Purchase Attempts Research Articles

Online Retail of Derived Psychoactive Cannabis Products: Age and Shipping Restrictions

PurposeThe 2018 US Farm Bill's definition of hemp resulted in the proliferation of derived psychoactive cannabis products (DPCPs), which appeal to some youth. Despite the importance of restricting youth access, few studies have systematically examined the DPCP retail environment, particularly their online accessibility. MethodsIn May 2023, Google incognito mode was used to search "buy delta thc." Among the first 100 results, data were collected from the 20 most trafficked websites that sold and delivered DPCPs. For each site, we documented the following policy-relevant information: 1) age verification measures for site entry and purchase attempts, 2) adult signature reportedly required upon delivery, and 3) shipping restrictions. ResultsOverall, 14 websites (70%) required individuals to indicate their age. Most websites (n = 13, 65%) did not verify age at attempted purchase, nor indicated that an adult signature was required upon delivery (n = 15, 75%). Only three websites (15%) had rigorous age verification procedures during checkout that included contact information as well as an image of their photo ID, which would then be validated through a third-party software. None required age verification upon both purchase and delivery. Thirteen websites (65%) mentioned state shipping restrictions; four of these provided conflicting information across different sections of the website. DiscussionAs the e-commerce landscape continues to evolve, clearer regulations regarding DPCP online retail sales and related enforcement are needed. In particular, measures are needed to enforce shipping restrictions and prevent youth access, including increasing the rigor of age verification.

Retailers' Compliance with Federal Age of Cigarette Sales Policies -- Pitt County, North Carolina, January-March 2022.

Tobacco use remains a leading cause of preventable morbidity and premature mortality. In December 2019, the federal age of sale for tobacco products increased from 18 to 21 years of age. This study aimed to evaluate the implementation of federal tobacco 21 policies in Pitt County, North Carolina (NC), by conducting multiple purchase attempts for cigarettes. Stores in Pitt County that sold cigarettes were randomly sampled and visited by up to six different underage (18-20) buyers who attempted to buy cigarettes from January-March 2022. Buyers made a total of 217 cigarette purchase attempts from 49 Pitt County retailers. Analyses were conducted using SPSS Complex Samples (v.28/Macintosh) and estimate retailer prevalence of requesting identification (ID) and selling to underage buyers across multiple purchase attempts. On average, retailers failed to request ID in 15.4% of purchase attempts (95% CI: 9.4%-21.3%) and sold to an underage buyer 34.2% of the time (95% CI: 27.0-41.4%). Additionally, 75.5% (95% CI: 63.4%-84.6%) of retailers sold to an underage buyer at least once. This study is limited to a single county in NC and to underage buyers aged 18 to 20. There is widespread non-compliance with federal age of sale policies for tobacco products in Pitt County, NC. State enforcement is warranted, and NC's youth access law should be amended to match the federal age of sale. Changes to the law should allow research involving underage purchases.

Evaluations of Compliance With California's First Tobacco Sales Bans and Tobacco Marketing in Restricted and Cross-Border Stores.

Beverly Hills and Manhattan Beach were the first California cities to end tobacco sales. Previous research assessed retailers' perceptions of the laws. This study is the first to evaluate compliance (Study 1), assess whether branded or unbranded tobacco cues remain, and examine cigarette prices/discounts in cross-border stores (Study 2). Each of the four data collectors requested Marlboro or e-cigarettes (randomly assigned) in all restricted stores (n = 33) until four attempts were exhausted or a violation occurred. Follow-up visits recorded whether former tobacco retailers advertised tobacco or contained unbranded cues. In a random sample of 126 cross-border stores (half within 1 mile of no-sales cities and half 2-4 miles away), data collectors recorded price of Marlboro and presence of cigarette discounts. Mixed models (stores within tracts), tested for differences between near and far stores, adjusting for store type and median household income. Compliance was 87.5%: three stores sold Marlboro (US $8, $10, and $10) and one sold Puff Bar (US $16). Tobacco-branded items and unbranded tobacco cues remained in one store each. Mean Marlboro price was US $10.61 (SD = 1.92) at stores within 1 mile of no-sales cities, averaging US $0.73 more than at stores farther away (p < .05). However, odds of advertising cigarette discounts did not differ between stores nearby and farther from no-sales cities. Nearly all retailers complied with tobacco sales bans within 6-12 months of implementation. In addition, retail tobacco marketing was nearly eliminated in the two cities. There was no evidence of price gouging for Marlboro cigarettes in cross-border stores. Evidence from two early adopters of tobacco sales bans suggests that such local laws can be implemented effectively in California, although results from these high-income cities in a state with a strong tobacco control record limits generalizability. Enforcement involving routine purchase attempts rather than visual inspection of tobacco products is recommended. Although Beverly Hills and Manhattan Beach are each surrounded by communities where tobacco sales persist, there was no evidence of price gouging for cigarettes or greater presence of discounts in cross-border stores. Evaluations of the economic impacts and public health benefits of tobacco sales bans are much needed.

