Changes in the Point-of-Sale Among Vape Shops in Six U.S. Metropolitan Areas Over Time, 2018-2021.

INTRODUCTION: E-cigarette retail surveillance is needed during regulatory changes, like the U.S. increasing minimum legal sales age to 21 (T21) and flavor restrictions (2019 and 2020) and certain state/localities increasing related restrictions. AIMS AND METHODS: We examined regulatory compliance (eg, minimum-age signage), promotional strategies (eg, health claims), and products at 2 timepoints among vape shops across six U.S. metropolitan statistical areas (MSAs; Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, Seattle). In summer 2018, pairs of trained auditors assessed randomly selected shops (n = ~30/MSA). In fall 2021, audits were conducted among 2018 shops (if open and allowed) and additional randomly selected shops (n = ~20/MSA). Data from 179 shops in 2018 and 119 in 2021 (43 from the 2018 sample) were compared. RESULTS: There were decreases (p < .01) in the proportion of shops with (1) minimum-age signs (90.5% vs. 73.9%), (2) their own e-liquid brand (68.2% vs. 44.5%), onsite vaping (73.2% vs. 46.2%), counter seating (65.2% vs. 34.5%), and e-liquid sampling (90.0% vs. 33.6%), and (3) signs with product/price promotions (89.9% vs. 65.5%), health/cessation claims (29.1% vs. 12.6%), and cartoon imagery (27.4% vs. 11.8%). The proportions selling wet/dry vaporizers (26.4% vs. 39.5%), CBD products (23.3% vs. 71.4%), and pipes/glassware/papers (18.4% vs. 52.9%) increased. In 2021, many sold THC (12.6% e-liquids, 62.2% other products) and kratom (40.3%). CONCLUSIONS: With increasing restrictions (eg, on flavors, sampling, and T21), fewer shops sold their own e-liquid brands or accommodated onsite use/sampling, but fewer also posted minimum-age signage. Notably, more offered cannabis-related products. These changes underscore the need for comprehensive surveillance to assess regulatory impact. IMPLICATIONS: The past 6 years marked increasing e-cigarette sales restrictions in the United States, yet limited research has examined the implications for tobacco specialty shops selling e-cigarettes. This study found that, from 2018 to 2021, there were significant decreases in the proportion of vape shops with their own e-liquid, onsite vaping, e-liquid sampling, lounge/counter seating, and price promotions, as well as minimum-age signs. There were increases in the proportion selling cannabis-derived products and related paraphernalia. Tobacco control research and regulatory agencies must consider how tobacco specialty stores have evolved alongside legislative changes that impact them and consumers.

Brief report on IQOS point-of-sale marketing, promotion and pricing in IQOS retail partner stores in Atlanta, Georgia, USA.

OBJECTIVES: Philip Morris has a history of aggressive marketing tactics in its global pursuit of IQOS sales, which extant literature suggests may appeal to non-smokers and young adults. This study was the first to examine point-of-sale (POS) marketing and pricing of IQOS after it entered the US market in October 2019. METHODS: Trained field staff assessed 75 retail partner stores selling IQOS/HeatSticks in the Atlanta area in February-November 2020 using an IQOS-tailored, standardised assessment tool. The tool assessed store characteristics, product availability and accessibility, marketing and promotions and pricing for each store. RESULTS: All stores assessed sold HeatSticks in at least one of the three flavours (tobacco, smooth menthol, fresh menthol), but did not sell the IQOS device. IQOS/HeatSticks marketing was present inside 98.5% and outside 17.3% of stores assessed. Marketing for other tobacco products was present inside 98.5% and outside 32% of stores. The average price per HeatSticks pack was US$6.40 compared with US$6.08 for Marlboro Red cigarettes. CONCLUSION: Our study revealed a considerable amount of POS marketing and promotion for IQOS/HeatSticks at retail partner locations, visible to all retail consumers, including youth and non-smokers. This study was the first to examine IQOS POS marketing and promotion in the US context and findings add to the extant literature on IQOS global marketing strategies. As additional novel tobacco/nicotine products continue to enter the market, targeted monitoring of the POS marketing and promotion for these new products is warranted.

