  • Approximately two-thirds of current smokers reported poly-use (65% in 2012-2013).
  • Among current smokers, cigarettes were most commonly used with e-cigarettes (46%) and hookah (44%), followed by cigarillos (24%), dip (15%), and snus (14%) in 2012-2013.
  • Among current smokers, e-cigarette use increased from 28% to 46%, while use of multiple tobacco products decreased. The odds of using multiple tobacco products (vs. cigarettes only) was higher among men and those who reported past 30-day binge drinking.



Practitioners may want to address other tobacco product use, and specifically use of multiple products, among young adults. Additionally, interventions that target young adults should include the bar-going population, who may be at higher risk for poly-use than the general young adult population.

Kegler MC, Haardörfer R, Bundy LT, Escoffery, Berg CJ, Fernandez M, Williams R, Hovell M. (2015). Do partial home smoking bans signal progress toward a smoke-free home? doi: 10.1093/her/cyv/066


The home is often the main source of secondhand smoke exposure for children and nonsmokers. Establishing smoking bans in households can reduce exposure to secondhand smoke, particularly if there is a full ban on smoking at home. In many cases, households may restrict smoking by establishing partial bans (allowing it only at certain times or places within the home). Knowing who establishes partial bans, what they cover, and whether they lead to full bans can inform smoke-free home interventions.

Data for this study were collected from a randomized-controlled trial at baseline, and 3 and 6 months after the intervention. Participants were recruited from United Way Greater Atlanta 2-1-1 contact.

The purpose of this study was to understand the similarities and differences between households with a partial smoking ban and households with no smoking bans. Additionally, study investigators examined whether those with partial bans were more likely to advance to total smoking bans than those with no ban at all.

Value added

This study provides in-depth information on partial smoking bans and whether they indicate a household that is more willing to implement a full ban.

Study findings

  • At baseline, more participants reported having partial bans than no bans (61.3% vs. 38.7%).
  • Having a partial ban (as compared with no ban) was associated with being female, having more than a high school education, being married, and younger age. Households with children under 5 years of age reported higher rates of having a partial ban than no ban (58.7% vs. 41.3%). Households with children age 5-18 had even higher rates of partial bans (65.3%).
  • At the 6-month follow-up, a majority with a partial ban allowed smoking in designated rooms (52.6%), some did not allow smoking in front of children (18.4%), and a few did not allow it when the children were home or in the children’s room (5.6%).
  • Overall, participants who reported a partial ban at baseline reported higher rates of full ban implementation at 6 months (36.5%), compared with participants reporting no ban at baseline (22.1%).
  • Participants were asked to describe their partial smoking bans at the 6-month follow-up.
    • More than half of participants(52.6%)  allowed smoking only in designated rooms, such as the bedroom, bathroom, and living room/common area.
    • Other rules related to children. For example, 18.4% of participants did not allow smoking in front of children, and 5.6% did not allow smoking when children were home or in children’s rooms.



Findings from this study suggest that those with partial bans may be more ready to adopt full home smoking bans; practitioners may want to target households with partial bans in future interventions focusing on full home smoking bans.

Lange T, Hoefges M, Ribisl KM. (2015). Regulating tobacco products advertising and promotions in the retail environment: a roadmap for states and localities. doi: 10.1111/jlme.12326


Tobacco product advertising is linked to adolescent initiation and long-term tobacco use. In response to this, state and local governments and tobacco control advocates are interested in restricting tobacco POS advertising and promotion to prevent youth tobacco initiation and addiction. However, these kinds of state and local-level tobacco control policies face at least two significant legal obstacles in the United States.

First, policies restricting the advertising or promotion of tobacco products may be considered an infringement of First Amendment rights, because a state or local government’s restriction of the advertising and promotional content, or certain restrictions on how such products are sold, may be viewed as an infringement of commercial speech/expression. Second, federal preemption limits the ability of state and local governments to pass policies to regulate advertising for cigarettes and smokeless products. Moreover, local jurisdictions must also consider any state-level preemption.

This paper explains the current state of First Amendment commercial speech doctrine and federal preemption law that should be considered when proposing or introducing new state or local tobacco control policies, and how to navigate around such potential legal challenges to meet the policy goals of reducing youth exposure to tobacco advertising and promotion.

Value added

This paper outlines the complex history of how the First Amendment and preemption doctrine have been applied to various tobacco control policies in the past and provides a helpful roadmap for practitioners to consider in regulating tobacco product advertising and promotion at the state and local levels.