Serving Alcohol to an "Obviously Intoxicated" Patron.

Alcohol overservice at on-premises establishments is associated with driving while intoxicated, violence, and other harms. This study examined rates of alcohol overservice and service refusal among licensed on-premises establishments in northern California and characteristics of establishments, servers, and pseudo-patrons (PPs) that may be associated with service refusal. In 2022, 300 licensed on-premises establishments were sampled in nine counties representing the San Francisco Bay Area. From July 2022 to January 2023, PP and observer teams visited each establishment, and PPs attempted to buy alcohol while displaying obvious signs of intoxication. The outcome of each purchase attempt; characteristics of establishments, servers, and PPs; and month, day, and time were recorded. Descriptive and regression analyses were conducted to address study objectives. Twenty-one percent of the establishments refused alcohol service to PPs. No establishment or server characteristics were significantly associated with service refusal in logistic regression analysis, nor were month, day, or time. However, service refusal was significantly more likely among female PPs (odds ratio = 3.71, 95% CI [1.67, 8.24], p < .01) and PPs displaying obvious or very obvious signs of intoxication (odds ratio = 9.28, 95% CI [1.99, 43.40], p < .01). There was no significant interaction effect of PP × Server Gender on the likelihood of service refusal. This study indicates that alcohol overservice to obviously intoxicated patrons remains common at licensed on-premises establishments. Mandatory responsible beverage service training of servers and enforcement of alcohol overservice laws are needed to reduce overservice and related harms.

Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023.

Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales,limiting pharmacist discretion for syringe sales, and targetingpharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.

Online Purchase Attempts of Flavored E-Cigarettes to Minors in California Before and After Senate Bill 793

This survey study assesses whether the online purchase attempt completion rate of e-cigarettes changed after passage of California Senate Bill 793.

"If You Just Tell Me You're 18, I'll Still Sell to You": A Qualitative Study of Underage Tobacco Product Purchasing Experiences in a Tobacco 21 Compliance Study.

Tens of thousands of underage tobacco buy attempts are conducted each year for research, compliance, and public health surveillance. However, little research has qualitatively examined the perceptions and experiences of underage buyers participating in these programs. We sought to understand underage buyers' experiences and gather recommendations for protocol improvements. We conducted semi-structured interviews in the fall of 2022 to assess experiences with underage tobacco product purchasing. Participants (N = 19, 58% male, 42% White) were research assistants aged 18-20 in New Jersey, New York, or North Carolina. Interviews examined purchasing experiences in relation to store characteristics, clerk interactions, and buyer identities. We used deductive and inductive thematic coding to explore key themes related to buyer experiences. We identified four themes: (1) non-chain stores lacked consistency in verifying age; (2) female data collectors experienced uncomfortable situations more frequently than male data collectors; (3) not identifying with the store's typical demographics impacted purchase attempts; and (4) participants suggested improvements for inspections and research during training. Retailer education, widespread adoption of ID scanners, and enforcement could increase standardization of ID requests and verification. Male and female buyers can be trained on what they might expect based on their gender, as well as how to maneuver through unwanted situations. Consideration of shared identity is important for future waves of data collection and research. Efforts to improve training include more extensive mock purchase training with supervisors well-versed in this area. Electronic ID verification and promoting compliance at non-chain retailers could impact access to tobacco products for underage buyers. Training for underage buyers in research and compliance assessments should focus on ways to enhance data collectors' confidence when making a purchase attempt, which may improve the validity of the rate of sales to individuals under 21.

Factors associated with successful purchase of cigarettes among students aged 11-17 years who made a purchase attempt in The Gambia: Evidence from the 2017 Global Youth Tobacco Survey.