Vape Shop Owners/Managers' Opinions About FDA Regulation of E-Cigarettes.

INTRODUCTION: In the United States, prominent sources of vaping products are specialty vape shops, which are subject to Food and Drug Administration (FDA) regulation. This study interviewed vape shop owners/managers to assess: (1) reasons for entering into or engaging in vape shop retail; (2) personnel training, particularly with regard to FDA and state regulations; and (3) how existing regulations are perceived and the anticipated impact of future regulation. AIMS AND METHODS: The current study involved phone-based semi-structured interviews of 45 vape shop owners/managers in six metropolitan statistical areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle) during Summer 2018 as FDA regulations regarding minimum age verification, bans on product sampling, and health warnings (among others) were first being implemented. RESULTS: Vape shop owners/managers reported: (1) entering the industry with positive intentions for their customers, (2) training their personnel to adhere to regulations and provide good customer service, and (3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors. CONCLUSIONS: These findings indicate the complexities in implementing tobacco regulations, particularly from the perspective of the vape shop industry. Current findings should inform future regulatory actions and efforts to assess compliance with regulations. IMPLICATIONS: Current and impending FDA regulation of vaping products present a critical period for examining regulatory impact on the vape shop industry. Current results indicated that many vape shop owners/managers reporting positive intentions for engaging in the vaping product industry and in training vape shop personnel to adhere to regulations. However, the majority reported concerns about FDA regulation and other state/local regulations that could have negative implications for their industry. Particular concerns include difficulty understanding the regulations due to complexity, vagueness, and changes in language and/or interpretation over time. These issues have implications for compliance that must be addressed.

Exploring the Point-of-Sale Among Vape Shops Across the United States: Audits Integrating a Mystery Shopper Approach.

INTRODUCTION: Vape shops represent prominent, unique retailers, subject to Food and Drug Administration (FDA) regulation in the United States. AIMS AND METHODS: This study assessed compliance of US vape shop retail marketing strategies with new regulations (eg, required age verification, prohibited free samples) and pre-implementation conditions for other regulations (eg, health warning labels on all nicotine products, required disclosures of e-liquid contents). RESULTS: 95.0% of shops displayed minimum-age signage; however, mystery shoppers were asked for age verification at 35.6% upon entry and at 23.4% upon purchase. Although 85.5% of shops had some evidence of implementing FDA health warnings, 29.1% had signage indicating prohibited health claims, 16.3% offered free e-liquid samples, 27.4% had signage with cartoon imagery, and 33.3% were within two blocks of schools. All shops sold open-system devices, 64.8% sold closed-system devices, 68.2% sold their own brand of e-liquids, 42.5% sold e-liquids containing cannabidiol, 83.2% offered price promotions of some kind, and 89.9% had signage for product and price promotions. CONCLUSIONS: Results indicated that most shops complied with some implementation of FDA health warnings and with free sampling bans and minimum-age signage. Other findings indicated concerns related to underage access, health claims, promotional strategies, and cannabidiol product offerings, which call for further FDA and state regulatory/enforcement efforts.

A Menu to Evaluate Factors Influencing Implementation of Obesity Prevention Early Care and Education Regulations.

