Underutilisation of no-tobacco-sale orders against retailers that repeatedly sell to minors, 2015-2019, USA.

IMPORTANCE: Research demonstrates that policies aimed at retailers who sell to minors must be strongly enforced to have an impact on youth usage rates. OBJECTIVES: In the USA, the Food and Drug Administration (FDA) conducts compliance checks, issues fines, and can order retailers to stop selling tobacco products (ie, no-tobacco-sale orders (NTSOs)) to enforce the Family Smoking Prevention and Tobacco Control Act. We sought to assess FDA's utilisation of NTSOs. METHODS: We conducted a quantitative content analysis of FDA's enforcement actions for inspections decided between 1 October 2015 and 29 March 2019. From the 536 134 inspection records we identified 148 NTSOs and 249 720 unique retailer locations, of which 2095 had three or more violations. We randomly sampled NTSOs (n=76) and retail locations (n=152) with frequent violations. We calculated the proportion of NTSOs that could have been issued earlier by FDA. We then calculated the proportion of retailers that could have been issued an NTSO, and the proportion actually issued an NTSO using FDA's approach and a more stringent approach. RESULTS: Among NTSOs, 94.7% (95% CI: 89.8% to 97.4%) of NTSOs could have been issued earlier under a more stringent approach. On average, when an NTSO could have been issued earlier, it could have been issued 453 days earlier (95% CI: 418 to 489; range: 89-1159). Among frequently violating retail locations, 73.6% (95% CI: 66.0% to 80.0%) were eligible for an NTSO. Of those, 1.9% (95% CI: 0.5% to 7.0%) had received an NTSO. CONCLUSIONS: The FDA's failure to fully leverage its powers to address retailers' underage sales of tobacco products has weakened efforts to curb the youth e-cigarette epidemic.

Strengthening a Tobacco-Free College Campus Policy Through Signage: GIS Mapping for Advocacy to Improve Implementation.

Implementing tobacco-free policies on university campuses has become increasingly common. However, promoting policy compliance remains a challenge. It is important to develop strategies that can overcome barriers to successful policy implementation and promote compliance. This Practice Note presents a case study of a practical strategy for addressing poor implementation of a newly adopted tobacco-free policy. Following principles of advocacy research, a team of student researchers and a faculty advisor developed a protocol to identify tobacco-related signage and environmental cues for tobacco use (e.g., cigarette-butt receptacles, designated smoking areas) on campus. Ten months after a tobacco-free campus policy went into effect, we identified 153 signs and 65 environmental cues. Of these, only two signs accurately described the current policy. Mapping signage and cues to use tobacco on campus can be an important advocacy tool to improve the implementation of tobacco-free campus policies. Increased adherence to new policies can be achieved through advocacy and outreach to university administrators.