Access to tobacco plays a strong role in smoking initiation among youth. This study aimed to quantify successful purchase of cigarettes and assess the factors associated with cigarette purchase access among students aged 11-17 years in The Gambia. We used the 2017 Global Youth Tobacco Survey (GYTS) of 12585 students, aged 11-17 years from The Gambia. The analysis was restricted to 2951 students aged 11-17 years who bought and/or attempted to buy cigarettes within the past 30 days regardless of smoking status. Our outcome was purchasing access, defined as successfully purchasing cigarettes within the past 30 days. We report a weighted prevalence of successful purchase attempt. Multivariable logistic regression assessed the factors associated with successful purchase of cigarettes and was adjusted for non-response and the complex survey design. Most students (59.4%, 95% CI: 55.4-63.3) who attempted to purchase cigarettes were successful, most of whom were boys (61.3%, 95% CI: 57.8-64.6). However, there was no significant difference in successful attempts to purchase cigarettes between boys (59.3%, 95% CI: 54.2-64.2) and girls (59.4%, 95% CI: 55.4-63.3). Older age (AOR=2.45; 95% CI: 1.25-4.78), higher school grade (AOR=1.53; 95% CI: 1.09-2.16) and current cigarettes smoking (AOR=1.41; 95% CI: 1.08-1.85) were significantly associated with successful attempt to purchase cigarettes. Sex, parents' smoking status and students' weekly pocket money were not associated with successful cigarettes purchase attempt. Among students who currently smoke cigarettes, 55.6% (95% CI: 47.7-63.2) bought them from a store, shop, street vendor, or canteen; 12.2% (95% CI: 8.3-17.5) obtained them from someone else, and 6.7% (95% CI: 4.4-10.0) used other means the last time they smoked. Students in The Gambia can purchase cigarettes without much hinderance despite the restrictions. Our research findings can guide the implementation of policies, programs, and public health strategies including more efforts toward implementing tobacco control laws and regulations that protect children from exposure and use of all forms of tobacco products.

Assessing the Effectiveness of Tobacco 21 Laws to Reduce Underage Access to Tobacco: Protocol for a Repeated Multi-Site Study.

Prior to the federal law passed in December 2019, many states passed an increased age of sale law prohibiting youth under age 21 (or Tobacco 21) from purchasing tobacco products, including e-cigarettes. Although previous research has documented tobacco retail sale violations, fewer studies have examined age verification and illegal tobacco sales in the context of Tobacco 21 or repeated purchase attempts in various settings. In this study conducted between 2019 and 2022, buyers aged 18 to 20 years made repeated unsupervised purchase attempts of cigarettes, cigars, e-cigarettes, tobacco-free nicotine pouches, and smokeless tobacco at over 180 tobacco or e-cigarette retailers in New Jersey, New York City, and Pitt County (North Carolina). Buyers documented whether they were asked for identification and whether they were able to successfully purchase a tobacco or nicotine product at each visit. The primary outcome will be the percent of retailers that checked the buyers' identification at store visits and the percent of visits that resulted in a successful underage tobacco product purchase. We will compare the results across time periods, study sites, products, and buyer characteristics (i.e., gender, minoritized racial/ethnic identity) while controlling for repeated visits. These results will inform improvements to current compliance check inspection programs as well as interventions that reduce youth access to tobacco.

A mystery-shopping study to test enforcement of minimum legal purchasing age in Lithuania in 2022.

According to the Lithuanian law to prevent the sale of alcohol to customers below the legal minimum purchasing age of 20 years, young adults below 25 years must be asked to show an age-verification document when purchasing alcohol. The aim of this study was to assess whether off-premise outlets comply with the law. In 2022, mystery-shopping study was carried out in three consecutive phases: (i) in a representative sample (n = 239) of off-premise alcohol outlets covering all Lithuanian district centres, (ii) after lifting the requirement to wear a mask and (iii) after warning the outlets that a mystery-shopping study was ongoing. Phases 2 and 3 were held in two cities. The mystery shopping involved attempts by young, but legally eligible customers to purchase alcohol. Across the three study phases, we compared compliance with the law by measuring overall success of purchase attempts and included situational characteristics (working day or weekend), time of day and number of customers in line as an additional predictor. Out of 239 attempts to purchase alcohol from off-premise outlets in the main phase of the study, 107 (or 44.8%) were considered to be successful (visits in which staff were willing to sell alcohol). There was a significantly higher chance of success to purchase alcohol with no ID request if a mystery shopper was the only customer in a queue and on weekends. The results indicate an insufficient level of age-verification control in Lithuania, and that additional action is needed to increase compliance.