CONTEXT: In recent years, several states have adopted new regulations concerning nutrition, physical activity, and screen time in early care and education (ECE) settings to help prevent childhood obesity. OBJECTIVE: To disseminate a menu of factors that facilitate and/or impede implementation of obesity prevention regulations in ECE settings. DESIGN: To create the menu, we condensed and categorized factors identified in the literature and through field work by placing them within domains. We applied the menu by conducting semistructured interviews during a pilot test assessing implementation of ECE regulations in Colorado. SETTING AND PARTICIPANTS: We first interviewed state and local government agency leaders responsible for policy oversight, and state employees and contractors who acted as intermediaries to direct implementers. We then interviewed directors at ECE centers in the Denver, Colorado, area. We selected 21 ECE centers for a site visit on the basis of feasibility, percentage of low-income families, and diversity in race and ethnicity at each center. Seven centers participated. MAIN OUTCOME MEASURES: Minor and major facilitators and impediments to implementation of childhood obesity prevention regulations in ECE settings. RESULTS: The resulting menu includes 7 domains and 39 factors influential for implementation of ECE regulations. Of these 39 factors, interviewees identified 7 facilitating factors (4 major and 3 minor) and 2 impeding factors (both major). Major facilitating factors were buy-in from parents/caregivers, training and communication provided by governing authority and their contractors, and low level of change required by the regulations themselves. Major impeding factors were timing of implementation and balancing the demands of the regulations against other priorities. CONCLUSIONS: The menu developed by our research team, combined with existing frameworks in dissemination and implementation research, can be used by researchers, practitioners, and policy makers to anticipate factors that facilitate and/or impede implementation of ECE policies to prevent childhood obesity.

'No, the government doesn't need to, it's already self-regulated': a qualitative study among vape shop operators on perceptions of electronic vapor product regulation.

While the market share of electronic vapor products (EVPs), sold primarily through vape shops and other outlets, has increased rapidly, these products remained largely unregulated until 2016. This study, conducted prior to announcement of the deeming regulations, provides insights into vape shop operator attitudes toward potential government regulations of EVPs. In 2015, we conducted 37 in-person interviews of vape shop operators across nine US cities. Shops were identified through extensive web-searches. We used QSR International's NVivo 11 qualitative data analysis software to analyze the transcripts. Many vape shop operators viewed regulations requiring safe production of e-liquids, child-resistant bottles and listing e-juice ingredients as acceptable. They disagreed with the elimination of free samples and bans on flavored e-liquid sales, which generate significant revenue for their stores. Many held negative perceptions of pre-market review of new product lines and EVP-specific taxes. All agreed that EVPs should not be sold to minors, but most felt that owners should not be fined if minors visited vape shops. Findings from this study offer insights into the acceptability of proposed regulations, as well as barriers to effective regulation implementation.

Prices for Tobacco and Nontobacco Products in Pharmacies Versus Other Stores: Results From Retail Marketing Surveillance in California and in the United States.

OBJECTIVES: To examine disparities in the price of tobacco and nontobacco products in pharmacies compared with other types of stores. METHODS: We recorded the prices of Marlboro, Newport, the cheapest cigarettes, and bottled water in a random sample of licensed tobacco retailers (n = 579) in California in 2014. We collected comparable data from retailers (n = 2603) in school enrollment zones for representative samples of US 8th, 10th, and 12th graders in 2012. Ordinary least squares regressions modeled pretax prices as a function of store type and neighborhood demographics. RESULTS: In both studies, the cheapest cigarettes cost significantly less in pharmacies than other stores; the average estimated difference was $0.47 to $1.19 less in California. We observed similar patterns for premium-brand cigarettes. Conversely, bottled water cost significantly more in pharmacies than elsewhere. Newport cost less in areas with higher proportions of African Americans; other cigarette prices were related to neighborhood income and age. Neighborhood demographics were not related to water prices. CONCLUSIONS: Compared with other stores, pharmacies charged customers less for cigarettes and more for bottled water. State and local policies to promote tobacco-free pharmacies would eliminate an important source of discounted cigarettes.

Estimating cigarette tax avoidance and evasion: evidence from a national sample of littered packs.

