Introduction: E-cigarettes have surpassed other tobacco products and emerged as the most popular tobacco/nicotine product used by adolescents. About 3.6 million middle and high school students were current (past 30 days) users of e-cigarettes in 2018, including 4.9% of middle school students and 20.8% of high school students (Cullen et al., 2018). Adolescents are exposed to the various harmful effects of nicotine, chemicals, heavy metals and flavorings in e-cigarettes and the long-term health effects are still unknown. Youth are widely exposed to e-cigarette advertisements from four major sources; at retail stores, via Internet, through television and through newspaper or magazines. According to the CDC, 14.4 million youths are exposed to e-cigarette advertisement at retail stores, 10.5 million youths are exposed via the Internet, 9.6 million youths are exposed via television or movies and 8 million youths are exposed via newspaper or magazines (CDC, 2018). Previous research showed strong association between exposure to e-cigarette advertising and youth susceptibility to use e-cigarettes, but there is an apparent gap in knowledge that focused specifically on the impact of Internet advertisements on intention to use e-cigarettes. Our study aims to compare the effect of Internet and conventional advertisement exposure on intention to use e-cigarettes among U.S. adolescents.

Methods: Secondary data analysis using the 2017 National Youth Tobacco Survey (NYTS) involving all public and private school students enrolled in middle and high school (grade 6 through 12) in the 50 U.S. states and the District of Columbia. A cross sectional study design was used involving a total of 17,872 participants. Descriptive statistical analysis and logistic regression were performed.

Results: In response to the two items measuring intention in the NYTS, 14312 participants expressed no intention to initiate e-cigarettes use and 1793 expressed intention to initiate e-cigarette use "soon" and "in the next year". Exposure to Internet e-cigarette advertisement was a significant predictor for intention to use e-cigarette (p<0.001). Current cigarette smoking status was another significant predictor for intention to use e-cigarettes (p<0.001). Cigarette smokers in general had greater intentions to initiate e-cigarette use than non-cigarette smokers when exposed to Internet advertisements. Conventional advertisement exposure (via newspaper/magazines, retail stores and television) was also a significant predictor for intention to use e-cigarette (p<0.001). When exposed to conventional advertisements, cigarette smokers in general showed higher intention to use e-cigarettes when compared with non-smokers.

Conclusion: Internet advertisement exposure has been associated with higher intention to initiate e-cigarette use among American adolescents.

Background. The Philippines is the fifth largest consumer of cigarettes in the world, largely boosted by what has been dubbed the strongest tobacco lobby in Asia. While the country has passed the Tobacco Regulation Act, no law bans the advertisement of tobacco products at points of sale (POS) in both traditional (sari-sari stores) and modern (supermarkets, gas stations, restaurants) outlets in the Philippines. This study documented the forms of cigarette advertising present at the POS for both modern and traditional retailers in order to provide evidence for a POS advertising ban in the country.

Methods. Data was gathered through a validated observation checklist administered by trained data collectors on 702 randomly selected traditional stores (TS) and 144 modern stores (MS) across six major cities in the country. Descriptive and inferential statistics were utilized to quantify the characteristics of the POS advertising.

Findings: Overall, 68% of TS and 44% of MS were observed to have some form of cigarette advertising within the POS. The most common forms of advertising were posters and stickers. Advertising in TS mainly showed cigarette pricing, ensuring retail prices were kept low, while advertising in MS consisted of general advertising that displayed the cigarette’s brand name and tagline. About 57% of the MS with POS advertising had ads located near the checkout counter, the area that gets the most traffic. More than half (58.5%) of the TS displayed cigarettes visibly in front of the store or in a special display box. Stores who received visits from more than two tobacco companies were significantly more likely to have POS advertising than those who received visits from only one (p=0.000). Stores in cities that did not have comprehensive anti-smoking ordinances were significantly more likely to have POS advertising (p=0.014) than cities that did, with three out of every four stores displaying cigarette-related fliers or posters.

Conclusion: This is the first nationwide study in the Philippines to document the presence of POS advertising in both traditional and modern stores. We recommend the implementation of a nationwide tobacco display and advertising ban such as in other Southeast Asian countries, which have been shown to reduce smoking prevalence by 16%.

Background: Current research suggests that flavored tobacco use is considerably high among the LGBTQ population. The purpose of this study is to assess community knowledge, attitudes, and perceptions regarding tobacco and health as well as the adoption of ordinances to prohibit or restrict the sale and distribution of all flavored tobacco products, including menthol cigarettes within one jurisdiction in Los Angeles County.

