Single Cigarette Sales: State Differences in FDA Advertising and Labeling Violations, 2014, United States.
OBJECTIVE
Single cigarettes, which are sold without warning labels and often evade taxes, can serve as a gateway for youth smoking. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the US Food and Drug Administration (FDA) authority to regulate the manufacture, distribution, and marketing of tobacco products, including prohibiting the sale of single cigarettes. To enforce these regulations, the FDA conducted over 335,661 inspections between 2010 and September 30, 2014, and allocated over $115 million toward state inspections contracts.


OBJECTIVE
To examine differences in single cigarette violations across states and determine if likely correlates of single cigarette sales predict single cigarette violations at the state level.


METHODS
Cross-sectional study of publicly available FDA warning letters from January 1 to July 31, 2014.


METHODS
All 50 states and the District of Columbia.


METHODS
Tobacco retailer inspections conducted by FDA (n = 33 543).


OBJECTIVE
State cigarette tax, youth smoking prevalence, poverty, and tobacco production.


METHODS
State proportion of FDA warning letters issued for single cigarette violations.


RESULTS
There are striking differences in the number of single cigarette violations found by state, with 38 states producing no warning letters for selling single cigarettes even as state policymakers developed legislation to address retailer sales of single cigarettes. The state proportion of warning letters issued for single cigarettes is not predicted by state cigarette tax, youth smoking, poverty, or tobacco production, P = .12.


CONCLUSIONS
Substantial, unexplained variation exists in violations of single cigarette sales among states. These data suggest the possibility of differences in implementation of FDA inspections and the need for stronger quality monitoring processes across states implementing FDA inspections.
Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC hmbaker2@unc.edu.
Hannah M
HM
Baker
Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Joseph G L
JG
Lee
Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Leah M
LM
Ranney
Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Adam O
AO
Goldstein
D000293:Adolescent; D000329:Advertising / Q000191:economics / Q000331:legislation & jurisprudence*; D003132:Commerce / Q000191:economics / Q000331:legislation & jurisprudence*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D040541:Marketing / Q000191:economics / Q000331:legislation & jurisprudence; D011356:Product Labeling / Q000191:economics / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000453:epidemiology / Q000331:legislation & jurisprudence*; D013660:Taxes / Q000191:economics / Q000331:legislation & jurisprudence; D019460:Tobacco Industry / Q000191:economics / Q000331:legislation & jurisprudence; D062789:Tobacco Products / Q000191:economics; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence*