Introduction American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the USA. Tobacco marketing at point-of-sale is associated with smoking, possibly due to easy access to cheap tobacco products. The sale of novel tobacco products like little cigars/cigarillos (LCCs) has increased in recent years which may further increase combustible tobacco use among American Indians.
Methods Between October 2015 and February 2017, trained community health workers collected LCC product and price information by conducting audits of tobacco retailers on Tribal lands (n=53) and retailers within a 1-mile radius of Tribal lands (n=43) in California. Χ2 analyses were performed to examine associations among the availability and advertising of LCCs, including indoor price promotions and store location.
Results Overall, 85.4% of stores sold LCCs, 76.0% sold flavoured LCCs and 51.0% sold LCCs for less than $1. Indoor price promotions were displayed at 45 (46.9%) stores. Stores within a 1-mile radius of Tribal lands sold significantly more LCC (p<0.01) and flavoured LCCs (p=0.01) than stores on Tribal lands. Stores within a 1-mile radius of Tribal lands also displayed significantly more LCCs priced at less than $1 (p<0.01) than stores on Tribal lands.
Conclusions LCCs are widely available in stores on and near California Tribal lands. Stores located a short distance away from Tribal lands were more likely to sell LCCs, including flavoured versions, more likely to sell LCCs priced below $1, and more likely to advertise little LCC price promotions than stores on Tribal lands. Policy-makers and Tribal leaders should consider regulations that would limit access to LCCs at point of sale to help prevent youth initiation and reduce smoking-related morbidity and mortality among American Indians.
- advertising and promotion
- non-cigarette tobacco products
- priority/special populations
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Contributors SLS conceptualised the study, led data analysis and wrote the article. CS and TBC contributed to writing and revisions. NK contributed to data analysis and revisions. YLR manged the data collection and contributed to revisions . SS contributed to revisions. LB-G contributed to revisions and was the principal investigator of the broader study.
Funding This study was supported by the National Cancer Institute of the National Institutes of Health (NCI/NIH), the Food and Drug Administration (FDA) Center for Tobacco Products (CTP) for the USC Tobacco Center of Regulatory Science for Vulnerable Populations (NCI P50CA180905) (Pentz/Samet, PIs) – Project 2: Maximizing Retailers' Responsiveness to FDA Regulatory Authority in Minority Communities (Baezconde&Garbanati, Project Leader).
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of NCI, NIH, FDA, CTP, or USC.
Competing interests None declared.
Patient consent Not required.
Ethics approval Institutional Review Board approval was obtained from the University of Southern California.
Provenance and peer review Not commissioned; externally peer reviewed.