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

Rationale: Tobacco use disorder begins in adolescence. In December 2019, the Tobacco 21 federal law restricted sales of tobacco products to persons ⩾21 years old in the United States. It is unclear how underaged tobacco sales changed after passage of Tobacco 21. Objectives: To compare underaged sales violations in Iowa before and after Tobacco 21, identify retailers with frequent violations, and measure assessed federal penalties. Methods: We analyzed 2017-2023 retail inspections in Iowa from U.S. Food and Drug Administration (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. Results: The FDA recorded 16,530 inspections at 3,789 locations. A total of 1,148 inspections (6.9%) resulted in sales violations. Twenty-four percent of locations had one or more violations. Tobacco/vape shops proliferated 3.8-fold in 7 years. Retailers with the highest violation rates included tobacco/vape shops, liquor stores, and some gas station chains. Violations trended higher in urban counties. Inspections and violations varied because of 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. Conclusions: Underaged sales remained prevalent after passage of 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.