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Weak Age Restriction Enforcement and Retailer Proliferation Reveal Limits in Tobacco Control Policy
Journal article   Open access   Peer reviewed

Weak Age Restriction Enforcement and Retailer Proliferation Reveal Limits in Tobacco Control Policy

Anthony J Fischer, Justin D Krogh, Miah Boyle, Yosra Saad, Allison Frahm, Mary Teresi and Margaret Carrel
Annals of the American Thoracic Society, Vol.22(10), pp.1512-1521
10/2025
DOI: 10.1513/AnnalsATS.202501-095OC
PMCID: PMC12499879
PMID: 40466091
url
https://doi.org/10.1513/AnnalsATS.202501-095OCView
Published (Version of record) Open Access

Abstract

Tobacco use disorder begins in adolescence. In December 2019, the Tobacco 21 law restricted sales of tobacco products to persons ≥ 21 years old in the US. It is unclear how underaged tobacco sales changed following Tobacco 21. To compare underaged sales violations in Iowa before and after Tobacco 21, identify retailers with frequent violations, and measure assessed federal penalties. We analyzed 2017-2023 retail inspections in Iowa from FDA Tobacco Compliance Checks. We classified retailers by store type and used binary logistic regression to model underaged sales by retailer type, location, and time. We tabulated monetary penalties from FDA letters to retailers. The FDA recorded 16,530 inspections at 3,789 locations. 1148 inspections (6.9%) resulted in sales violations. 24% of locations had ≥1 violation. Tobacco/vape shops proliferated 3.8-fold in seven years. Retailers with highest violation rates included tobacco/vape shops, liquor stores, and some gas station chains. Violations trended higher in urban counties. Inspections and violations varied owing to the COVID-19 pandemic. After inspections paused in 2020, violations grew to 10.6% in 2021. Federal penalties to retailers totaled $152,903 in 7 years. By contrast, tobacco marketing in Iowa exceeds $100 million annually. Underaged sales remained prevalent following Tobacco 21. Tobacco specialty retailers proliferated in Iowa and frequently violated underaged sales restrictions. Violations rose after decreased inspections from the COVID-19 pandemic, emphasizing the importance of continued surveillance. Penalties for underaged sales were small relative to tobacco revenues. Higher penalties are needed to deter illegal sales. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 tobacco vaping adolescent rural health tobacco control

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