The emergence of e‐cigarette retail shops in a regulated tobacco control environment

Abstract Issue addressed E‐cigarettes are of growing concern. We aimed to determine the location and characteristics of retail shops selling e‐cigarette products in Perth, Western Australia. Methods Two phase study: (i) identifying all e‐cigarette retailers in the Greater Capital City Statistical Area of Perth; (ii) audit at the point‐of‐sale to assess products, promotions and shop characteristics (n = 41). Results Ninety‐eight retailers selling e‐cigarette products were identified: 43 tobacconists (44%), 21 vape shops (21% – up from one shop in 2017), 14 supermarkets (14%), 12 service stations (12%) and 8 smoke shops (8%). The most common e‐cigarette product was non‐nicotine e‐liquid, available at 38 (93%) stores audited. Most stores sold parts of e‐cigarette devices (n = 25, 61%). Front counter displays were the most frequent form of promotion (n = 40, 98%). Vape shops differed from other retailers, having bar‐style layouts (n = 15, 71%), lounge areas (n = 7, 33%) and free e‐liquid samples (n = 17, 89%). Conclusion The availability of e‐cigarette products from retail shops and particularly vape shops is increasing. E‐cigarette retailers are using traditional promotional techniques including point‐of‐sale displays to market their products, while vape shops are extending their appeal through bar style, lounge layouts and free trials. Implications for public health Understanding the e‐cigarette retail store environment is essential for identifying emergent trends, potential regulations and future research. So what? The e‐cigarette retail market in the Perth is growing, shops using traditional and new promotional techniques to market e‐cigarette products. Our findings identify a need for public health surveillance, regulations and legislation.


| INTRODUCTION
Electronic cigarettes (e-cigarettes) are battery-operated, handheld devices that heat e-liquid, also known as e-juice, to produce an aerosol that the user inhales. 1 E-cigarettes, also known as vapes were commercialised in the mid-2000s and have since evolved rapidly, resulting in a dynamic marketplace and a variety of e-cigarette terminologies, designs and engineering. 1 The two broad classes of e-cigarettes are closed systems and open systems. 2 Closed system either have a prefilled e-liquid cartridge or 'pod' that attaches to a device and cannot be modified. 3 In comparison, open system e-cigarettes have cartridges that the user fills with e-liquid. 3

