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Do Assurances of Voluntary Compliance Reduce Youth Access and Marketing?

Institution: Stanford University
Investigator(s): Lisa Henriksen, Ph.D.
Award Cycle: 2016 (Cycle 25) Grant #: 25IR-0026 Award: $461,386
Subject Area: State and Local Tobacco Control Policy Research
Award Type: High Impact Research Project Award

Initial Award Abstract

Assurances of Voluntary Compliance (AVCs) are agreements between the California Attorney General and more than a dozen national retail chains that require retailers to adopt “best practices” with goal of reducing tobacco sales to minors.  AVCs are contracts that also restrict the content and placement of tobacco marketing at the point of sale, and cannot be challenged under the First Amendment. Specifically, the marketing provisions: (a) prohibit imagery in tobacco advertising by limiting content to brand names, logos, and prices, and (b) confine tobacco advertising to the product display area (typically behind the counter). Established between 2002 and 2011, AVCs affect approximately 7,400 of the 35,000 licensed tobacco retailers in California. However, the efficacy of AVCs to reduce youth access and retail tobacco marketing has not been evaluated. The proposed research would fill this important gap.

Conducted in consultation with the Tobacco Litigation and Enforcement Section of the Office of the California Attorney General, this high-impact research has three aims: to evaluate the efficacy of AVCs to reduce underage access to cigarettes (Aim 1) and to restrict the content and placement of tobacco advertising at the point of sale (Aim 2). The proposed research is also designed to test a spillover effect of AVCs on reducing underage access to e-cigarettes (Aim 3).  To address Aim 1, secondary analyses of multiple data sources about tobacco sales to minors are proposed. Data for compliance checks will be obtained from public data maintained by the US Food & Drug Administration (FDA) and from the California Department of Public Health. We will code these records to determine which stores had AVCs in place at the time of inspection, and conduct multivariable logistic regressions to test (H1) whether AVC stores are less likely than non-AVC stores to sell tobacco to minors, adjusting for store type.

To address Aims 2 and 3, we propose to conduct a novel marketing surveillance and youth purchase survey in licensed tobacco retailers (n=540) that will be sampled randomly from two strata: “treatment” stores with AVCs and “matched control” stores without AVCs, youth and adults will record outcome data about tobacco marketing, request for ID, and illegal sales. Multivariable logistic regressions that adjust for store type and other covariates will test whether: (H2) AVC stores are less likely than non-AVC stores to contain image advertising for tobacco products and to place tobacco advertisements outside the primary display area (which examines compliance with marketing provisions of AVCs), and (H3) AVC stores are less likely than non-AVC stores to sell e-cigarettes to minors, which examines a spillover effect of AVCs on compliance with state law.

The proposed dissemination plan targets multiple stakeholders, with a long-term objective to inform state and local decisions about future allocation of resources to this policy intervention, both in California and the other 46 states that have signed AVCs. The proposed research is both innovative and timely. Youth access to tobacco and exposure to unregulated tobacco marketing at the point of sale are significant public health concerns. In addition, California has banned the sale of e-cigarettes to minors since 2010, but compliance with this law has not yet been assessed or enforced. The study results could also guide state and local health departments about how AVCs may be adapted to better regulate the retail environment for tobacco and to negotiate the terms of a “healthy retailer” license.