A Pilot Study to Examine Retailer Compliance Before and After Tobacco 21 in New Jersey.

Despite rapid diffusion of Tobacco 21 (T21) laws in the last several years, research examining T21 compliance remains limited. This pilot study examined retailer compliance with carding before and after T21 as well as sales violations after T21 in New Jersey. A 19-year-old buyer made alternating cigar and cigarette purchase attempts in 15 licensed tobacco retailers weekly for five weeks before and 10 weeks following the T21 effective date for a total of 222 visits. We analyzed carding pre and post T21 and sales violations post T21, by store and product type. Failure to card declined post T21 (81.3% to 69.4%), particularly for cigarettes, but not cigars. Overall, 63.3% of retailers sold tobacco to the underage buyer post T21. Following New Jersey's T21 law, compliance with carding improved, but underage sales persisted. Future research examining T21 compliance should consider using a familiarity protocol to mimic real word conditions.

Limited access to pharmacy-based naloxone in West Virginia: Results from a statewide purchase trial

BackgroundWest Virginia (WV) has the highest overdose mortality rate in the United States and expanding naloxone access is crucial for reducing opioid overdose deaths. We conducted a purchase trial to establish an objective measure of naloxone access under WV’s naloxone standing order (NSO) program. MethodsA stratified random sample of 200 chain and independent retail pharmacies across WV were included. Each pharmacy underwent two purchase attempts—one by a person who used illicit opioids (PWUIO) and one by a potential bystander who did not use illicit opioids but had a relationship with a PWUIO. We used matched-pairs analysis to identify differences in outcomes by purchaser type (PWUIO vs bystander). Chi-square and independent-samples t-tests were used to compare outcomes by pharmacy type (chain vs independent). ResultsOverall, 29% of purchase attempts were successful, with no significant difference between PWUIO and bystanders (p = 0.798). Fewer than half (44%) of successful purchases included verbal counseling, and bystanders were more likely to receive counseling than PWUIO (33% vs 4%, p = 0.018). Common reasons for failed purchases were naloxone not being in stock (41%), requiring a naloxone prescription (35%), and/or requiring formal identification (23%). Chain pharmacies were more likely to sell naloxone than independents (35% vs 19%, p = 0.001). ConclusionsWe documented limited naloxone access under the WV NSO. These findings indicate that simply establishing an NSO program is insufficient to expand access. Implementation efforts should ensure adequate naloxone stocks, pro-active delivery of NSO-related information and pharmacist training, and avoidance of recordkeeping requirements that may impede access.

Sales of cigarettes to pseudo-underage mystery shoppers: Experiences from Stockholm County.

Aims:There is an 18 years age limit for cigarette purchase in Sweden and in order to implement this law outlets need to perform ID checks. This study investigates the rate of cigarette sales and ID checks when pseudo-underage mystery shoppers attempted to purchase cigarettes. It explores possible factors associated with sales outcomes.Design:Nine mystery shoppers (6 females and 3 males) attempted to purchase cigarettes without providing ID. The mystery shoppers were 18 years old but had a younger appearance as judged by an expert panel. During each attempt, the adolescents worked in pairs (shopper and observer). A total of 320 outlets in 13 municipalities in Stockholm County were randomly selected based on an outlet type stratum (i.e., gas station, convenience store, kiosk, grocery store). Effects of variables on sales outcomes were analysed using Pearson’s chi-square and binominal regression analysis.Results:In 25.4% of the purchase attempts (total n = 287), cigarettes were sold although the pseudo-underage mystery shopper did not provide a valid ID. In 82.6% of the attempts, the shopper was asked to provide ID, and cigarettes were sold in 9.7% of these cases. The rate of sales was significantly higher among female mystery shoppers (29.5%) compared to male (15.0%). Age limit signs were observed in 89.5% of the outlets but they were not significantly associated with the success rate in a regression analysis.Conclusions:The results of the present study indicate that cigarettes could potentially and frequently be sold to underage adolescents by outlets within Stockholm County. Therefore, routines established for checking IDs clearly need to be improved. For example, strategies to improve adherence to the legal age limit on the purchase of cigarettes, such as compliance checks using mystery shopping with feedback to retailers, are needed.