Study findings

Regulatory opportunities—a roadmap for overcoming legal obstacles

  • Navigating the First Amendment: State and local governments that wish to directly limit POS advertising should give careful consideration to how the policy meets the four steps of the Central Hudson commercial speech test, which, among other things, requires that the government show how the policy “directly advances” its public health goals and demonstrates that there is a “reasonable fit” between the goal and proposed policy. Regulations are more likely to survive if: there are other existing regulations already in place that aim to reduce youth smoking, which provide support for the effectiveness of such policies; it can be shown that other kinds of policies have already been considered and rejected because such policies would not sufficiently address the stated goal; and the government has crafted the policy in a way to minimize the impact on commercial speech.
  • Avoiding federal preemption: Broadly speaking, state and local governments are only prohibited from restricting the promotional and advertising content of cigarettes (under the Federal Cigarette Labeling and Advertising Act), and smokeless tobacco (under the 1986 Comprehensive Smokeless Tobacco Health Education Act), but are permitted to restrict the time, manner, and place of cigarette advertising as long as the proposed policy does not violate the First Amendment. States and local governments are not preempted from regulating the content of tobacco advertising and promotion for other noncigarette or non–smokeless tobacco products, although any tobacco control policy that seeks to regulate the content of advertising or promotion will likely be challenged on First Amendment grounds.


Tobacco POS policy interventions that states and local jurisdictions may consider:

  • Regulating price strategies by limiting the redemption of coupons by retailers, and through minimum pricing laws
  • Requiring POS warnings or cessation information that are clearly attributable to the government and are “purely factual or uncontroversial”
  • Focusing on tobacco health warning requirements that apply only to noncigarette tobacco products
  • No tobacco advertising, or promotions or sales near youth-concentrated places, such as schools, playgrounds, and youth centers
  • No tobacco advertising or promotional activities visible before and after school, or during school lunch and vacation periods
  • Tobacco product displays limited to stores with no youth access or portions of stores where access is limited to adults.
  • Restrict size of brand displays by limiting number of tobacco product packages
  • Cap total amount of display space to reduce impact of “power walls”



In light of existing legal challenges, state and local officials considering POS policies may want to adopt the following best practices:

  1. Separately analyze the implications of potential First Amendment and preemption issues.
  2. Carefully document (a) evidence showing the likely effectiveness of the proposed legislation; and (b) consideration of alternative regulatory interventions that do not restrict the freedom of speech or that are less restrictive.
  3. Consider inserting more speech through social marketing campaigns or compelled commercial disclosures (rather than restricting advertising) or explain why such alternatives would be cost-prohibitive or ineffective.
  4. Clearly identify the government interests at stake and demonstrate that the proposed legislation will advance those interests and is not more extensive than necessary.

Lee JGL, Goldstein AO, Pan WK, Ribisl. (2015). Relationship between tobacco retailers’ point-of-sale marketing and the density of same-sex couples, 97 U.S. counties, 2012. doi: 10.3390/ijerph120808790


Tobacco use is higher among lesbian, gay, and bisexual (LGB) people than heterosexuals. There is limited research on why this disparity exists, and neighborhood-level marketing to LGB people has not been studied extensively.

Research has shown that same-sex couples are more likely to live in racially/ethnically diverse, lower-income neighborhoods. These neighborhoods have a high density of tobacco retailers and have historically been targeted by tobacco industry marketing.

This study examined association between census tracts’ rate of same-sex couple households and marketing characteristics of tobacco retailers in 1696 census tracts across 97 U.S. counties. The study used data from the 2010 census and information collected in 2012 store audits of tobacco retail marketing in both the interior and exterior of stores.

Value added

This is one of the largest national audit studies to date and is the first to assess the relationship between neighborhood-level retail tobacco marketing and LGB people.

Study findings

For the most part, tobacco retailers’ tobacco marketing characteristics did not differ substantially by the rates of same-sex couples in their neighborhood. For example:

  • The count of exterior ads was not associated with the same-sex couple rate.
  • Neither flavored cigars nor e-cigarette sales were associated with the same-sex couple rate.

There were small significant relationships found in opposite directions of what researchers had hypothesized:

  • There were higher Newport prices at stores in census tracts with more same-sex male couples and fewer ads at stores in census tracts with both male and female same-sex couples.


Further research at the neighborhood level can explore why LGB populations are at disproportionate risk for tobacco use.

Lisha NE, Neilands TB, Jordan JW, Holmes LM, Ling PM. (2015). The Social Prioritization Index and tobacco use among adult bar patrons. doi: 10.1177/1090198115621867


Young adulthood is an important time for tobacco prevention and control interventions. Young adults frequently self-identify as “social smokers” and often report tobacco use for social benefits.

The Social Prioritization Index (SPI) measures the degree to which young adults place a great importance on their social lives. The SPI measure is easy to administer and can be completed in less than 5 minutes.