INTRODUCTION: A number of recent studies document the proportion of all cigarette packs that are 'contraband' using discarded packs to measure tax avoidance and evasion, which we call tax non-compliance. To date, academic studies using discarded packs focused on relatively small geographical areas such as a city or a neighbourhood. METHODS: We visited 160 communities across 38 US states in 2012 and collected data from littered cigarette packs as part of the State and Community Tobacco Control (SCTC) Research Initiative and the Bridging the Gap Community Obesity Measures Project (BTG-COMP). Data collectors were trained in a previously tested littered pack data collection protocol. RESULTS: Field teams collected 2116 packs with cellophane across 132 communities. We estimate a national tax non-compliance rate of 18.5% with considerable variation across regions. Suburban areas had lower non-compliance than urban areas as well as areas with high and low median household income areas compared with middle income areas. DISCUSSION: We present the first academic national study of tax non-compliance using littered cigarette packs. We demonstrate the feasibility of meaningful large-scale data collection using this methodology and document considerable variation in tax non-compliance across areas, suggesting that both policy differences and geography may be important in control of illicit tobacco use. Given the geography of open borders among countries with varying tax rates, this simple methodology may be appropriate to estimate tax non-compliance in countries that use tax stamps or other pack markings, such as health warnings.

Relative and absolute availability of healthier food and beverage alternatives across communities in the United States.

OBJECTIVES: We examined associations between the relative and absolute availability of healthier food and beverage alternatives at food stores and community racial/ethnic, socioeconomic, and urban-rural characteristics. METHODS: We analyzed pooled, annual cross-sectional data collected in 2010 to 2012 from 8462 food stores in 468 communities spanning 46 US states. Relative availability was the ratio of 7 healthier products (e.g., whole-wheat bread) to less healthy counterparts (e.g., white bread); we based absolute availability on the 7 healthier products. RESULTS: The mean healthier food and beverage ratio was 0.71, indicating that stores averaged 29% fewer healthier than less healthy products. Lower relative availability of healthier alternatives was associated with low-income, Black, and Hispanic communities. Small stores had the largest differences: relative availability of healthier alternatives was 0.61 and 0.60, respectively, for very low-income Black and very low-income Hispanic communities, and 0.74 for very high-income White communities. We found fewer associations between absolute availability of healthier products and community characteristics. CONCLUSIONS: Policies to improve the relative availability of healthier alternatives may be needed to improve population health and reduce disparities.

The availability of electronic cigarettes in U.S. retail outlets, 2012: results of two national studies.

BACKGROUND: Since their introduction in 2007, electronic cigarette ('e-cigarette') awareness and use has grown rapidly. Little is known about variation in e-cigarette availability across areas with different levels of tobacco taxes and smoke-free air policies. This paper looks at US retail availability of e-cigarettes and factors at the store, neighbourhood and policy levels associated with it. METHODS: In-person store audit data collected in 2012 came from two national samples of tobacco retailers in the contiguous US. Study 1 collected data from a nationally representative sample of tobacco retailers (n=2165). Study 2 collected data from tobacco retailers located in school enrolment zones for nationally representative samples of 8th, 10th and 12th grade public school students (n=2526). RESULTS: In 2012, e-cigarette retail availability was 34% in study 1 and 31% in study 2. Tobacco, pharmacy and gas/convenience stores were more likely to sell e-cigarettes than beer/wine/liquor stores. Retail availability of e-cigarettes was more likely in neighbourhoods with higher median household income (study 1), and lower percent of African-American (studies 1 and 2) and Hispanic residents (study 2). Price of traditional cigarettes was inversely related to e-cigarette availability. Stores in states with an American Lung Association Smoke-Free Air grade of F (study 1) or D (study 2) compared with A had increased likelihood of having e-cigarettes. CONCLUSIONS: Currently, e-cigarette availability appears more likely in areas with weak tax and smoke-free air policies. Given the substantial availability of e-cigarettes at tobacco retailers nationwide, states and localities should monitor the sales and marketing of e-cigarettes at point of sale (POS).

Underage sales signage in vape shops: Comparison of stores near and far from California colleges.

