When Rebecca Williams, MHS, PhD, started studying online tobacco sales in the late 1990s, she was shocked by how easily minors could buy cigarettes. In a 2003 study, Williams and her research collaborators reported that nearly 92 percent of the internet vendors sold cigarettes to underage teens. It was clear there was a critical need for federal regulations of the online cigarette market.
Fast forward to this year, Williams reports in a study just published in the journal Tobacco Control that many online cigarette sellers have moved overseas in the wake of federal regulation and online tobacco sales to minors continues. Williams found that nearly one in three minors were able to buy cigarettes, all delivered by the U.S. Postal Service in violation of federal law, from overseas sellers. She also experienced more than $7,000 in fraudulent credit charges during her research.
Williams, a researcher with the University of North Carolina Lineberger Comprehensive Cancer Center, has spent nearly 17 years studying online sales of cigarettes and other tobacco products. She is the principal investigator for the Internet Tobacco Vendors Study at UNC-Chapel Hill.
While a career as a watchdog of the online tobacco industry is not what she had envisioned herself doing when she was growing up, she finds her work deeply rewarding. Williams recently shared insights about finding her career path and her most recent research findings.
What got you interested in research, and public health research in particular?
Actually it wasn’t something I always wanted to do. I ended up in public health through several sideways steps that led me down that path. I was really interested in potentially pursuing a career as an opera or Broadway singer or as a filmmaker, but those were careers I could very well spend the rest of my life working minimum wage jobs while waiting for my big break. I wanted a more reliable career. That directed me toward science.
My mother was a clinical psychologist. When I was starting college at the University of Rochester and was looking for some classes to fill up my schedule, I took Psychology 101 and I had a fantastic professor who became my mentor. He taught two of the most popular classes on campus – Psych 101 and Psychology of Human Sexuality. I worked with him as a teaching assistant for both of those courses. Ultimately, I became fascinated by the psychology work, especially because I’d grown up watching my mother as a psychologist.
I was really interested in doing research on human sexuality and there are very few programs in the country, but Johns Hopkins, where I went for my master’s degree, had a reproductive health program in their School of Public Health. And so that’s how I kind of ended up going sideways into public health.
I came to UNC after getting my master’s degree because I wanted to develop a stronger background in research methodology and designing health interventions programs. I got my doctorate in health behavior and health education at UNC. While I was working on my doctorate, I started working with Professor Kurt Ribisl, PhD, who was looking at adolescent smoking prevention and tobacco prevention.
That’s kind of how I ended up studying tobacco prevention and control. In my first year working with Kurt, who is the program leader of UNC Lineberger’s Cancer Prevention and Control Program, we started the Internet Cigarette Vendors Study which eventually expanded into the Internet Tobacco Vendors Study to examine vendors of all tobacco products. We’ve been studying online tobacco sales since 1999.
Was there an initial study or finding that grabbed you or piqued your interest in internet tobacco sales?
It struck me that it was really easy for kids to get tobacco products online. For the first big purchase study we did, we had kids buy cigarettes online, and they had a 92 percent success rate. This is comparable to our more recent findings about Internet e-cigarette sales to minors, which are similar to what we found during the pre-regulation infancy of the Internet cigarette sales industry. Before there were federal regulations governing those sales, it was kind of a free-for-all.
Back then, there were no federal regulations that addressed Internet cigarette sales. Some state regulations were added over time, but there were a lot of jurisdictional issues complicating enforcement. When you make an online sale, you have the buyer in one location, the seller’s website may be hosted in another location, the seller’s business may be in another, the products may be shipped from another location, and they may all be in different states or countries.So it’s really hard to for the states to go after violators of these laws. It’s also hard because there are literally thousands of internet tobacco vendors. When you try to sue a few of them, it doesn’t affect the others, and the ones that you sue can simply just close down their website and re-open a different web address.
Recognizing this, my mentor, Kurt Ribisl and I came up with the Q.U.I.T. Framework – the Quarantine of Unhealthy Internet Trade Framework. The idea was that because it’s so hard to go after individual vendors, greater success at restricting their sales may be found by cutting them off from the different businesses they work with to get their products to consumers, interrupting the supply chain.
Federal policies in 2005 and 2009 put this framework to use to cut internet cigarette vendors off from their payment processors and delivery companies, making it difficult for them to do business with their customers. But what our follow-up research showed was the industry was very adaptive and the vendors found and exploited loopholes in federal policies to continue business as usual.
What were your biggest findings from you latest study of online cigarette sales, which was published this month in the journal Tobacco Control?
In our most recent study, we had teens buy cigarettes online to see how easily they could get them without being stopped by age verification. We found it’s still really easily done.
I think for minors, it’s really important we protect them because they are not necessarily old enough to make well-informed decisions about using tobacco products. When it comes to cigarettes, about 90 percent of adult smokers started smoking before age of 18. Cigarette marketing has historically targeted young people.
In the wake of heavy regulation, many internet cigarette vendors have gone out of business. Of those still in the business, nearly all have moved overseas where they don’t perceive themselves subject to U.S. law despite the fact that really they are, if they’re shipping products to U.S. customers.
The other thing that was really remarkable in this study, what we hadn’t seen before, was widespread credit card fraud. These were cards opened specifically for the study and used for 10 or less purchases each. We ended up with over than $7,000 in credit card fraud on these cards, several times more than we spent ordering cigarettes.
You started this in 1999, we’re in 2016 now. What is the biggest change you’ve seen in 17 years?
There are three big changes that I’ve seen. One is that e-cigarettes have exploded on the market and skyrocketed in popularity. The second is that there’s been widespread federal regulation of Internet cigarette sales, and the FDA has announced its intention to regulate all tobacco products, and most notably, e-cigarettes. That includes the specific regulations that are going to take effect in August.
My research can provide the government with evidence about how the industry responds and adapts to regulation, inform regulatory enforcement plans, and assist in the development of new regulations. The third big change I’ve seen is that in the wake of federal regulation of Internet cigarette sales, vendors have moved overseas, and there is lot of fraud.
Do you ever get questions about the boundaries between personal freedom and regulation of these products, and what do you think about that?
I think that adults are adults, and they’re allowed to make their own decisions about what they do with their bodies, but it’s important for them to be properly informed about the actual health risks involved in the products they’re using. I think when there is substantial research evidence that shows this product is incredibly harmful, it is appropriate to restrict access. I have mixed feelings about cigarettes and e-cigarettes — whether they should be banned entirely or whether the public should be really well-educated about the risks of using them but allowed to use them. I think a lot of people don’t understand the full risks, and if they were better informed they might make different choices.
I think for minors, it’s really important we protect them because they are not necessarily old enough to make well-informed decisions about using tobacco products. When it comes to cigarettes, about 90 percent of adult smokers started smoking before age of 18. Cigarette marketing has historically targeted young people.
Now, research shows there are higher rates of e-cigarette use among teenagers than cigarette use. They’re starting, generally, with flavored e-cigarettes because they view them as being safe to use. Their friends are using them, they see them in the media, and they see commercials. That’s influencing young people to use these products. There’s a growing mountain of evidence that they’re are not safe. They are probably safer than cigarettes, but there is also new research showing that e-cigarettes, particularly flavored e-cigarettes, have detrimental health effects beyond those of cigarettes.