Authors: Purushothaman V, Cuomo RE, Li J, Mackey TK
Journal: Tobacco Prevention and Cessation
Year Published: 2023
Type: Original Research
Abstract:
Introduction:
The state of California has enacted progressive anti-tobacco policies, including Proposition 56 in 2016. In response, the alternative and emerging tobacco product (ATP) industry has increased its political activity. This study explores the association between the proportion of people voting against Proposition 56 and tobacco/ATP retail density.

Methods:
We conducted a retrospective analysis using data on licensed California tobacco retailers, which were then cross-referenced for categorization using Yelp. Proportion voting against Proposition 56 was obtained from the Secretary of State’s website. A series of linear regression tests were performed between populationnormalized retailer density and voting proportion at the county level before and after adjusting for covariates such as age, gender, race/ethnicity and median household income.

Results:
The total number of licensed tobacco retailers increased by 29.31% from 2015 to 2019. Association between proportion voting against Proposition 56 and retail density was significant during voting and during periods of policy implementation and post-implementation (2016–2018) for non-specialized tobacco retailers. For specialized/ATP retailers, significance was only detected during the post-implementation period (2018–2019) after normalization. Proportion voting against Proposition 56 was also a significant predictor of increase in total number of non-specific (β=0.48, p=0.008) as well as specialized tobacco and/or ATP retail storefronts (β=0.21, p=0.001) from 2016 to 2018.

Conclusions:
This study provides initial evidence of the association between tobacco retail density and voting patterns for anti-tobacco policy. Future research should examine the role of tobacco retail density on variation in local support for state tobacco control initiatives, including tailoring outreach to specific voting census blocks in communities with heavy retail presence.
Citation:
Purushothaman V, Cuomo RE, Li J, Mackey TK. Examining the association between California tobacco licensed retail density and public support or opposition to state anti-tobacco legislation. Tobacco Prevention & Cessation. January (2023): 2. doi:10.18332/tpc/156460.

Authors: Nali M, Purushothaman V, Xu Q, Cuomo RE, Mackey TK
Journal: Tobacco Induced Diseases
Year Published: 2021
Type: Original Research
Abstract:
Introduction
Recent reports of lung injury associated with Electronic Nicotine Delivery System (ENDS) products precipitated by increasing vaping prevalence and interest in flavors among adolescents has led to policies that restrict the sale, distribution, and accessibility of ENDS products. This study assessed compliance of online ENDS vendors to the Massachusetts temporary sales ban.

Methods
The study involved structured web surveillance for online ENDS vendors using keyword searches on Google search engine (October to November 2019.) Once vendors were identified, we conducted simulated online purchases, defined as placing an order for an ENDS product by putting it in the website shopping cart without finalizing payment. Simulated purchases and content analysis of websites was conducted to determine compliance characteristics. Fisher’s exact test was used to identify associations between compliance and website characteristics such as location and age verification requirements.

Results
Simulated online purchases from 50 identified ENDS vendors yielded 72% (n=36) stores that were non-compliant and allowed placement of ENDS product orders, without restrictions, to a Massachusetts address. The remaining 14 websites had processes in place to prevent orders from buyers located in Massachusetts. Other characteristics of interest, including use of age verification, location data, and web registrar/registrant data were collected and reported.

Conclusions
The September 2019 Massachusetts executive order was a comprehensive ban on selling ENDS products both online and offline. However, our study found that close to three-fourths of the vendors appeared to be non-compliant, indicating that implementation and enforcement are ongoing challenges for future tobacco control efforts on the internet. Policymaking needs to be specifically tailored to address the unique challenges of online environments, particularly in the context of identifying non-compliant sites, ensuring age verification, and addressing non-US sellers."
Citation:
Nali M, Purushothaman V, Xu Q, Cuomo RE, Mackey TK. Characterizing and Assessing Compliance of Online Vendors to the State of Massachusetts ENDS Product Sales Ban. Tob Induc Dis. 2021;19:5

Authors: Cuomo RE, Yang J, Purushothaman V, Nali M, Li J, Mackey TK.
Journal: Tobacco Prevention & Cessation
Year Published: 2021
Type: Original Research
Abstract:
Introduction
Concomitant with the popularization of vaping, vape shops have dramatically proliferated over the past years. This study assesses whether vape storefronts in California are significantly associated with density of different age groups, and whether this differs between tobacco storefronts or non-specific tobacco retailers.