E-liquid for open system devices is sold in bottles,
with the consumer able to purchase any brand, or mix their own by adjusting flavouring additives and nicotine concentrations. 4 Open systems include 'build your own' devices that have customisable parts. 4 E-cigarettes are marketed by the tobacco industry as a potentially 'reduced risk' alternative to traditional tobacco products, 5,6 even though their long-term health and safety impact is not yet established. 1 Being potentially less harmful than traditional tobacco products, which cause the premature death of up to two-thirds of long-term users, 7 does not mean they are a safe product, and any use by non-smokers will increase their risk of harm. 8 There is also accumulating evidence that e-cigarettes have adverse respiratory 9 and cardiovascular health impacts. 10 In Australia, young adults aged 18 to 24 are the group with the highest rates of ever use or experimentation with e-cigarettes, with 63.9% of smokers and 19.6% of non-smokers reporting having ever used an e-cigarette. 11 Between 2016 and 2019, the proportion of young adults who were current e-cigarette users (including daily, weekly, monthly or less than monthly) almost doubled from 2.8% to 5.3%. 11 E-cigarette products are primarily sold through three channels: online, traditional tobacco retailers and vape shops. The majority of ecigarette users in Australia purchase their products online, 12 however, brick and mortar vape shops are a large sector of the retail market in countries where e-cigarettes are more freely available 13 and an avenue for attracting new users, particularly youth. 14 Vape shops provide a wide range of e-cigarette brands, customisable devices and flavoured e-juice, while offering an environment where consumers can discuss products and receive personalised advice. [15][16][17] Products by the same manufacturers are often sold across channels, with online vendors selling in retail settings and vice versa. 18,19 In 2017, the Australian ecigarette industry was estimated to be worth $AUD50.1 million. 20 While the relationship between traditional tobacco retailer density and sales promotion strategies are well documented, 21 York reported e-cigarettes to be more readily available in economically advantaged communities. 28 Australia provides a unique context with a strict regulatory environment for tobacco products and the prohibition of nicotine for use in e-cigarettes. 29 E-cigarettes containing nicotine can only be obtained with an authorised prescription from a medical practitioner; it is an offence to manufacture, supply or sell nicotine without a licence or permit, as required by all states and territories. 29 The regulation of nonnicotine e-cigarettes varies depending on state and territory legislation, with almost all jurisdictions having regulated the sale and promotion of non-nicotine e-cigarettes in a similar way to traditional tobacco products. 29 As such, in most Australian states and territories it is illegal to sell e-cigarettes to people under the age of 18 years, the use of ecigarettes is prohibited in existing smoke-free areas, and there are restrictions on the advertising, marketing and display. 29 Western Australia (WA) differs from other Australian states and territories in that the Tobacco Products Control Act 2006 (WA) (s. 106) states a person 'must not sell any food, toy or other product that is designed to resemble a tobacco product or packaging'. 30 In 2014, the WA Supreme Court convicted a retailer of breaching the Act for selling e-cigarettes that resembled a tobacco product. 31 As a result of this case precedent, e-cigarette devices cannot be sold in WA whether they contain nicotine or not. Since e-cigarettes are not explicitly referred to in the Tobacco Products Control Act 2006 (WA), 30 the display and sale of the e-liquid and e-cigarette parts are not restricted in the same way as traditional tobacco products. E-liquid is not considered a tobacco product because it does not contain tobacco, meaning there are no minimum age requirement laws for e-liquid or e-cigarette paraphernalia sold in WA. 30 Despite strict regulations in WA, there are concerns e-cigarettes have the potential to undermine current tobacco control efforts by attracting and supporting the initiation of nicotine addiction among youth and young adults. 3 In addition, evidence indicates retailers are circumventing regulations by facilitating customers to purchase e-cigarette devices. 32,33 The parts of open system e-cigarettes (refillable devices, often consisting of customisable parts and accessories) do not always resemble a tobacco product when parts are sold separately and may not breach the legislation if one retail shop does not sell all parts to complete the device. 32 E-cigarette retailers are not required to have a licence; therefore, the extent to which e-cigarettes are available and promoted through bricks and mortar shops in WA is unknown. This study is the first to assess the location, products, promotion, POS display and characteristics of shops selling e-cigarette paraphernalia and e-liquids in Perth, WA.

| Mapping
The location of e-cigarette retailers was compiled using a systematic internet search. The search engines included Google, Google Maps, Facebook and a combination of the search terms: 'vape shop', 'vape store', 'e-cigarettes', 'e-cigarette retailer', 'Perth'. This search methodology has been identified as a valid method to identify vape shops, tobacconists and other retailers that sell ecigarette products. 34,35 The geographical area of the study was the GCCSA of Perth, as defined by the Australian Bureau of Statistics (ABS), 36 represents the functional extent and urban area of WA's capital city. 36  3. Tobacconist: a retailer that sells conventional tobacco products and accessories and includes newsagencies and convenience stores.
The socio-economic advantage and disadvantage for each suburb was measured using the Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) from the ABS Socio-Economic Indexes for Areas. 39,40 The scores were reported in suburb-based deciles, with 1 representing the most disadvantaged areas and 10 representing the most advantaged. The deciles were collapsed into three categories, low (decile 1-4), medium (decile 5-7) and high (decile 8-10).

