The effects of assurances of voluntary compliance on retail sales to minors in the United States: 2015-2016.

Multiple state attorneys generals have entered assurances of voluntary compliance (AVCs) with numerous national retail chains as an application of consumer protection laws to help prevent tobacco sales to minors. Little is known about the effectiveness of AVCs in reducing the violations of tobacco retailers for underage sales. We collected inspection data involving minors (n=53,832) on tobacco retailers in 2015 and 2016 from the Food and Drug Administration (FDA) compliance check database. Inspections on 13 national retail chains were classified into four categories: gas stations from oil companies, convenience stores, pharmacy stores, and supermarkets. Multilevel logistic regression models were performed to examine the effectiveness of AVCs, adjusted for state tobacco control policies, state youth smoking rates, and socio-economic status (SES) at census tracts. Overall the Retail Violation Rate for sales to minors (RVRm) significantly varied by retail category from 7.7% in pharmacy stores to 18.9% in gas stations from oil companies. Retailers that entered an AVC had lower odds of underage sales violations in convenience stores (aOR=0.75, 95% CI [0.61-0.93]) and supermarkets (aOR=0.74, 95% CI [0.59-0.93]). For gas stations from oil companies and pharmacy stores, there were no significant differences in RVRm between stores with an AVC and stores without an AVC. We found that entering into AVCs is associated with fewer retail violations of underage sales for convenience stores and pharmacy stores. Continued efforts to strengthen the enforcement of AVCs and to expand AVCs to more states and other retail chains may improve youth tobacco control.