Virginia Via Research Day Book 2026

Medical Student Research Public Health

06 GEOGRAPHIC PATTERNS OF SYNAR COMPLIANCE AND ADOLESCENT VAPING BEHAVIORS ACROSS VIRGINIA

Tierra S. Kindred, OMS-IV, Theresa J. McCann, PhD, MPH Corresponding author: tkindred@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

Background: According to the U.S. Centers for Disease Control and Prevention, cigarette smoking remains the leading cause of preventable morbidity and mortality in the United States. In response, federal and state legislation has increasingly focused on reducing youth access to tobacco products, most recently through the Tobacco 21 initiative in 2018. However, federal efforts to limit tobacco sales to minors began earlier, with the 1992 Synar Amendment, sponsored by Congressman Mike Synar. This amendment became the first federal legislation requiring states to enact and enforce laws prohibiting the sale of tobacco products to individuals under 18 years old. Although retailer violation rates are publicly reported each year as part of Synar compliance monitoring, the extent to which these measures correlate with adolescent tobacco-use patterns remains unclear. Objective: To assess geographic variation in Synar compliance across Virginia and evaluate its association with the prevalence of adolescent vaping behaviors. Findings may inform clinical screening practices, enhance counseling strategies in pediatric and primary care settings, and guide evidence-based policy efforts to reduce harmful vaping behaviors in youth.

Methods: This cross-sectional study will utilize 2022 Synar Retailer Violation Rates (RVR) via the counter tools mapping online database to assess compliance throughout Virginia. Associations between regional Synar retailer violation rates (RVR's), retailer density, and adolescent vaping behaviors will be analyzed using multivariable linear regression models adjusted for urban/rural composition and demographic characteristics. Phase 1 analyses focused on descriptive statistics and geographic mapping of Synar compliance across counties. Planned Phase 2 analyses will integrate compliance and youth vaping datasets to examine geographic associations between retailer compliance and adolescent vaping behaviors.​ Results: In 2022, approximately 60 counties reported at least one sale of vaping products to an individual less than 21 years old during Synar compliance checks, with a mean county-level violation rate of 51%. Among the top 10 counties, failure rates ranged from 50% to 100%, with five counties demonstrating 100% failure despite limited numbers of retailers and inspections. Petersburg City recorded the highest number of sales to minors (n=6) and compliance checks (n=11). Counties with high retailer density but fewer compliance checks also exhibited elevated failure rates.

Conclusion: Synar violation rates varied substantially across counties and were not consistently associated with population size, retailer density, or inspection frequency. High failure rates in both rural counties with few inspections and urban jurisdictions with more extensive monitoring suggest systemic gaps in enforcement and retailer compliance, contributing to ongoing youth access to vaping products. Widespread retailer noncompliance represents a significant public health concern and may undermine efforts to reduce youth vaping. More consistent, targeted compliance strategies—combined with clinician screening, counseling, and advocacy—are needed to limit youth access to nicotine products. Future analyses will merge compliance data with youth vaping datasets to examine geographic associations with adolescent vaping behaviors. IRB Statement: This study relies exclusively on de identified, publicly available data and qualifies for institutional review board exemption.

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20 Edward Via College of Osteopathic Medicine (VCOM)