Methods
Addresses for licensed tobacco retailers were obtained from the California Department of Tax and Fee Administration. Business names and addresses were used to obtain store categories cross-referenced from Yelp. Using a cross-sectional ecological design, stores categorized as ‘Vape Shop’ or ‘Tobacco Shop’ were geolocated and compared with age-related variables from the American Community Survey. Regression was conducted in R to determine relationships between age group concentration, in ventiles, and proportion of tracts with tobacco-specific or vape-specific stores. Geospatial visualization was conducted using ArcGIS.

Results
We found 848 vape shops, 820 tobacco shops, 419 categorized as both, and 20320 retailers with neither category. Overall, 1800 tobacco and/or vape shops were categorized in 1557 of California’s 23194 census tracts. A positive linear association was found between ventiles of two age categories, 20–24 and 25–34 years, and proportion of tracts with vape-specific or tobacco-specific shops separately.

Conclusions
Positive associations were found for ages 20–34 years but not for other ages, suggesting vape shops are strategically located in areas populated by young adults. Location-based targeting increases access, thereby increasing proportion of tobacco users, and could be a critical factor in e-cigarette uptake and use. Further study to identify additional age-related demographic characteristics among clientele of tobacco storefronts is warranted.
Citation: Cuomo RE, Yang J, Purushothaman V, Nali M, Li J, Mackey TK. A Geospatial Analysis of Age Disparities in Resolute Localities of Tobacco and Vaping-Specific Storefronts in California. Tobacco Prev Cessation. 2021;7(May):32

Authors: Shah N, Nali M, Bardier C, Li J, Maroulis J, Cuomo R, Mackey TK
Journal: Tobacco Control
Year Published: 2021
Type: Original Research
Abstract:
Background
Increased public health and regulatory scrutiny concerning the youth vaping epidemic has led to greater attention to promotion and sales of vaping products on social media platforms.

Objectives
We used unsupervised machine learning to identify and characterise sale offers of electronic nicotine delivery systems (ENDS) and associated products on Instagram. We examined types of sellers, geographic ENDS location and use of age verification.

Methods
Our methodology was composed of three phases: data collection, topic modelling and content analysis. We used data mining approaches to query hashtags related to ENDS product use among young adults to collect Instagram posts. For topic modelling, we applied an unsupervised machine learning approach to thematically categorise and identify topic clusters associated with selling activity. Content analysis was then used to characterise offers for sale of ENDS products.

Results
From 70 725 posts, we identified 3331 engaged in sale of ENDS products. Posts originated from 20 different countries and were roughly split between individual (46.3%) and retail sellers (43.4%), with linked online sellers (8.8%) representing a smaller volume. ENDS products most frequently offered for sale were flavoured e-liquids (53.0%) and vaping devices (20.5%). Online sellers offering flavoured e-liquids were less likely to use age verification at point of purchase (29% vs 64%) compared with other products.

Conclusions
Instagram is a global venue for unregulated ENDS sales, including flavoured products, and access to websites lacking age verification. Such posts may violate Instagram’s policies and US federal and state law, necessitating more robust review and enforcement to prevent ENDS uptake and access.

Citation: Shah N, Nali M, Bardier C, Li J, Maroulis J, Cuomo R, Mackey TK. Applying topic modelling and qualitative content analysis to identify and characterise ENDS product promotion and sales on Instagram. Tobacco Control. doi: 10.1136/tobaccocontrol-2021-056937

Authors: Cuomo RE, Purushothaman V, Yang J, Mackey TK