Effects of a multi-component alcohol prevention intervention at sporting events: a quasi-experimental control group study.

Alcohol intoxication among spectators and related problems are common at sporting events. This study estimated the impact a multi-component community-based alcohol prevention intervention, implemented at Swedish Premier Football (soccer) League matches, had on intoxication levels among spectators and refusal rates of alcohol service to, and arena entry of, obviously intoxicated spectators. A quasi-experimental controlled study using a repeated cross-sectional design. Spectators and sport arenas in Stockholm and Gothenburg, Sweden. The intervention was implemented in Stockholm and consisted of community mobilisation and collaboration, training of staff and improved enforcement and policy work. Gothenburg was the comparison area and received usual care. Primary outcomes were spectators' mean breath alcohol concentration (BrAC), proportion of spectators with high intoxication levels, (defined as BrAC ≥0.1%), overserving at licensed premises inside arenas and refused arena entry of obviously intoxicated spectators. Baseline data were collected during 2015 and follow-up during 2016 and 2017. BrAC assessments (n=10 188), arena entry attempts (n=201) and alcohol purchase attempts at premises inside arenas (n=495) were collected. There was evidence that the refusal rates of alcohol purchase at premises inside arenas improved differently between study areas and over time (adjusted odds ratio [aOR]=0.28, 95% CI=0.07, 1.06, P=0.060, Bayes factor [BF]=8.60). In both study areas, the arena entry refusal rates improved over time (aOR=5.87, 95% CI=1.16, 29.83, P=0.033, BF=17.7), but evidence that the rates improved differently between study areas and over time was equivocal (aOR=0.57, 95% CI=0.09, 3.56, P=0.543, BF=1.2). Mean BrAC levels decreased over time in both study areas (β=-0.032, 95% CI=-0.050, -0.015, P<0.001), and differently (β=0.104, 95% CI=0.061, 0.146, P<0.001), but evidence for an interaction effect was equivocal (β=-0.002, 95% CI=-0.022, 0.018, P=0.868, BF=1.0). Evidence was equivocal regarding whether the proportion of spectators with high intoxication levels decreased differently between study areas and over time (aOR=1.17, 95% CI=0.91, 1.50, P=0.220, BF=2.2). A multi-component community-based alcohol prevention intervention at sporting events may have increased staff intervention toward obviously intoxicated spectators. It was not clear whether this translated into a reduction in intoxication, which can be explained by improvements in the comparison area.

An Examination of Retailers' Compliance with the Minimum Legal Drinking (purchasing) Age Law in Slovenia: A Quasi-experimental Intervention Study.

IntroductionAlcohol consumption among young people is strongly related to alcohol availability. The minimum legal drinking (purchasing) age (MLDA) is a legal measure that regulates alcohol availability to minors in Slovenia. This study examines (1) retailers’ compliance with the MLDA law in Slovenia and (2) the effectiveness of two interventions directed at cashiers in off-premise stores.MethodsThe study uses a non-randomized quasi-experimental design to evaluate the effectiveness of (1) a communication intervention directed at off-premise store managers, and (2) an intervention by the Slovene Market Inspectorate. The first intervention focused on informing cashiers about MLDA’s importance and their role as gatekeepers of young people’s health, while the second involved law enforcement. Using the mystery shopping protocol, we conducted two waves of purchase attempts with decoy underage shoppers pre- and post-intervention in 97 off-premise stores. We collected data on the shopping process at the point of sale and conducted 40 semistructured interviews with cashiers to evaluate the barriers and incentives regarding MLDA compliance.ResultsRetailers’ initial noncompliance rate with MLDA in off-premise stores was high, but improved significantly after the law enforcement intervention. We identified a significant correlation between the cashiers’ ID requests and the refusal of alcohol sales, but cashiers’ ID requests remained low. Qualitative findings reveal that cashiers experience several issues when handling MLDA in practice.ConclusionNoncompliance with MLDA persisted even after the law enforcement intervention, revealing the need for policy makers to introduce new strategies for MLDA enforcement, such as revocable alcohol licenses for off-premise stores.

