Exploring the Point-of-Sale Among Vape Shops Across the United States: Audits Integrating a Mystery Shopper Approach
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Nicotine & Tobacco Research, 2020, 1–10
doi:10.1093/ntr/ntaa041
Original Investigation
Received June 26, 2019; Editorial Decision February 11, 2020; Accepted February 25, 2020
Advance Access publication February 28, 2020
Original Investigation
Exploring the Point-of-Sale Among Vape Shops
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Across the United States: Audits Integrating a
Mystery Shopper Approach
Carla J. Berg PhD, MBA1, , Dianne C. Barker MHS2, Christina Meyers
MPH3, Amber Weber MPH3, Amy J. Park MPH3, Akilah Patterson
MPH3, Sarah Dorvil MPH3, Robert T. Fairman MPH4, , Jidong Huang PhD4,
Steve Sussman PhD5, Melvin D. Livingston PhD1, Theodore L. Wagener
PhD6, Rashelle B. Hayes PhD7, Kim Pulvers PhD, MPH8,
Betelihem Getachew MPH3, Nina Schleicher PhD9, Lisa Henriksen PhD9
1
Department of Prevention and Community Health, Milken Institute School of Public Health; George Washington
Cancer Center, George Washington University, Washington, DC; 2Barker Bi-Coastal Health Consultants, Inc.,
Newport, RI; 3Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory
University, Atlanta, GA; 4Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia
State University, Atlanta, GA; 5Departments of Preventive Medicine and Psychology, and School of Social Work,
University of Southern California, Alhambra, CA; 6Ohio State University Comprehensive Cancer Center and Division
of Medical Oncology, The Ohio State University, Columbus, OH; 7Department of Psychiatry, Virginia Commonwealth
University School of Medicine, Richmond, VA; 8Department of Psychology, California State University San Marcos,
San Marcos, CA; 9Stanford Prevention Research Center, Department of Medicine, Stanford University School of
Medicine, Palo Alto, CA
Corresponding Author: Carla J. Berg, PhD, Department of Prevention and Community Health, Milken Institute School
of Public Health; George Washington Cancer Center, George Washington University, 800 22nd Street NW, #7000C,
Washington, DC 20052, USA. Telephone: 404-558-5395; Fax: 202-912-8475; E-mail: carlaberg@gwu.edu
Abstract
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 strat-
egies 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 prohib-
ited 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
© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. 1
All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.2 Nicotine & Tobacco Research, 2020, Vol. XX, No. XX
concerns related to underage access, health claims, promotional strategies, and cannabidiol
product offerings, which call for further FDA and state regulatory/enforcement efforts.
Implications: Current and impending FDA regulation of vaping products presents a critical period
for examining regulatory impact on vape shop marketing and point-of-sale practices. Findings
from the present study indicate that vape shops are complying with several regulations (eg,
minimum-age signage, FDA health warnings, free sampling bans). However, results also highlight
the utility of mystery shoppers in identifying noncompliance (eg, age verification, health claims,
sampling, cannabidiol product offerings). This study provides baseline data for comparison with
future surveillance efforts to document the impact of full implementation of the FDA regulations
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on vape shop practices and marketing.