Method: A public intercept survey was conducted during events with large LGBTQ in attendance such as Pride festivals within Los Angeles County. The survey instrument consisted of 12 questions related to knowledge (3) questions related to tobacco and health, attitude/belief (7) questions about policies that prohibit or restrict the sale and distribution of all flavored tobacco products, including menthol cigarettes, and behavior (2) question related to smoking behavior. Data analysis was conducted using descriptive statistics and chi-square analysis.

Results: A convenience sample of 464 participants fully completed the survey. Results showed differences in knowledge, attitudes and behaviors on smoking and health among the LGBTQ population in LA County by gender, sexual orientation and age. Results also showed lack of knowledge among the LGBTQ population, and lack of support for tobacco policies that restrict the sale and distribution of flavored tobacco products. Furthermore, the LGBTQ population was significantly more likely to be current smokers compared to their heterosexual counterpart.

Conclusion: The findings suggest that efforts to reduce flavored tobacco use may have the potential to reduce tobacco use and tobacco diseases and death among LGBTQ population particularly when interventions are tailored to specific age and gender groups. Targeted efforts to educate the LGBTQ population about the positive impact of implementing policies driven systems change interventions that focus on flavored tobacco are imperative. Finally, more research is needed that investigate the psychological, social and cultural factors underlying LGBTQ smoking behavior.

Background: San Francisco has long required all retailers to obtain a tobacco retail license for the privilege of selling tobacco. Since 2010, a variety of additional local and state laws have added restrictions to the local tobacco retail environment, intended to protect youth and vulnerable communities. These include adoption of a pharmacy sales prohibition, requirement of e-cigarette vendor licensing, changing the minimum tobacco sales age to 21, substantial state tobacco tax increase, and an ordinance prohibiting the sale of flavored tobacco products. Methods: In 2014, San Francisco adopted a retailer density cap with the aim of both monitoring and reducing the number of permitted tobacco retail establishments citywide. The San Francisco Department of Public Health and youth partner agencies had spent years researching this issue using a health equity lens and determined that neighborhoods with an equal number of residents had vastly unequal distribution of permitted tobacco sales locations. One district had only 37 tobacco permits for approximately 75,000 middle-income residents while another neighborhood with a disproportionately large youth, minority, and low income population had 180 tobacco retail locations for 75,000 residents. The ordinance placed a future cap of 45 tobacco permits per district, not taking away active permits, and not allowing any new permits in an overburdened district. Results: The density of local tobacco retail permits has been monitored on a quarterly basis and shows a net reduction of 232 tobacco permits citywide between June 2014 (970) and January 2019 (738), a 24% citywide reduction in permits due to attrition as well as changing city demographics. Conclusions: The greatest reduction was seen in the most heavily burdened district; tracking shows the dramatically lower income SOMA/Tenderloin neighborhood with 123 fewer permitted tobacco sales locations (a 32% reduction). Density limits appear to increase equitable distribution of tobacco sales locations.

Issue: Baseline tobacco retail density is highly differential across neighborhoods. Lower-SES communities are exposed to more tobacco retailers, more prolific and prominent tobacco advertising in their stores, and steeper discounts on tobacco products. By no coincidence, tobacco use is also higher among low-SES groups, and these groups bear a disproportionate burden of tobacco-related diseases. Restricting certain types of retailers (such as pharmacies) from selling tobacco products has emerged as a promising strategy for reducing overall tobacco retail density. These policies may differentially impact communities with more retailers of that type, and thus implicate health equity.

Description: A progressive density policy would harness a health equity rationale to prohibit tobacco sales by retail categories that target low-SES neighborhoods. For instance, “discount retailers” (e.g., dollar stores) are rapidly expanding in lower-income urban and rural areas, even as other retail categories are shrinking across the nation. New York State has, at minimum, 680 discount retailers, and more stores are planned.

Lessons Learned: This presentation explores the current tobacco retail environment to examine trends in the density of discount retailers, including through geospatial analysis of existing and planned stores. We will explore whether prohibiting discount retailers from selling tobacco is a feasible public health policy for local governments, drawing from lessons learned from zoning policies targeting discount retailers in order to increase healthy food availability.

Recommendations: We will introduce a model definition for this retail category, mindful of minimizing equal protection and other legal claims. We will detail implementation of a policy through local retail license requirements, and share other best practices. For instance, tobacco control advocates may amplify their work by collaborating with advocates for healthy food availability, who share interest in regulating the discount retail category.