The goal of this study was to examine whether the SPI predicts tobacco use. The researchers also conducted a factor analysis to determine if the number of items in the SPI could be reduced while still retaining the index’s relationship with smoking. Young adults completed cross-sectional surveys in bars in seven U.S. cities over 2 years (2012-2014).

Value added

This study adds to the literature by exploring whether the measure of social prioritization can help identify young adults who are at high risk for tobacco use.

Study findings

  • Higher SPI scores were related to an increased likelihood of being a nondaily or daily smoker, compared to a nonsmoker, both independently and while controlling for demographics and other smoking-related attitudes.
  • The factor analysis showed that five items could be dropped from the original 13-item SPI while still maintaining a meaningful measure of how socially oriented individuals are and a strong relationship with smoking.


Researchers and practitioners can use these findings to develop interventions that target young adults at risk for smoking, especially in bars and other risk-taking settings. The quick and easy-to-use reduced SPI measure is an even more efficient way to identify at-risk adults than the original index.


Moreland-Russell S, Combs T, Jones J, Sorg AA. (2015). State level point of sale policy priority as a result of the FSPTCA. (2015). doi: 10.3934/publichealth.2015.4.681


The 2009 Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) gave U.S. states and localities the ability to adopt and enforce legislation that restricts the time, place, and manner (but not content) of tobacco advertising. Thanks to this important provision, state and local governments are exploring POS policies in the following areas: (1) address licensing and restrict density; (2) use nontax approaches to raise tobacco prices; (3) restrict product placement; (4) restrict advertising at the point of sale; (5) require health warnings; and (6) other POS policies (such as banning flavored tobacco products and requiring minimum pack size).

Traditional tobacco control policy efforts (e.g., smoke-free laws, tobacco taxes, and restricting the sale of tobacco to minors) remain the core of most state and community tobacco control efforts. States and localities, especially those who have made progress in traditional tobacco control policy areas, are now moving forward with policies in the retail environment. However, the legal feasibility of these policies and the lack of existing U.S.-based evidence for their effectiveness pose challenges.

This study explored the impact of the Tobacco Control Act on POS policy development in state tobacco control programs. Researchers conducted interviews with state tobacco control points of contact in 48 states in 2012 and 2014. During the interviews, state program staff rated the importance of focusing on POS interventions in their programs. Using a mixed-method approach of logistic regression and thematic analyses, the study explored perceived importance of POS interventions in state tobacco programs.

Value added

This study is the first to assess how states rank the importance of POS policy work since the passage of the Tobacco Control Act. Understanding the factors that influence the importance of this work and challenges encountered by states can inform policy efforts.

Study findings

  • Most tobacco control staff reported that POS policies had become more important to their programs over time.
    • In 2012, 58% said that POS policies had become more important since the passage of the Tobacco Control Act.
    • By 2014, 75% reported that POS policy work had become more important to their programs.
  • Program staff who reported increased importance mentioned that there was greater awareness about local authority and tools available to support their policy work. Staff who reported that POS work was the same or less important described challenges, such as limited funding, competing priorities, and lack of capacity to do POS work.
  • A logistic regression model explored state-level factors that affect the importance of POS policies.
    • As the proportion of state tax revenue from tobacco increased or the years since the tax was raised increased, respondents were less likely to say that POS policy had become more important.
  • As states’ smoke-free air ratings increase or time passes since the Tobacco Control Act, respondents were more likely to say that POS policies had become more important.


This study shows that state tobacco control programs consider POS policy work to be an important tobacco control strategy, but barriers remain that pose challenges to their efforts. The tobacco control community can continue to offer support to help state programs address these challenges and be successful with POS efforts.

Pesko MF, Kenkel DS, Wang H, Hughes JM. (2015). The effect of potential electronic nicotine delivery systems regulations on nicotine product selection. doi: 10.1111/add.13257


Electronic nicotine delivery systems (ENDS) have drastically changed the tobacco marketplace in recent years. Sales of e-cigarettes in the United States have increased from $20 million in 2008 to $1.5 billion in 2014, while sales of cigarettes have gradually fallen. Regulating ENDS is complicated because consumers may not be aware of the relative risks of ENDS compared with cigarettes and because ENDS have potential value as harm reduction devices.

This study assesses the influence of price, warning labels, and flavors on smokers’ preferences between ENDS products using a discrete choice experiment (DCE) design. In a DCE, respondents make hypothetical choices to purchase products and product attributes are varied to identify consumer preferences. In a series of choice experiments, this study presented participants with different ENDS options (varying price, warning labels, and flavors) and asked whether they would choose their preferred cigarette brand, nicotine replacement therapy, or the ENDS product.

Value added

This study contributes evidence that can be used by policymakers as they consider ENDS regulations addressing price, warning labels, and flavors.