Introduction Vape shops also market via social media,15 which may promote
youth exposure to vaping imagery and advertising.8
Over the past decade, e-cigarettes emerged globally.1 E-cigarettes FDA regulations may uniquely affect vape shops.24 Free sampling,
may deliver fewer harmful chemicals than traditional cigarettes including those historically offered at vape shop tasting bars,14,25 is
and potentially support cessation efforts.2–4 However, e-cigarettes no longer allowed under the new federal regulations. Health warn-
contain chemicals that may increase risks of addiction and disease ings are required on all products/ads, particularly relevant given that
(eg, cardiovascular, lung, pulmonary, cancer).5 Moreover, youth vaping has been endorsed for cessation or harm reduction.14,26 FDA
e-cigarette use—or vaping—is a major public health concern.6 As of regulation also requires minimum-age signage and age verification
November 2019, there were 2172 vaping-related lung injury cases to enter vape shops and to purchase tobacco products for those
and 42 deaths in the United States.7 ≤27 years old. This is important given that young adults represent a
In the United States, the Food and Drug Administration (FDA) large vape shop market segment,25 many vape shops (15–27%14,27,28)
has regulatory authority over tobacco product manufacturing, dis- have no minimum-age signage, and vape shops often allow minors
tribution, and marketing (eg, packaging, labeling, advertising), as to enter.25
well as cessation pharmacotherapy including nicotine replacement Another relevant consideration is marijuana, given the high
therapy. In 2016, FDA finalized a rule extending its authority be- rates of marijuana-tobacco co-use29,30 and the growing market for
yond cigarettes to all tobacco products, including e-cigarettes (or retail marijuana in 10 states and the District of Columbia that le-
vaping products).8 Figure 1a details select regulatory actions and im- galized recreational use by 2018. Vape shops may carry products
plementation timeline; important components include minimum-age (eg, devices, e-liquids) that facilitate vaping cannabidiol (CBD) and
requirements, health warning labels, and prohibiting free samples. tetrahydrocannabinol. FDA regulations regarding tobacco products
In the United States and globally, there has been an expansion do not specify oversight of CBD, but tetrahydrocannabinol prod-
of vape shops (ie, tobacco specialty stores that predominately sell ucts are not legal for sale in vape shops.31,32 States with recreational
vaping devices and nicotine e-liquids but not conventional tobacco marijuana laws have designated regulatory oversight of marijuana,
products).9 FDA does not require federal licenses to sell tobacco/ which may increase barriers to vape shops offering such products
nicotine products, and its vape shop registry is limited to manufac- and/or may have social norms more conducive to using marijuana in
turers.10 However, one estimate indicated 9945 vape shops in the general and via vaping; not having such laws may deter marijuana
United States as of December 2015, a nearly threefold increase from use or lead consumers to pursue more discrete ways to use marijuana
2013; 11 newer estimates have not been published. such as through vaping.33
Whereas other retail settings (eg, convenience stores) typically This study addresses critical gaps in the literature, advances
sell select closed systems (ie, devices with e-liquid included), vape methodological approaches for assessing licit drug retail, and en-
shops sell many other devices, including open systems that con- hances the evidence base regarding vape shop retail. Specifically, we
sumers fill with e-liquids, herbal/dry chamber vaporizers, and wet/ examined compliance of US vape shop retail marketing strategies
dry vaporizers.9 Particularly relevant, some more advanced vaping with new regulations (eg, required age verification, prohibited free
devices may be effective in supporting smoking cessation.12 Vape samples) and pre-implementation conditions for other regulations
shops also feature various accessories and e-liquid flavors9 (critical (eg, health warning labels on nicotine products, required disclos-
in consumer appeal13) and some promoted experimenting and social- ures of e-liquid contents). Limited research addresses point-of-sale
izing at tasting bars.9,14 practices of vape shops. Two surveillance methods are point-of-sale
Vape shops use various marketing strategies (eg, product adver- audits14,28 and “mystery shopper” approaches.34,35 An extensive lit-
tising, price promotions).15 Such strategies expand tobacco markets, erature uses point-of-sale audits to characterize traditional to-
attract new users, promote continued use, and build brand loy- bacco,36 and a literature on vape shop audits has emerged in the past
alty.16–18 Advertising can influence how and why consumers vape9,19,20 6 years.36,37 Mystery shoppers have been used to examine age veri-
(eg, perceived safety or cessation utility,14,19–21 social/entertainment fication in tobacco and alcohol retail,34,35 but are relatively new to
value, achieve a “buzz” 19,20). With concern for youth appeal, the FDA vape shop surveillance. Used in combination, these two approaches
issued warnings to manufacturers, distributors, and retailers for may yield important new findings about vape shop retail practices.
selling e-liquids with advertising/labeling with cartoon-like imagery In particular, mystery shoppers can assess factors missed by trad-
in 201822 and is in the process of banning certain e-liquid flavors.23 itional point-of-sale surveillance, including actual age verificationNicotine & Tobacco Research, 2020, Vol. XX, No. XX 3
A
Time/Period
May 10, 2016 August, 2016-2018 September, 2018 August, 2019
Preparation Period Compliance Period Required health Enforcement Period
Regulations officially Existing products (prior to August warning labels and FDA enforcement
publicized. 8, 2016) may be sold. No new required for all products
90-day window to products (without FDA disclosures of e- and regulations
continue selling and authorization) may be released). liquid contents begin.
releasing new Shops required to verify enforcement
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products. customers’ ages. begins. Fully
No modified risk claims. required by
Ban on free samples. August, 2019.
