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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<0.05); 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<0.05). 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.

This article presents an analytic approach to assessing the relationship between policy advocacy activities and outcomes for discrete episodes of advocacy, using a holistic array of factors that affect the relationship between advocacy and policy change. The factors pertain to not only advocacy organizational structure and strategies, but also the policy environment, the policy issue and available options to address it, and technical assistance that advocates receive. By focusing on the entire context in which advocates operate, this approach can be used to assess both advocacy campaign strategies and the broader contextual factors that contribute to advocacy outcomes. The array of factors also facilitates analytic generalizability across advocacy episodes, as evaluators can compare the role of similar factors across advocacy efforts. This analytic approach is illustrated by its application to a multiple case study evaluation of Voices for Healthy Kids.

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. [ABSTRACT FROM AUTHOR]

Objective—This study aimed to assess the effect of the Master Settlement Agreement’s (MSA) 24 April 1999 ban on billboard tobacco advertising on the tobacco industry’s point-of-purchase marketing strategies.Methods—Observations were conducted from 16 February through 23 June 1999 in 3,464 tobacco-selling retail stores in a total of 191 communities across the nation. Communities were determined by the location of schools in a nationally representative sample of students in grades 8, 10, and 12 in the United States. At each store, information was collected on the extent of interior and exterior tobacco advertising, extent of tobacco functional objects, presence of tobacco promotions, and placement of tobacco and low-height advertisements. Logistic regression and cumulative logit analyses were used to assess changes in pre- and post-ban retail environments, after adjusting for store type, store size, presence of state tobacco control program and urbanicity.Results—After adjustment for covariates, there were significant post-ban increases in the presence of tobacco sales promotions, the presence and extent of functional objects, the presence of exterior and interior store advertising, and the extensiveness of exterior store advertising.Conclusions—The observed increase in point-of-purchase marketing in the period following the billboard advertising ban suggests that the tobacco industry may be shifting at least some of the expenditures once spent on billboard advertising to the advertising and promotion at the point-ofpurchase. To the extent that this is so, the intended effects of the MSA billboard ban may not be fully realized.

Objectives - To determine the relationship between extent of restrictions on smoking at home, at school and in public places, and smoking uptake, smoking prevalence and monthly cigarette consumption by school students.Design - Cross-sectional survey with merged records of extent of restrictions on smoking in public places.Setting – United States.Participants – 17,287 high school students.Main outcome measures – Five-point scale of smoking uptake; 30-day smoking prevalence; monthly cigarette consumption among current smokers.Results – More restrictive arrangements on smoking at home were associated with a greater likelihood of being in an earlier stage of smoking uptake (p

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. [ABSTRACT FROM AUTHOR]

This article presents an analytic approach to assessing the relationship between policy advocacy activities and outcomes for discrete episodes of advocacy, using a holistic array of factors that affect the relationship between advocacy and policy change. The factors pertain to not only advocacy organizational structure and strategies, but also the policy environment, the policy issue and available options to address it, and technical assistance that advocates receive. By focusing on the entire context in which advocates operate, this approach can be used to assess both advocacy campaign strategies and the broader contextual factors that contribute to advocacy outcomes. The array of factors also facilitates analytic generalizability across advocacy episodes, as evaluators can compare the role of similar factors across advocacy efforts. This analytic approach is illustrated by its application to a multiple case study evaluation of Voices for Healthy Kids. [ABSTRACT FROM AUTHOR]

Upon graduation from medical school the average student owes $46,224, a burden that causes concern among medical educators and students, health policy makers and physicians. Financial aid takes the form of scholarships without practice obligations, scholarships with practice obligations (for example, through the National Health Service Corps or the military), and loans. The only two viable options are loans, and the Armed Forces Health Professions scholarships, for which there are six applicants for every award. Thus, the only real option for the great majority of students is to incur debt. Because physicians' earnings are high, it is often felt that this is unimportant. However, it affects the types of medical school applicants, the specialties they will choose, and where they will practice. The students with the most debt are most likely to be from low-income families and minority groups, and the expectation of huge debts may deter some candidates, at a time when the value of medicine as a profession is being debated. Faculty members sense that medical school is now looked at more as job training than as preparation for professional responsibility. At the same time, the high cost raises questions about the quality of medical education and the attention devoted by faculty. How much of the cost of a medical education should a student bear? Should the schools, since they derive only about 4.5 percent of their revenue from tuition, put a moratorium on tuition increases? Should tuition be abolished altogether? These and other questions should be considered. Among the most important questions is whether federal and state governments should reinstate a period of service so that doctors could meet the needs of the underserved population in exchange for free tuition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Criticisms of current medical education include the divergence between physician training and patient needs; focus on research and patient care at the expense of teaching; poor interaction between the basic sciences and clinical aspects of medical school training; lack of opportunity for students to monitor patients throughout the entire course of illness; and lack of emphasis on problem-solving skills, continued learning, and development of faculty role models. Reform of medical education has been particularly slow in American medical schools. It is not clear whether medical school deans, department chairpersons, and faculty perceive a need for reform and are willing to undergo a change in the medical education system. A national survey of US medical educators was conducted to determine their views on the perceived need for changes in undergraduate medical education, the nature of the proposed changes, and the willingness of institutions to adopt such changes. Reforms ranged from moderate changes in the curriculum to widespread restructuring of the management over the school's educational program. The factors that would enhance or prevent reforms in medical school education were also assessed. There were 1,369 respondents to the survey. Most educators, with the exception of basic sciences faculty, felt a need for fundamental changes in medical school education in the US. Almost 75 percent of deans and associate deans expressed a need for either fundamental changes or complete reform. Seventy-nine percent of educators supported six specific reforms, including rewards for teaching excellence and increased clinical education in outpatient and community settings. Reforms related to reducing class sizes or centralizing management were seen as less important. Widespread support would be essential for changes in the medical education system. These findings suggest that medical educators are not satisfied with the present system of medical education. (Consumer Summary produced by Reliance Medical Information, Inc.)

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]