Evaluation of a Local Ordinance to Prevent Any Underage Purchases in Liquor Stores: The Need for Enforcement

In June 2012, Baltimore City, MD, enacted legislation (commonly referred to as the Mosby Bill) prohibiting all liquor stores (outlets that primarily sell alcoholic beverages) from selling "any food, goods, wares, supplies, or other merchandise to any person under the age of 18." Three years after enactment, we evaluated the impact of this legislation on non-alcohol product sales among youth. Research assistants (RAs) ages 16-20 were trained in using a standardized observational tool to quantify and record characteristics of the outlets, including products sold. A trained pair comprising one RA age 16 to 20 and one RA exactly age 18 were sent into every liquor store (i.e., packaged goods stores and bar/taverns with packaged goods sales) in Baltimore to conduct the assessment and make a non-alcohol purchase. Since the research was not conducted in concert with the police, the 18-year-old RA made the purchase attempt while the other (age 16 to 20) RA completed the assessment. Purchase attempts were made at 502 liquor stores, and 352 of those attempts were successful (able to make purchase without being asked for identification or age; noncompliance rate = 68.1%). Noncompliance was highest among packaged goods stores compared with bar/taverns, and in neighborhoods with a lower median household income and a higher proportion of African American residents (p < .050). Noncompliant outlets were also located closer to public schools (p < .050). This evaluation demonstrates that, in the absence of enforcement, ordinances are neither likely to be honored nor to achieve the intended public health benefits.

Compliance to the Alcohol Law: Overserving to Obviously Intoxicated Visitors at Music Festivals.

Music festivals are often high-risk settings associated with large numbers of visitors and high alcohol intoxication levels, which contribute to a number of public health-related problems. According to the Swedish Alcohol Act, servers are responsible for not overserving alcohol to obviously intoxicated patrons. The aim of the current study was to examine compliance to the Swedish Alcohol Act at music festivals by assessing the rate of alcohol overserving to festival-goers. We conducted a study at a large music festival in Sweden hosting approximately 50,000 visitors. Professional actors, i.e., pseudo-patrons, enacted a standardized scene in which a highly intoxicated festival-goer attempted to buy beer at licensed premises inside the festival. Observers monitored each attempt. A total of 52 purchase attempts were conducted. The rate of overserving was 26.9% and was not influenced by the server’s gender, the number of servers, or the level of crowdedness at the bar area. Overserving differed between server age groups, which was not statistically significant when controlling for other factors. Compliance to the Alcohol Act at the festival can be improved. Intoxication levels and related problems can be reduced by implementing a multicomponent intervention including staff training, policy work, and improved enforcement.

Alcohol policy in the Netherlands in a National Prevention Agreement: results of three studies

Abstract Introduction On 23 November 2018 in the Netherlands more than 70 organizations signed the National Prevention Agreement. This document had been set up by the Dutch government aiming to create a healthy generation in 2040. It focuses on alcohol, next to overweight and tobacco control. Participants are a.o. NGO's, the sports sector, insurance companies, municipalities but also the alcohol industry and retailers. Methods Three studies were performed aiming to map how alcohol use might be reduced. 30 days without alcohol: the IkPas (No Thanks) campaignAlcohol screening and interventions for patients in General HospitalsPrioritizing alcohol enforcement and prevention efforts by combining prevalence and success-rate for minors purchasing alcohol. Respectively a quantitative survey among adult alcohol users (n = 15.947), qualitative interviews among health professionals (n = 21), a quantitative survey among youngsters (n = 510) and purchase attempts (n = 1.373) of alcohol by mystery shoppers were performed. Results Beside on youth, in the Prevention Agreement priority has been laid on elderly, pregnant women, members and visitors of sports clubs and students. Also important are measures in primary and secondary health care and health policy in industrial companies. Measures are proposed in the field of the 'three best buys' (higher prices, lesser advertisement and restrictions in availability). The three studies showed that participants of the IkPas campaign feel fitter, sleep better, lose weight and drink less after 6 months follow-up. Furthermore, implementation of alcohol screening and interventions for patients in Dutch hospitals is still in its infancy. Lastly, bars/cafes/discos should be given priority for enforcement and prevention. Conclusions The question that will be discussed is whether the Netherlands by this agreement really do make a step forward in developing a healthy alcohol policy. Will the ambitious goals formulated in the agreement be reached in 2040? Key messages Alcohol policy measures are needed to reach a healthy population in 2040. Campaigns, screening and brief interventions, and alcohol enforcement are promising.