FDA Action
B
894 complete phone 459 (51.3%) eligible vape shops
verification
(81.8% completion) 303 (33.9%) sold vaping products
and other tobacco products
1,093 potential
shops identified 20 (2.2%) did not sell vaping
products
199 (18.2%) incomplete
112 (12.5%) permanently closed,
phone verification
duplicate entries, or not retail
storefronts
Figure 1. FDA tobacco regulation timeline and vape shop identification flowchart. (a) FDA tobacco regulation timeline for select policies; (b) vape shop
identification flowcharts. Source: https://www.fda.gov/tobacco-products/compliance-enforcement-training/pipe-cigar-and-vape-shops-are-regulated-both-
retailers-and-manufacturers.
and characterizing communication from shop personnel about ces- retailers or customers as vape shops. After restricting lists to stores
sation and product safety, which may be inaccurate or countermand with complete addresses, we linked Google and Yelp records based
FDA’s requirements for modified-risk tobacco products, and there- on address, eliminated duplicate entries within and between sources,
fore could undermine tobacco control efforts. Additionally, prior reviewed (hand-cleaned) records, and geocoded records to latitude/
US vape shop surveillance efforts have not typically assessed avail- longitude using ArcGIS v10.1 (mapping rate 100%), yielding 1093
ability of nontobacco products. Examining whether vape shops offer likely vape shops across MSAs.
marijuana-related products is novel and relevant to state regulation. We used a telephone protocol to confirm that stores met our def-
inition of vape shop (ie, sold vape products but not other tobacco
products). Of the 894 retailers from Google/Yelp searches with com-
pleted phone verifications, 51.3% (n = 459) met our definition of
Methods
vape shop (Figure 1b). Roadway distances between these 459 stores
Study Settings and the MSA centroid were computed, and 30 vapes shops within 25
We selected six metropolitan statistical areas (MSAs)—Atlanta, miles of the MSA centroid were randomly selected. The remainder
Boston, Oklahoma City, Minneapolis-St. Paul, Seattle, and San of shops within 25 miles were randomly listed as replacements to be
Diego—representing geographic diversity and a gradient of tobacco assessed if the initial 30 were not open, out of business, or declined
control (eg, excise taxes, smoke-free air), vaping-related policies,10 participation.
and marijuana legislation. For example, California and Minnesota
tax vaping products; California, Minnesota, and Washington require Data Collection
licenses for vaping product retail sales; California, Massachusetts, In May–July 2018, data collection was conducted in Atlanta,
Minnesota, and Washington regulate vaping product packaging10; Oklahoma City, San Diego, Seattle, Boston, and Minneapolis-St.
and California, Colorado, and Washington had legalized recre- Paul, respectively. Data collectors were six paid MPH student re-
ational marijuana use at time of assessment. search staff (ages 23–25, five female) and were perceived to be under
the FDA age threshold of 27 years old. Each vape shop was visited
Sample twice. First, mystery shopper assessments were conducted by in-
We adapted procedures from previous research to identify vape shops dividual staff. Separately, one to three days later, point-of-sale au-
in the six MSAs.38,39 We searched “vaporizer store” on Google and dits were conducted by a pair of trained researchers who gained
“vape shops” on Yelp13 to identify stores in the six states tagged by permission to collect data. No data collector participated in both4 Nicotine & Tobacco Research, 2020, Vol. XX, No. XX
tasks. Data were recorded via assessment forms programmed in Price
surveygizmo.com and downloaded on iPads. All questions offered Lowest and highest prices for devices (closed systems, open systems
check boxes for response options and open fields for notes. with and without starter kits) and for e-liquids (with and without
Of the initially selected 180 shops, mystery shopper assess- nicotine salt) were assessed.
ments were completed in 176 and point-of-sale audits in 163 (non-
completion due to: not meeting definition of vape shop, n = 1; Promotions
not open at assessment, n = 2; and research staff asked to leave, We assessed price specials on devices or e-liquids (eg, buy one,
n = 14). Following assessment in replacement shops, data collectors get one; two for one); happy hour/early bird specials; daily/
completed 196 mystery shopper tasks and 179 point-of-sale au- weekly/monthly specials; membership/loyalty/rewards programs;
dits. Current analyses focus on vape shops where point-of-sale as- e-liquid bargain bins; drawings/raffles for discounts/coupons; dis-
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sessments occurred (n = 179) and included data from the mystery counts for military/veterans; and discounts for college students.