| Observational audit
Observational audits were conducted between July and September 2019, assessing products (e-cigarette devices, e-liquid, accessories and tobacco products) promotion (free samples, outside signage, quantity discounts, price discounts, loyalty programs), POS display and shop characteristics (layout, vaping in-store, signage indicating minimum age to enter or purchase products). All vape shops were selected for inclusion (n = 21) and a random sample of other retailers: Tobacconist (n = 12); smoke shops (n = 4); supermarkets (n = 2) and service stations (n = 2) from low, middle and high IRSAD categories Evaluating retail shop environments using photography has been documented as a rapid method for capturing accurate information on marketing and advertisements. 43

| Data analysis
The location of e-cigarette retailers was recorded in a spreadsheet and geocoded by the address using Google Maps. Descriptive analyses were conducted for the observational data using crosstabulations and frequencies to assess product type, promotion, POS display and shop characteristics by type of retailer. Survey data was exported from Qualtrics, and statistical analyses were conducted using SPSS v25. 44 3 | RESULTS/
No retailers sold closed system e-cigarette devices (such as Juul).

| Product display -POS
All but one retailer displayed their e-cigarette products, so they were visible from the counter (n = 40, 98%). Three-quarters displayed ecigarettes at the checkout and behind the front counter (n = 29, 71%), and 8 (19%) retailers displayed products next to confectionary, while 16 (39%) had the e-cigarette products in a locked/closed cabinet (Table 3).

| DISCUSSION AND INTERPRETATION
The e-cigarette retail market in WA is nascent but growing rapidly, as seen by the exponential growth from 2017 to 2019, with e-cigarette products available at vape shops, smoke shops, tobacconists, supermarkets and service stations across Perth. The mapping of e-cigarette retailers showed a relatively even distribution across low, medium and high socio-economic areas. However, over half of the vape shops (n = 12, 57%) were located in the lowest area of socio-economic disadvantage. This is consistent with research showing that traditional tobacco retailers are more likely to be situated in lower socioeconomic areas 21,22 and a study in New Zealand that found tobacco outlets selling e-cigarette products were typically located in areas with higher deprivation. 23 However, it contrasts with US research, including a study in New York City that found e-cigarettes were more accessible in higher income and predominantly white neighbourhoods. 28 This indicates the need for research to identify associations between the socio-economic location of e-cigarette retailers, customer demographics and differentiation between stores, to identify any potential public health implications This study identified strategies being adopted by e-cigarette retailers to circumvent WA laws to facilitate e-cigarette purchases.
These strategies included having two separate shops adjacent to each other, one selling the mods (the main part of the device that contains the battery) and the other the tank (part of the device that holds the e-liquid). Retailers creating two businesses to enable the purchasing of the whole e-cigarette device through two transactions has been identified by previous WA research, 33   Finally, vape shops were distinct from other retailers in the way they provided an inviting environment with bar-style layouts, couches, free trials and opportunities to vape, essentially a community recreational space. These findings are consistent with other studies which reported vape shops offered an opportunity to socialise, reinforce a vaping identity, 49 and sense of community, 32 providing a wide range of e-liquids and customisable devices, and discuss products and receive personalised advice. 50

| LIMITATIONS
Our study should be interpreted in the context of its limitations. First, we followed a previously validated online search method to identify vape shops for the mapping. 34,35 However, we did not identify all the e-cigarette retailers (eg tobacconists, supermarkets and service stations) in the Greater Perth area, whose primary business is not e-cigarette products. It still provides a snapshot of the activity in this area. Second, one observer collected all the audit data, however, subjectivity was reduced by using a standardised observational audit that had been reviewed by three researchers and pilot tested prior to data collection.

| CONCLUSION
We found that the e-cigarette brick and mortar retail market is expanding in the Perth GCCSA with vape shop numbers increasing from 1 in 2017 to 21 in 2019. Identified e-cigarette retailers included vape shops, supermarkets, service stations, tobacconists and smoke shops. We found retail stores are using traditional tobacco promotional techniques to market their products. The specialist vape shops are creating casual attractive environments to encourage the trialling of e-cigarette products as well as harnessing a sense of community.
This growth in the e-cigarettes retail environment represents a challenge for public health and policymakers as the number of retailers is increasing exponentially exposing these products to new users.
Understanding this environment is essential for identifying emergent trends and providing evidence of the need for public health surveillance, potential regulations and legislation and future research.

DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request.