Study findings

  • Increasing the cost of ENDS from $3 to $6 was associated with a 13.6% drop in ENDS selection.
  • Restricting flavor availability reduced ENDS selection by 2.1%.
  • The proposed FDA warning label reduced ENDS selection by 1.1%, and the (more stringent) MarkTen warning label reduced ENDS selection by 5.1%.
  • Young adult smokers were 3.7% more likely to choose ENDS when multiple flavors were available than were older adults.


Practitioners can use this information to educate policymakers about the impact of price, warning labels, and flavors on smokers’ decisions to purchase ENDS. ENDS policies that increase prices and feature warning labels may discourage adult smokers from switching to ENDS. Limiting flavor availability may reduce ENDS use by young adult smokers and decrease the appeal of the products to adolescents.

Rose SW, Emery SL, Ennett S, Reyes HLM, Scott JC, Ribisl KM. (2015). Retailer opinions about and compliance with Family Smoking Prevention and Tobacco Control Act point of sale provisions: a survey of tobacco retailers. doi: 10.1186/s12889-015-2231-2


The Tobacco Control Act established new sales and marketing provisions at the point of sale. Tobacco retailers are often seen as tobacco industry allies because of the money generated through tobacco sales at their stores. However, previous research has shown that most retailers are compliant with the Tobacco Control Act’s POS provisions.

In this study, researchers interviewed 252 tobacco retailers (store managers, clerks, and owners) in three North Carolina counties about their opinions of POS policies. They linked these opinions with data from in-person audits of the stores’ compliance with POS policies.

Value added

This is the first study that investigates the association between retailer opinions of POS policies and store compliance with these provisions. Understanding the relationship between the two can provide insight on how to promote compliance with the Tobacco Control Act. This study provides rich information about barriers to compliance that can be useful to practitioners and policymakers.

Study findings

  • Store audits found that 16% of the 252 stores were noncompliant with Tobacco Control Act provisions.
    • The most common violations included sales of modified risk labeled cigarettes (e.g., “light” or “low tar”) in 13% of stores, and self-service displays of cigarettes or smokeless tobacco in 2% of stores.
  • Less than half of retailers (43%) were aware of the Tobacco Control Act provisions 3 years after its implementation.
  • Almost all respondents (97%) had at least one source of information about tobacco control regulations. The most common source were bosses/store managers (86%), while almost 70% of retailers cited tobacco companies as a usual source of information. Only 24% of retailers cited government agencies as a usual source of information about regulations.
  • Overall, 41% of owners and managers noted at least one barrier to complying with the regulations. The most common barrier was that making changes to how tobacco is sold hurt their business (29%). Less than one-quarter noted that it was too hard to redo space/displays (24%), took too much time to make the required changes (23%), or was too expensive (22%).
  • Over 90% of retailers supported minors’ access policies (fines for retailers that sold tobacco to minors and increased fines for repeat sales), while over 40% supported graphic warning labels and promotion bans. The menthol ban provision had the least support of the various Tobacco Control Act provisions (17%).



Practitioners may consider working with retailers as stakeholders in tobacco control efforts, rather than viewing them as adversaries. Interventions may focus on strengthening retailer support for policies and removing barriers to implementation to promote compliance with the Tobacco Control Act.




Upcoming Event



Register Now! Forum on Emerging Science in Tobacco Control

We are excited to announce that the Emerging Science in State and Community Tobacco Control Policy and Practice forum will be held on May 4, 2016, in Washington, DC. This forum, hosted by RTI International and the SCTC research initiative, aims to stimulate dialog among policymakers, researchers, and practitioners about the critical needs and lessons learned in state and community tobacco control.

Who? Since 2011, the National Cancer Institute’s SCTC research initiative has funded leading investigators to address critical gaps in state and community tobacco control, such as secondhand smoke policies and mass media strategies. Howard Koh, MD, MPH, former Assistant Secretary of the U.S. Department of Health and Human Services, will moderate the forum, and panelists who have researched and implemented tobacco control policies and practices will share their emerging knowledge.

What? A forum open to policymakers, advocacy groups, federal agencies, partners, and press. The SCTC research initiative and partners will discuss how research findings from the last 5 years have informed policy and practice, and how this research helps to advance tobacco control locally and nationally. 

When? Wednesday, May 4, 2016, 1:00 p.m.–4:00 p.m., ET. Registration for onsite attendees will begin at 12:30 p.m. ET.

Where? There are two ways you can join the forum:

  1. Attend in person at the National Press Club.
  2. Watch the event through a live stream.


Register Now! Please find additional details and register by visiting the Eventbrite page. Click the Register button if you plan on attending in person or via the live stream. Seating is limited at the National Press Club, and you must register to attend. The event staff will send updates, including the livestream URL, to the e-mail provided in the registration form.

Questions? E-mail the SCTC Coordinating Center at