shopper assessments that coincided (n = 174). We also assessed advertising signage, defined as follows: 8.5 ×
11 inches or larger, branded with the intent to sell product, and
Mystery Shopper Assessment professionally produced and/or amateur/hand written.41 We as-
Two research staff (23 years old) conducted mystery shopper as- sessed signage promoting products or price promotions and
sessments, adapting previously used strategies.34,40 Single staff en- signage using cartoon imagery (use of comically exaggerated
tered each vape shop without identifying him/herself as research features, attribution of human characteristics to animals, etc.42).
staff to vape shop personnel or customers. If asked for age veri- We also assessed other ways of promotion, such as chalkboards/
fication, he/she presented his/her real ID. If not, he/she assessed whiteboards, lit-up signs, TV/other screens, or functional items
whether age verification was requested at purchase. In the interim, (eg, pens, changemats). Promotional products available for con-
the mystery shopper referred to a soft script (to facilitate replica- sumers to take for free (eg, stickers/decals) or for purchase (shop/
tion and allow adaptability during assessments) and asked whether product-branded apparel/paraphernalia) were also assessed.
vaping (1) is safe and (2) could help him/her or could help “a Finally, we assessed promotion of shops’ social media page(s) or
friend who smoked” quit smoking. Whether the mystery shopper delivery options.
presented him/herself as a “smoker” or “nonsmoker” was deter-
mined by coin tosses prior to entry. After assessments (duration Vape Shop Setting/Context
5–25 minutes), mystery shoppers immediately coded data to opti- Other nearby facilities (eg, smoke/head shops, other vape shops, li-
mize retention/accuracy. quor stores, schools, parks) were assessed by walking/driving around
each retailer covering two blocks in each direction using reliable,
Point-of-Sale Audit validated methods.43 We also assessed no-vaping or smoking signs
The Standardized Tobacco Assessment for Retail Setting (STARS)14 and actual vaping/smoking on premises, as well as vape shop interior
and prior vape shop surveillance work28 were used to develop the settings (ie, lounge seating, tasting bars).
point-of-sale surveillance tool (specific measures below). To assess
inter-rater reliability, trained pairs conducted point-of-sale assess- Training and Quality Control
ments (duration 15–45 minutes). Staff completed a 3.5-day training in Atlanta. Among the 30 ran-
domly selected vape shops in Atlanta, both point-of-sale audit teams
Age Verification (two pairs) and two mystery shoppers (working alone) were each
We assessed signage indicating minimum-age requirements for assigned 18 shops; six shops were assessed by two point-of-sale
entering and purchasing. audit teams and two mystery shoppers to examine initial reliability
among teams/mystery shoppers. (Note that all data collectors were
Health Warnings and Claims trained in both data collection protocols but were designated exclu-
We assessed (1) whether required FDA health warning labels were sively to point-of-sale or mystery shopper audits throughout data
visible on no, some, or most/all closed devices and e-liquids, respect- collection.) Staff checked in weekly with the first and second authors
ively; (2) health warnings posted on signage (eg, contraindications, (C.B., D.B.) to address data collection issues, ensure data quality,
cautions); and (3) messaging related to health claims (eg, safer than and provide feedback on emergent themes potentially integrated into
other tobacco, safe in general, health benefits, cessation aid). surveillance tools. Thus, after assessments in Atlanta and Oklahoma,
the point-of-sale surveillance tool was revised to include additional
items (noted in Tables 1–3).
Product Availability
We assessed (1) devices (closed systems, open systems, herbal/dry
chamber vaporizers, wet/dry vaporizers, Juul- and Suorin-specific Data Analysis
brands); (2) types of e-liquids (shop’s own brand, other vendors’ Using SAS 9.4, we conducted descriptive analyses and then bivariate
brands, e-liquids containing nicotine salt, ranges of nicotine and analyses to identify differences among the MSAs using chi-square
nicotine salt, e-liquids containing CBD); (3) other CBD or tobacco tests for categorical outcomes and ANOVA for continuous outcomes.