87 Is Canadian Federal Legislation Effective in Preventing Youth Access to Vaping Initiation Products? A secret shopper and online study

Abstract Background Electronic cigarette use (“vaping”) is associated with negative health outcomes. Vaping among youth has recently risen to the highest levels recorded. Between 2017 and 2018, Canadians 16 to 19 years old who reported vaping over the past 30 days increased by 74%. This directly coincides with the Tobacco and Vaping Products Act (the “Act”) enactment, which lifted the ban on e-cigarette importation and sales without pre-approval while attempting to restrict youth access to e-cigarettes, and the entry of JUUL e-cigarette products into the Canadian market. Objectives The purpose of the study was to evaluate the Act’s effectiveness in protecting the health of youth by preventing their access to vaping products, using a secret shopper interventional design. Design/Methods Study subjects were vaping and convenience store employees and deliverers of vaping products ordered online. Confederate researchers (minors aged 15-16 and young adults aged 19-21) entered retail stores to buy JUUL Starter Kits. Three improper scenarios were used: (1) a minor(s); (2) a young adult with no or invalid identification; and (3) a young adult with valid identification clearly purchasing on behalf of an accompanying minor. The main outcome measured was vendor willingness to sell, recorded upon exit from stores. Five minors also ordered JUUL Starter Kits online from their homes. Frequencies were calculated for each variable and tests of association were completed using chi square analysis. Results In total, 42.5% of vendors (51/120) were willing to sell JUUL Starter Kits to the young adults and minors. Most vendors requested identification in all scenarios (97/120, 80.8%) but, of these, 28 vendors were willing to sell even though no or false identification was provided (28.9% of those who requested identification). Of those vendors who did not request identification (23/130, 19.2%), all were willing to sell. Where a young adult was clearly buying vaping products for a minor, vendors were willing to sell 63.2% of the time (24/38, p=0.016). In five online purchase attempts, 60% of deliverers did not meet the Act’s verification requirements. Conclusion Given that almost half of the vendors were willing to sell JUUL Starter Kits in improper circumstances, the Act does not adequately achieve its goal of protecting the health of youth. To prevent youth access to vaping products, the Act needs stricter enforcement and amendment to impose positive obligations on vendors to request identification, to prohibit sales to adults buying for minors, and to require manufacturers to disclose the product contained in delivered parcels.

Assessing pharmacy-based naloxone access using an innovative purchase trial methodology

ObjectivesMassachusetts was among the first states to allow standing orders to facilitate pharmacy-based naloxone purchases and reduce opioid overdose deaths. We conducted a unique purchase trial to establish a valid measure of standing order naloxone in Massachusetts, using purchasers from 2 high priority populations to determine whether naloxone is less accessible to those who use illicit opioids than other potential purchasers. DesignPurchase trial. Setting and participantsThe study used a stratified random sample of 200 chain and independent retail pharmacies across Massachusetts. Each pharmacy underwent 2 purchase attempts—1 by a person who used illicit opioids (PWUIO) and 1 by a potential bystander who did not use illicit opioids but had a relationship with someone at risk of opioid overdose. Outcome measureSuccessful or unsuccessful naloxone purchase attempt. ResultsOverall, 322 of 397 purchase attempts (81%) were successful, with no statistically significant difference between PWUIO and bystanders (P = 0.221). Most purchases (93%) resulted in the acquisition of single-step nasal naloxone (Narcan; median cost $133.38). Forty percent of the purchases included state-mandated verbal counseling, and PWUIO were significantly less likely to receive counseling than bystanders (30% vs. 51%, P < 0.001). Common reasons for failed purchase were not stocking naloxone (47%), price > $150 (25%), and requiring a prescription (15%). Chain pharmacies were significantly more likely to sell naloxone than independent pharmacies (86% vs. 53%, P < 0.001). ConclusionWe documented high levels of naloxone access for both PWUIO and bystanders, suggesting Massachusetts could serve as a model for states seeking to improve pharmacy-based naloxone access. Additional implementation efforts should focus on expanding availability at independent pharmacies and supporting pharmacies in proactively offering naloxone to PWUIO and other high-risk individuals.