Objective: Two-thirds of U.S. colleges are near vape shops, where higher rates of underage sales exist. This study examined vape shop compliance with state-mandated age-of-sale signs, the presence of age-of-entry signs and the tobacco industry's "We Card" sign. Participants: Random sample of 614 California vape shops, stratified by distance to community colleges or 4-year universities/colleges; visited June-August, 2019. Methods: Logistic regressions examined whether signage varied by distance to colleges and whether stores sold other tobacco products (OTP). Results: Compliance with the state-mandated age-of-sale sign was 69.4%; vape-only stores were less compliant than vape + OTP (AOR = 0.39, 95% CI = 0.22,0.70). Age-of-entry signs were more common in vape-only (AOR = 1.87, 95% CI = 1.07,3.28) than vape + OTP stores. However, this difference was greater for vape-only stores near community colleges and attenuated for vape-only stores near 4-year universities/colleges. Conclusion: Improved enforcement and retailer education regarding age-of-sale signage are needed, particularly near colleges where greater potential for underage sales presumably exists.

Changes in Retail Tobacco Product Availability Following a Chicago City Ordinance Restricting Sales of Menthol and Other Flavored Tobacco Products Near Schools.

BACKGROUND: In April 2016, the City of Chicago implemented an ordinance restricting the sale of all flavored (including menthol) tobacco products (FTPs), including electronic cigarettes, at retailers located within 500 feet of any public, private, or alternative elementary, middle ("primary"), or high ("secondary") school. We examined changes in retail availability of FTPs from before to after policy implementation among policy-affected retailers compared with retailers not subject to the policy. METHOD: Observational data were collected in June to September 2015 (Wave 1; pre-policy) and November to December 2016 (Wave 2; post-policy) from a panel of 194 randomly selected policy-area stores (located within 500 feet of a school), and a panel of 199 randomly selected comparison-area stores (located more than 500 feet from a school). Using generalized estimation equation regression, we assessed differences in FTP availability changes across study areas. RESULTS: We observed a statistically significant policy effect on FTP availability (Area × Wave interaction, p < .05); however, more than half of policy-area retailers continued to display at least one FTP after policy implementation (87.11% at Wave 1, 57.73% at Wave 2, p < .05). Similar reductions were seen for the availability of flavored cigarillos/little cigars and menthol cigarettes, while policy effects varied across store types. DISCUSSION: FTP availability reductions appear to be associated with policy implementation, but FTPs remained readily available at retailers subject to the policy. This study contributes to the evidence base indicating that policies with exclusions or exemptions for certain flavors, products, store types, or retailer locations have a limited effect on retail availability of FTPs.

Menthol brand switching among adolescents and young adults in the National Youth Smoking Cessation Survey.

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes; by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes.

Turning over a new leaf: Vape shop closings, openings and transitions in six U.S. Metropolitan statistical areas.

This study characterizes vape shop closings, openings, and changes in product mix in six U.S. metropolitan statistical areas with different tobacco and marijuana policies. With concern for higher rates of marijuana use among those who vape nicotine, the presence of marijuana-related terms in store names was also assessed. A census of stores that were classified online as vape shops/stores or vaporizer stores were telephoned in April-May 2018 (n = 739) and July-September 2019 (n = 919) to verify whether vape products and other tobacco products (OTP) were sold. We computed the percent of stores that closed, opened, and started/stopped selling OTP. Multilevel models tested whether these events varied by store type and by neighborhood demographics. Within 16 months, 11.5% of 739 stores had closed and 29.8% of 919 stores at follow-up had opened. Closings were more likely among vape-only than vape + OTP stores (AOR = 2.51, 95% CI = 1.47,4.29); vape-only stores were less likely to open (AOR = 0.46, 95% CI = 0.34,0.62). Regardless of store type, the odds of a store opening increased as the proportion of non-Hispanic/Latino White residents in the census tract increased (AOR = 1.47, 95% CI = 1.18,1.85). Overall, 2.0% of stores (vape-only and vape + OTP) had marijuana-related names at baseline and 3.5% at follow-up. The observed change (1.6% to 5.8%) was greatest in Oklahoma City, where the state legalized medical marijuana between baseline and follow-up. More stores were opening than closing in six U.S. metropolitan statistical areas before statewide sales restrictions on flavored tobacco and COVID-19. Uniform licensing is recommended to define vape shops and track their location and sales practices.

Vape shop owners'/managers' attitudes about CBD, THC, and marijuana legal markets.