products; and (4) pipes, glassware, or wrapping papers. Data col- When cell sizes were small (ie, ≤5), Fisher’s exact test was used. We
lectors also assessed e-liquid sampling by identifying signage re- conducted analyses on the dimensions assessed by the point-of-sale
garding sampling, inquiring shop personnel if sampling (free or auditors to determine inter-rater reliability, using kappas for categor-
otherwise) was provided, and/or probing to determine conditions ical variables estimated in PROC FREQ and ICCs for continuous
under which sampling could occur. variables in PROC MIXED.Nicotine & Tobacco Research, 2020, Vol. XX, No. XX 5
Results sold e-liquids containing nicotine salt, and 42.5% sold e-liquids con-
taining CBD. Other CBD products were sold in 23.3% of shops.
Age Verification
About a fifth (18.4%) sold pipes, glassware, or wrapping papers.
Overall, 95.5% had minimum-age signage, either to enter (60.9%) Nicotine levels (without salt) ranged 0–50 mg, and nicotine salt
or to purchase (90.5%; Table 1). Of the 174 mystery shopper assess- levels ranged 0–75 mg.
ments, 35.6% resulted in age verification upon entry; of 107 subse- Significant differences in product availability across MSAs
quent purchase attempts, only 23.4% resulted in age verification at were documented. For example, shops in Minneapolis-St. Paul
purchase. The poorest age verification practices were documented in were least likely to sell closed-system devices (26.7% vs. ≥50%
Oklahoma City and Atlanta. in the other MSAs). Shops in Seattle, where retail marijuana is
legal, were most likely to sell herbal/dry chamber vaporizers or
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Health Warnings and Claims combined wet/dry vaporizers (63.6% and 60.9% vs. ≤58.6% and
Signage with health warnings was documented in 19.0% of shops ≤41.4%, respectively, in other MSAs). Shops in Oklahoma City
(Table 1). While 85.5% of shops had some evidence of implementing were most likely to sell their own brand of e-liquids (100.0% vs.
the impending FDA health warnings on products, with 84.8% ≤80.0% in other MSAs). Shops selling e-liquids containing CBD
having some FDA health warnings on e-liquids and 8.0% on closed- were most commonly found in Atlanta (75.9%), Boston (65.5%),
system devices. and Oklahoma City (61.3%). Other CBD products were also most
However, 29.1% had at least one sign indicating health claims prominent in Boston (37.9%) and Oklahoma City (32.3%). (Note
(21.2%) and/or claims that vaping aids in cessation (14.5%), with San that this item was added to the surveillance tool after Atlanta data
Diego having no shops with such claims and Boston having 44.8% collection, as it emerged as a theme that had not been systematic-
of shops with such claims (Table 1). When personnel were asked by ally assessed.)
mystery shoppers if vaping was safer than smoking, 100.0% affirmed
either “Yes” or “I’m not supposed to say that, but yes” (ie, they legally
E-liquid Sampling
could not make medical claims but believed so or their personal ex-
E-liquid sampling was available at 90.0% of shops (Table 2), with
perience suggested so). When mystery shoppers asked whether he/she
16.3% offering free samples. Samples were provided in a range of
could quit or his/her friend could quit smoking by vaping, 100.0%
ways, including using the shop’s devices or the consumers’ devices
(n = 86/86) and 98.8% (n = 85/86) said “yes,” respectively.
either with or without nicotine, as well as by smelling or tasting
e-liquids. Parameters regarding sampling were also noted, such as
Product Availability samples for a quarter or membership programs that, with a small
All vape shops sold open-system devices, with 64.8% also selling annual fee, would cover unlimited samples.
