title: The effects of tobacco control policies on retailer sales to minors in the USA, 2015.
abstract: Under the 2009 Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (FDA) has been routinely inspecting tobacco retailers' compliance with under-age sales laws. We seek to identify factors associated with Retail Violation Rate for sale to minors (RVRm).
  
  
  
  We collected the tobacco retailer inspection data for 2015 from the FDA compliance check database. RVRm was calculated at the census tract level and overlaid with tobacco regulations and youth smoking prevalence at the state level. Multi-level spatial analysis was performed to examine the impacts of tobacco jurisdiction variations, youth smoking rates and neighbourhood social characteristics on RVRm.
  
  
  
  A total of 136 816 compliance checks involving minors conducted by the FDA in 2015 were analysed. A higher RVRm was associated with higher youth smoking prevalence (aRR=1.04, p<0.0001). Tobacco regulations show significant relationships with RVRm. For every one dollar increase in cigarette tax per pack, the likelihood of retail violations was reduced by 2% (aRR=0.98, p=0.03). For every 10% increase in tobacco prevention spending towards Centers for Disease Control recommended funding targets, the likelihood of retail violations was reduced by 1% (aRR=0.99, p=0.01). RVRm increased in states that enacted stronger smoke-free air policies (aRR=1.08, p<0.0001).
  
  
  
  We observed associations of tobacco regulations and neighbourhood social characteristics with tobacco retailers' compliance with under-age sales laws. This study provides evidence to support stronger tobacco regulations and control policies in reducing youth access to tobacco products.
authors.affiliation: Health Services & Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri, USA.|Department of Biomedical & Health Informatics, University of Missouri, Kansas City, Missouri, USA.|Department of Pediatrics, University of Missouri, Kansas City, Missouri, USA.
authors.forename: Hongying
authors.initials: H
authors.lastname: Dai
authors.affiliation: Bellevue University, Omaha, Nebraska, USA.
authors.forename: Jianqiang
authors.initials: J
authors.lastname: Hao
mesh_terms: D000293:Adolescent; D002648:Child; D003132:Commerce / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D008297:Male; D033242:Minors / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D061845:Smoke-Free Policy; D012907:Smoking / Q000453:epidemiology; D066252:Sociological Factors; D062789:Tobacco Products / Q000191:economics* / Q000331:legislation & jurisprudence*; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration / Q000706:statistics & numerical data
keywords: Disparities; Prevention; Priority/special populat