Over the past decade in the US there have been marked pivotal changes in the policy and retail environment regarding cannabinoids, particularly cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). Many vape shops may carry products relevant to these two markets. This study interviewed vape shop owners/managers to assess their perceptions of consumer interests/behaviors regarding CBD and THC and of the impact of legalized marijuana retail on vape shops. The current study involved phone-based semi-structured interviews of 45 vape shop owners/managers in six metropolitan statistical areas (MSAs; Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle) during Summer 2018. Overall, 82.2% of participants were male, 77.8% were non-Hispanic White, 64.4% were managers, 8.9% reported past 30-day smoking, and 95.6% reported past 30-day vaping. Overall, 44.4% sold e-liquids containing CBD. Vape shop owners/managers indicated minimal perceived risk and some beliefs in therapeutic benefits of CBD products; however, there was a broader range of perspectives regarding marijuana retail and selling marijuana for recreational use. Some chose to distance themselves from marijuana products, their use, and the possibility of entering marijuana retail if it were to evolve in their state, while some indicated high levels of enthusiasm for the growing retail marijuana market. Future research should examine how vape shops and other retailers of CBD and marijuana communicate with consumers about products and modes of using such products, as well as how various industry sectors (e.g., vape shops) adapt or evolve with increasing regulation of nicotine and increasing legalization of marijuana retail.

Vape shop identification, density and place characteristics in six metropolitan areas across the US.

Vaping is increasingly prevalent and controversial. Vape shops and convenience stores are common but distinct sources of vaping products, and where they locate may reflect likely target markets. This study examined the density and neighborhood demographics of vape shops and convenience stores in six metropolitan statistical areas (MSAs): Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, Seattle. We identified 459 vape shops using Yelp and Google application programming interfaces and 10,777 convenience stores using ReferenceUSA and Dun & Bradstreet. Retailers were geocoded to census tracts (n = 4,442), and logistic regressions were conducted using as predictors percent non-White, percent youth (5-17 years or 5-20 years), and median household income from the American Community Survey, 2013-2017. Per 10,000 young adults, vape shop density ranged from 0.6 (Boston, San Diego) to 1.7 (Oklahoma City), and convenience store density ranged from 12.6 (San Diego) to 26.3 (Oklahoma City). Logistic regressions indicated that vape shops more likely resided in tracts with lower percentages of youth in Boston, but higher percentages of youth in Atlanta, as well as with lower incomes in Boston and Seattle. Convenience stores more likely resided in tracts with lower percentages of non-Whites in Atlanta and Boston; lower incomes in Atlanta, Boston, San Diego, and Seattle; and higher percentages of youth in Atlanta, Boston, and Minneapolis. These common retail sources of vaping products differentially locate in relation to neighborhood sociodemographics across MSAs. Findings suggest that, in some MSAs, vape shops and convenience stores may target youth and lower income populations.

ENDS retailers and marketing near university campuses with and without tobacco-free policies.

INTRODUCTION: This study characterizes the retail environment for Electronic Nicotine Delivery Systems (ENDS) near public universities in California, assesses marketing in the first random sample of ENDS retailers, and compares ENDS retailer density and retail marketing near campuses with and without tobacco-free policies. METHODS: Two data sources were used to construct a sampling frame of possible ENDS retailers, which were mapped within 1 to 4 miles of the 33 University of California and California State University campuses. To assess retailer density, a telephone survey of possible ENDS retailers (n=1186) determined which sold e-cigarettes or e-liquids (completion rate=72.9%). To assess retail marketing, trained data collectors completed observations in a random sample (n=438, M=13.3 stores per campus, SD=11.2) in fall 2015. RESULTS: In a telephone survey, 59.1% of retailers reported selling e-cigarettes or e-liquids. Half of the campuses had 10 or more ENDS retailers nearby. Most ENDS retailers were convenience stores (42.5%), and more were head shops (8.4%) than smoke shops (6.8%) or vape shops (6.2%). Nearly half (43.6%) of ENDS retailers sold products marketed as zero-nicotine and 13.9% sold NRT. ENDS advertising was visible in 72.1% and on the exterior of 28.1% of retailers. However, the presence of exterior advertising for ENDS was significantly lower near campuses with established tobacco-free policies than campuses with recent or no tobacco-free policies (OR=0.45, 95% CI=0.22, 0.94). CONCLUSIONS: The large number of tobacco retailers that sell ENDS near colleges suggests a need for better monitoring and regulations of ENDS availability and marketing. The widespread availability of zero-nicotine products suggests a need to examine whether nicotine-free products are as advertised and safe to use. Longitudinal research is needed to understand how retail marketing for ENDS responds to change in tobacco-free policies at nearby campuses.