closed-system (Table 2). Additionally, 88.3% sold Suorin, and 52.5%
sold Juul. Additionally, 34.4% sold herbal/dry chamber vaporizers,
and 26.4% sold combined wet/dry vaporizers. Pricing
Two-thirds (68.2%) of shops sold their own brand of e-liquids, Table 2 provides average low and high prices for products across
and overall 84.4% sold other vendors’ brands. In addition, 81.0% MSAs, indicating significant differences across MSAs. Price ranges
Table 1. Smoking/Vaping on Premises, Age Verification, and Health Warning and Claims Across Vape Shops in Six US Metropolitan Areas
Total Atlanta Boston MSP OKC San Diego Seattle
N (%) Kappa N (%) N (%) N (%) N (%) N (%) N (%) p*
Age verification N = 179 N = 29 N = 29 N = 30 N = 31 N = 30 N = 30
Any minimum-age signage 171 (95.5) 0.83 27 (93.1) 29 (100.0) 29 (96.7) 29 (93.6) 27 (90.0) 30 (100.0) .361
Minimum age to enter signage 109 (60.9) 0.68 18 (62.1) 21 (72.4) 15 (50.0) 23 (74.2) 5 (16.7) 27 (90.0)6
Table 2. Products and Measure Reliability Across 179 Vape Shops in Six US Metropolitan Statistical Areas (MSAs)
Total Atlanta Boston MSP OKC San Diego Seattle
N = 179 N = 29 N = 29 N = 30 N = 31 N = 30 N = 30
N (%) Kappa N (%) N (%) N (%) N (%) N (%) N (%) p*
Device products
Closed systems 116 (64.8) 0.96 24 (82.8) 28 (96.6) 8 (26.7) 16 (51.6) 15 (50.0) 25 (83.3)Nicotine & Tobacco Research, 2020, Vol. XX, No. XX 7
were as follows: closed-system devices, $7.49–$90; open-system Inter-rater Reliability
starter kits, $9.99–$300; open-system devices (no starter kit), Kappas ranged 1.00 (for FDA health warning labels on closed-
$12.95–$900; and e-liquids, $0.11–$4.65 per mL. system devices, selling other vendors’ e-liquid brands, e-liquids that
contain CBD, use of shop device to vape e-liquid with nicotine, taste
Promotional Strategies test; Tables 1 and 2) to 0.39 (for device price promotion signage;
Table 3).44 Inter-rater reliability for other product availability meas-
Overall, 83.2% of shops offered price promotions of some kind,
ures were good to excellent (kappas ranging 0.79–0.99; Table 2).
with 55.9% having price specials on e-liquids (eg, buy one, get one);
Items with kappas below 0.60 (see Tables 1 and 3) may have resulted
41.3% membership, loyalty, or rewards programs; 26.3% price spe-
due to interpretation, for example, with regard to functional items
cials on devices; 25.7% e-liquid bargain bins; 24.0% daily, weekly,
(kappa = 0.49) or signage with health warnings (kappa = 0.42),
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or monthly specials on e-liquids; 13.4% happy hour or early bird
health claims (kappa = 0.60), cessation claims (kappa = 0.66), car-
specials on e-liquids; and 13.4% discounts for military/veterans.
toons (kappa = 0.46), or product/price promotions (kappa = 0.62).
Despite significant differences across the MSAs, price promotions
Regarding the latter, there may have been inconsistencies where de-
were found in >65% of shops in each MSA.
vice prices were posted on signage but may not have been special
In total, 89.9% of shops displayed promotion signage, with
promotional prices; in these cases, auditors may have coded such
27.4% having signage that used cartoon imagery and 26.1%
signs as either product or price promotion signage.
having signage promoting CBD products (note: CBD item added
to the surveillance tool after assessments in Atlanta and Oklahoma
City). Advertising and promotions were also conveyed through Discussion
chalkboards/whiteboards (56.4%), lit-up signs (26.8%), TV/other
screens (22.4%), or functional items (eg, pens, 62.6%). A range of The present study used rigorous retail surveillance methods and pro-
promotional items was also available for customers to purchase or vided important empirical findings regarding vape shop retail in the
take away, including shop/product-branded apparel/paraphernalia midst of global increases in vaping and vape shops,1 controversy re-
(58.1%) and/or stickers/decals (62.0%). Over a fourth (26.3%) pro- garding population risks and benefits of vaping,2–4 implementation
moted their shop’s social media page(s), and 2.8% indicated delivery of existing FDA regulations, and further regulation to address youth
options. vaping.22,23 Findings indicated concerns in relation to age verification,
health claims, promotional strategies, and CBD product availability.
Overall, 95.5% of shops had some minimum-age signage, similar
Vape Shop Setting and Context to rates shown in other research.14 However, only a third verified
With regard to location, 35.3% of vape shops were within two age upon entry, and in shops where age was not verified at entry,
blocks of liquor stores, 33.6% schools, 21.0% head/smoke shops, only a quarter of the purchase attempts resulted in age verification.
16.8% parks, 9.2% other vape shops, 5.0% playgrounds, 4.2% Moreover, one in three shops were located near schools, historic-
college campuses, and 1.7% marijuana retailers. No-vaping or ally an issue with tobacco retailers24 and marijuana dispensaries.45
no-smoking signs were observed in 10.1% and 21.8% of shops, Similar to legislation regarding alcohol and traditional tobacco re-
respectively; 73.2% had vaping occurring and 1.7% had smoking tailers, state and/or local retail licensing laws may prohibit vape shop
on premises during assessment. Regarding interior context, 88.8% retail proximity to child-friendly areas (eg, schools, playgrounds).10
had customer lounge seating, and 65.2% had counter/tasting bar Also noteworthy, over 25% of shops displayed signage with cartoon
seating. imagery, similar to prior findings from e-cigarette industry Instagram
Table 3. Marketing and Promotional Strategies and Inter-rater Reliability Measures Across 179 Vape Shops in Six US MSAs
Total Atlanta Boston MSP OKC San Diego Seattle
N = 179 N = 29 N = 29 N = 30 N = 31 N = 30 N = 30
N (%) Kappa N (%) N (%) N (%) N (%) N (%) N (%) p*
Any price promotions 149 (83.2) 0.69 21 (72.4) 19 (65.5) 28 (93.3) 25 (80.7) 28 (93.3) 28 (93.3) .008
Any signage with product/price promotions 161 (89.9) 0.62 23 (79.3) 26 (89.7) 29 (96.7) 29 (93.6) 25 (83.3) 29 (96.7) .148
Devices 84 (46.9) 0.70 12 (41.4) 14 (48.3) 12 (40.0) 10 (32.3) 10 (33.3) 26 (86.7)8 Nicotine & Tobacco Research, 2020, Vol. XX, No. XX
posts.42 Although few shops indicated delivery options, a quarter in- how different messaging strategies regarding health risks versus
dicated advertising on social media (with implications for youth ex- claims are perceived should be further examined, as research has
posure to vaping)8 and links to online purchasing that may facilitate indicated that consumers may perceive reduced health risk even if
sales to minors.46 These findings underscore the need for regulatory language does not explicitly state reduced risk.50 In addition, further
efforts to curb youth vaping.22,23 assessment is needed regarding CBD product characteristics within
During data collection (May–July 2018), the majority of shops vape shops to inform state regulation and enforcement.
displayed some FDA health warning labels, mostly on e-liquids.
This was promising, as by August 2018, all devices and e-liquids Limitations
were required to carry a warning label about nicotine. However, Findings have limited generalizability to vape shops in the MSAs,
nearly a third of shops had signage indicating health or cessa- across the United States, and across the world. The assessment tools
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tion aid claims, similar to the prevalence found in other research.14 also required adaptation across contexts to account for themes that
Moreover, when mystery shoppers asked shop personnel about emerged, thus underscoring that (1) findings across settings should
vaping, personnel universally endorsed vaping safety and utility be considered within the relevant policy context and (2) surveillance
in supporting cessation; prior research has similarly shown that tools must adapt within the current context, particularly relevant as
vape shop personnel endorse these beliefs and frequently make the tobacco/vaping product market and policy contexts change over
claims regarding vaping safety and/or use for cessation.14,37 time and across jurisdictions. Additionally, despite rigorous data col-
Although evidence has increasingly supported a role of e-cigarettes lection training and quality control, data may have been affected
in cessation,2–4 it is illegal to market vaping devices as cessation by differences in how research staff approached assessment or how
aids without FDA approval as modified-risk tobacco products. vape shop personnel interacted with research staff. Relatedly, inter-
However, vape shop personnel frequently couched their responses rater reliability on some assessments, specifically signage regarding
regarding the utility of vaping for cessation in their personal ex- health warnings/claims, cartoon imagery, and product/price promo-
periences. Vaping on premises was also prevalent, which may also tions, indicates the needs for improved training and to acknowledge
implicitly promote product safety. that these messages may not be explicit. Additionally, age verification
Vape shops offered various devices, nicotine levels, prices, gaps may have resulted from vape shop personnel perceiving mys-
brands, and flavors, likely to appeal to consumers who prioritize tery shoppers to be ≥27 years old. Finally, the quickly evolving vape
different product characteristics.13,47 This is important, as more ad- products and discourse regarding their impact on youth will require
vanced devices and the broad range of nicotine levels may support retail, and thus surveillance efforts, to adapt accordingly.
