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| Name | Class |
|---|---|
| China Medical Board | OTHER |
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This study is a national-level randomized control trial to measure the effects of dressing in professional attire by adolescents on regulation compliance-related behaviors of electronic cigarette (e-cigarette) retailers defined by both age verification and potential underage sales. The corresponding null hypothesis that will be tested is that dressing in professional attire by adolescents will have no effect upon retailer behaviors in regulation compliance. The secondary objectives are to determine the impacts of type of dress by adolescents on marketing and communication strategies adopted by retailers, as well as to document the differences in the behaviors between e-cigarette and tobacco retailers.
Electronic cigarette (e-cigarette) use has been growing dramatically and poses a significant public health threat to adolescents in China. After the online sales of these products has been banned, purchases from brick-and-mortar stores became the only legal option for the users. However, little research has been conducted to document sales behaviors of the physical retailers and identify the associated factors. The study will investigate the extent to which dressing in professional attire by adolescents on regulation compliance in retailer behaviors, including inquiring about age, requesting identity cards for age verification, and completing transactions even when identity cards are not presented. Adopting the simulated client method, the study will collect information on regulation compliance, store environment, product availability, and marketing strategies through interacting with retailers across China. Considering that e-cigarette retailers are predominately located in the most densely populated cities, the investigators will include approximately 1,080 e-cigarette retailers from 36 cities, including 4 municipalities directly under the Central Government, 27 provincial capital cities, and 5 cities specially designated in the state plan. Store addresses and contact information will be obtained through web scraping from the AutoNavi map (the most popular map app in China). The investigators plan to randomly sample 32 retailers in each city if the number allows, and cities with less than 32 retailers identified will all be included. To capture reality, retailers will not be informed during visit. The sampled ones within each city will be randomized into the intervention and control group, with a balance gender ratio of the simulated clients. These clients will be recruited from university students younger than 20 years old, who can easily be considered as minors (under 18) when purely judged by their appearance. Clients visiting retailers in the control group will dress in school uniforms and carry a school bag, while those in the intervention group will dress in professional attire with a business-style backpack for males or a leather bag for females. The clients will record retailer responses, including (1) inquiring about age verbally, (2) requesting identity cards for age verification, and (3) whether retailers still sell products even when identity cards are not presented. For each e-cigarette retailer, the nearest tobacco retailer identified through the AutoNavi Map will be used for comparison to document the differences in the behaviors between the two types of retailers. Additionally, communication and marketing strategies, e.g., mentioning available flavored products, dissuading clients not to purchase, are also collected.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dress in School Uniforms | No Intervention | Simulated clients dress in school uniforms, enter e-cigarette stores, and act as minor buyers. | |
| Dress in Professional Attire | Experimental | Simulated clients dress in business casuals, enter e-cigarette stores, and act as potential "adult e-cigarette buyers". |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dress in Professional Attire | Other | "Adolescents" pretend to be "adult e-cigarette buyers" by dressing in professional attire. |
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| Measure | Description | Time Frame |
|---|---|---|
| Non-compliant sales | The simulated clients will report whether retailers sell e-cigarette products to possible minors even when identity cards are not presented for age verification. | During visit (day 1) |
| Measure | Description | Time Frame |
|---|---|---|
| Inquiring about age | The simulated clients will report whether retailers inquire about their age verbally in stores. | During visit (day 1) |
| Requesting identity cards | The simulated clients will report whether retailers request them to show identity cards for the purpose of age verification. |
| Measure | Description | Time Frame |
|---|---|---|
| Online contact | The simulated clients will report if they are able to add retailers as WeChat (the online most popular chat app in China) contacts. | During visit (day 1) |
| Delivery service offered | The simulated clients will report if salespersons mention that products ordered online can be delivered to them. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Yang Wang, PhD | Peking University Health Science Center | Principal Investigator |
| Hai Fang, PhD | Peking University Health Science Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| 36 major metropolitan areas (Beijing included) | Beijing | Beijing Municipality | 100191 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41071555 | Derived | Wang Y, Lv X, Laestadius LI, Guidry JPD, Mahmoudi E, Kong G, Chang J, Martin A, Yang M, Yan D, Si L, Bustamante AV, Fang H. E-Cigarette Sales to School-Uniformed Adolescents in China: A Randomized Clinical Trial. JAMA Netw Open. 2025 Oct 1;8(10):e2535623. doi: 10.1001/jamanetworkopen.2025.35623. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jul 27, 2023 | Jul 29, 2024 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Sep 3, 2023 | Jul 29, 2024 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D000072137 | Vaping |
| ID | Term |
|---|---|
| D012907 | Smoking |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D001458 | Bandages |
| ID | Term |
|---|---|
| D004864 | Equipment and Supplies |
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| During visit (day 1) |
| During visit (day 1) |
| Illegal flavored e-cigarette products available | The simulated clients will report if salespersons mention that flavored (non-national-standard) e-cigarette products are available in stores. | During visit (day 1) |