Indicators of activity-friendly communities: an evidence-based consensus process.

BACKGROUND: Regular physical activity, even at modest intensities, is associated with many health benefits. Most Americans, however, do not engage in the recommended levels. As practitioners seek ways to increase population rates of physical activity, interventions and advocacy efforts are being targeted to the community level. Yet, advocates, community leaders, and researchers lack the tools needed to assess local barriers to and opportunities for more active, healthy lifestyles. Investigators used a systematic review process to identify key indicators of activity-friendly communities that can assess and improve opportunities for regular physical activity. METHODS: Investigators conducted a comprehensive literature review of both peer-reviewed literature and fugitive information (e.g., reports and websites) to generate an initial list of indicators for review (n=230). The review included a three-tiered, modified Delphi consensus-development process that incorporated input of international, national, state, and local researchers and practitioners from academic institutions, federal and state government agencies, nonprofit organizations, and funding agencies in public health, transportation, urban planning, parks and recreation, and public policy. RESULTS: Ten promising indicators of activity-friendly communities were identified: land use environment, access to exercise facilities, transportation environment, aesthetics, travel patterns, social environment, land use economics, transportation economics, institutional and organizational policies, and promotion. CONCLUSIONS: Collaborative, multidisciplinary approaches are underway to test, refine, and expand this initial list of indicators and to develop measures that communities, community leaders, and policymakers can use to design more activity-friendly community environments.

Commentary: Forces That Drive the Vape Shop Industry and Implications for the Health Professions.

At least three factors may be driving the evolution of the vape shop industry, a rapidly growing market sector that specializes in the sales of electronic cigarettes: (1) the tobacco industry, (2) the public health sector and its diverse stakeholders, and (3) consumer demand. These influences and the responses of the vape shop sector have resulted in a rapidly changing landscape. This commentary briefly discusses these three factors and the implications for the health professions, as they address the vape shop industry and its consequences for public health.

Child-directed marketing inside and on the exterior of fast food restaurants.

BACKGROUND: Children who eat fast food have poor diet and health outcomes. Fast food is heavily marketed to youth, and exposure to such marketing is associated with higher fast food consumption. PURPOSE: To examine the extent of child-directed marketing (CDM) inside and on the exterior of fast food restaurants. METHODS: Data were collected from 6,716 fast food restaurants located in a nationally representative sample of public middle- and high-school enrollment areas in 2010, 2011, and 2012. CDM was defined as the presence of one or more of seven components inside or on the exterior of the restaurant. Analyses were conducted in 2014. RESULTS: More than 20% of fast food restaurants used CDM inside or on their exterior. In multivariate analyses, fast food restaurants that were part of a chain, offered kids' meals, were located in middle- (compared to high)-income neighborhoods, and in rural (compared to urban) areas had significantly higher odds of using any CDM; chain restaurants and those located in majority black neighborhoods (compared to white) had significantly higher odds of having an indoor display of kids' meal toys. Compared to 2010, there was a significant decline in use of CDM in 2011, but the prevalence increased close to the 2010 level in 2012. CONCLUSIONS: CDM inside and on the exterior of fast food restaurants is prevalent in chain restaurants; majority black communities, rural areas, and middle-income communities are disproportionately exposed. The fast food industry should limit children's exposure to marketing that promotes unhealthy food choices.