cessation efforts.4,12 Promotions were also pervasive, with >80%
having some type of price promotion. Almost all offered some way
to sample e-liquids, similarly noted in other research.14 Although few Conclusion
provided free samples, other strategies, such as membership/loyalty
Current findings indicated some implementation of FDA health
programs that included sampling as part of annual fees, were used to
warnings, some compliance with free sampling prohibition, and
side-step “free” sample bans. Additionally, the majority of shops had
high rates of compliance with minimum-age signage alongside
customer lounges or bars, which facilitate sampling and socializing
concerns related to actual age verification, health claims, promo-
as well as exposure to secondhand aerosol.13,25,48 The majority also
tional strategies, and CBD product offerings. FDA and state/local
sold or gave away shop/product-branded apparel, paraphernalia, or
regulation must step up enforcement efforts and address attempts
stickers/decals. These findings collectively suggest that vape shop
to circumvent existing laws/regulations. Moreover, this study pro-
marketing aims to build shop brand loyalty by having diverse prod-
vides baseline data for comparison with future surveillance efforts
ucts available and engaging consumers.
documenting the impact of full implementation of FDA regulations
E-liquids and other products containing CBD were prominent,
on vape shop marketing at point-of-sale.
particularly in Atlanta, Boston, and Oklahoma City. Laws regarding
CBD across states vary and are often vague.49 States with legal-
ized recreational and medical marijuana (ie, California, Colorado,
Supplementary Material
Washington) or medical marijuana only (ie, Massachusetts [at time
of assessment], Minnesota) have regulatory entities overseeing mari- A Contributorship Form detailing each author’s specific involvement with this
content, as well as any supplementary data, are available online at https://
juana/cannabis, which may deter vape shops from selling such prod-
academic.oup.com/ntr.
ucts. However, states such as Georgia and Oklahoma (at time of
assessment) allow certain levels of CBD,49 but have limited regula-
tory oversight of such products.
Funding
This publication was supported the National Cancer Institute (NCI)
Areas for Future Research (R01CA215155-01A1; PI: Berg). Dr. Berg is also supported by other NCI
The surveillance methods used in this study allow further examin- funding (R01 CA179422-01; PI: Berg; P30 CA138292; PI: Curran) and the US
Fogarty International Center/NCI (1R01TW010664-01; MPIs: Berg, Kegler).
ation of vape shop retail over time and across contexts, particularly
Dr. Pulvers is supported by funding from the NIH (SC3GM122628;
critical given different regulatory environments across states and
PI: Pulvers; R01 CA190347; MPIs: Strong and Pierce), TRDRP
countries and pending FDA regulation implementation. Research
(27IP-0041; PI: Pulvers; 28IP-0022S; PI: Oren), and the USDHHS
must also bridge across brick-and-mortar retail and online retail to (3GM1226290FK0105-01-00; PI: Fernando Sañudo).
ascertain underage access and advertising using safety and cessation Dr. Wagener is supported by funding from the NIH and US FDA
claims or cartoon imagery to ultimately inform regulatory efforts (R01CA204891, PI: Wagener; U01DA045537, PI: Wagener; R21DA046333,
to minimize youth access and exposure more broadly. Additionally, MPI: Wagener and Villanti).Nicotine & Tobacco Research, 2020, Vol. XX, No. XX 9
Ethical Approvals 18. Burton S, Clark L, Jackson K. The association between seeing retail dis-
plays of tobacco and tobacco smoking and purchase: findings from a
Institutional Review Board approvals were not required for this manuscript, as
diary-style survey. Addiction. 2012;107(1):169–175.
no human subjects were involved in this manuscript.
19. Berg CJ. Preferred flavors and reasons for e-cigarette use and discon-
tinued use among never, current, and former smokers. Int J Public Health.
2016;61(2):225–236.
Declaration of Interests
20. Getachew B, Payne J, Vu M, et al. Perceptions of alternative tobacco prod-
None declared. ucts, anti-tobacco media, and tobacco regulation among young adult to-
bacco users: a qualitative study. Am J Health Behav. 2018;42(4):118–130.
21. Berg CJ, Escoffery C, Bundy L, Haardoerfer R, Zheng P, Kegler MC.
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