ANNUAL SYNAR REPORT
42 U.S.C. 300x-26
OMB № 0930-0222

FFY 2022
State: MA

Table of Contents

Introduction	i
FFY 2022: Funding Agreements/Certifications	1
Section I: FFY 2021 (Compliance Progress)	2
Section II:FFY 2022 (Intended Use)	11
Appendix A: Forms 1–5	13
Appendixes B & C: Forms	20
Appendix B: Synar Survey Sampling Methodology	19
Appendix C: Synar Survey Inspection Protocol Summary	21
Appendix D: List Sampling Frame Coverage Study	25

								OMB No. 0930-0222
								Expiration Date:  06/30/2022

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0930-0222.  Public reporting burden for this collection of information is estimated to average 18 hours per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Rockville, MD 20857.

INTRODUCTION

The Annual Synar Report (ASR) format provides the means for states to comply with the reporting provisions of the Public Health Service Act (42 U.S.C. 300x-26) and the Tobacco Regulation for the Substance Abuse Prevention and Treatment Block Grant (SABG) (45 C.F.R. 96.130 (e)).

How the Synar report helps the Center for Substance Abuse Prevention 

In accordance with the tobacco regulations, states are required to provide detailed information on progress made in enforcing youth tobacco access laws (FFY 2021 Compliance Progress) and future plans to ensure compliance with the Synar requirements to reduce youth tobacco access rates (FFY 2022 Intended Use Plan). These data are required by 42 U.S.C. 300x-26 and will be used by the Secretary to evaluate state compliance with the statute. Part of the mission of the Center for Substance Abuse Prevention (CSAP) is to assist states by supporting Synar activities and providing technical assistance helpful in determining the type of enforcement measures and control strategies that are most effective. This information is helpful to CSAP in improving technical assistance resources and expertise on enforcement efforts and tobacco control program support activities, including state Synar program support services, through an enhanced technical assistance program involving conferences and workshops, development of training materials and guidance documents, and onsite technical assistance consultation.

How the Synar report can help states

The information gathered for the Synar report can help states describe and analyze substate needs for program enhancements. These data can also be used to report to the state legislature and other state and local organizations on progress made to date in enforcing youth tobacco access laws when aggregated statistical data from state Synar reports can demonstrate to the Secretary the national progress in reducing youth tobacco access problems. This information will also provide Congress with a better understanding of state progress in implementing Synar, including state difficulties and successes in enforcing retailer compliance with youth tobacco access laws.
Getting assistance in completing the Synar report

If you have questions about programmatic issues, you may call CSAP’s Division of State Programs at (240) 276-2550 and ask for your respective State Project Officer, or contact your State Project Officer directly by telephone or email. If you have questions about fiscal or grants management issues, you may call the Grants Management Officer, Office of Financial Resources, Division of Grants Management, at (240) 276-1422.

Where and when to submit the Synar report

The ASR must be received by SAMHSA no later than December 31, 2021 and must be submitted in the format specified by these instructions. Use of the approved format will avoid delays in the review and approval process. The chief executive officer (or an authorized designee) of the applicant organization must sign page one of the ASR certifying that the state has complied with all reporting requirements.

The state must upload one copy of the ASR using the online WebBGAS (Block Grant Application System). In addition, the following items must be uploaded to WebBGAS:
•	FFY 2022Synar Survey Results: States that use the Synar Survey Estimation System (SSES) must upload one copy of SSES Tables 1–8 (in Excel) to WebBGAS. Please note that, in the FFY 2022 ASR, SSES will generate Tables 6, 7, and 8, which are based on the optional microdata on product type, retail outlet type, and whether identification was requested.  If your state does not submit these optional data, Tables 6, 7, and 8 will be blank.  Tables 6, 7, and 8 are generated for the convenience of the state, and states are not required to submit completed versions of Tables 6, 7, or 8.States that do not use SSES must upload one copy of ASR Forms 1, 4, and 5, and Forms 2 and 3, if applicable, (in Excel), as well as a database with the raw inspection data to WebBGAS. 
•	Synar Inspection Form: States must upload one blank copy of the inspection form used to record the result of each Synar inspection.
•	Synar Inspection Protocol: States must upload a copy of the protocol used to train inspection teams on conducting and reporting the results of the Synar inspections.  This document should be different than the Appendix C attached to the Annual Synar Report.
•	A scanned copy of the signed Funding Agreements/Certifications
Each state SSA Director has been emailed a login ID and password to log onto the Synar section of the WebBGAS site.

FFY 2022: Funding Agreements/Certifications

The following form must be signed by the Chief Executive Officer or an authorized designee and submitted with this application. Documentation authorizing a designee must be attached to the application.
PUBLIC HEALTH SERVICES ACT AND SYNAR AMENDMENT	
42 U.S.C. 300x-26 requires each state to submit an annual report of its progress in meeting the requirements of the Synar Amendment and its implementing regulation (45 C.F.R. 96.130) to the Secretary of the Department of Health and Human Services.By signing below, the chief executive officer (or an authorized designee) of the applicant organization certifies that the state has complied with these reporting requirements and the certifications as set forth below.	
SYNAR SURVEY SAMPLING METHODOLOGY	
The state certifies that the Synar survey sampling methodology on file with the Center for Substance Abuse Prevention and submitted with the Annual Synar Report for FFY 2022 is up-to-date and approved by the Center for Substance Abuse Prevention.	
SYNAR SURVEY INSPECTION PROTOCOL	
The state certifies that the Synar Survey Inspection Protocol on file with the Center for Substance Abuse Prevention and submitted with the Annual Synar Report for FFY 2022 is up-to-date and approved by the Center for Substance Abuse Prevention.	
State:     
	
Name of Chief Executive Officer or Designee:     
	
Signature of CEO or Designee:     
	
Title:	     		Date Signed:	     	

If signed by a designee, a copy of the designation must be attached.	

	FFY: 2022	State:	Massachusetts	

SECTION I: FFY 2021 (Compliance Progress)

YOUTH ACCESS LAWS, ACTIVITIES, AND ENFORCEMENT
42 U.S.C. 300x-26 requires the states to report information regarding the sale/distribution of tobacco products to individuals under age 21.

1.	Please indicate any changes or additions to the state tobacco statute(s) relating to youth access since the last reporting year. If any changes were made to the state law(s) since the last reporting year, please upload a copy of the state law to WebBGAS. (see 42 U.S.C. 300x-26).
a.	Has there been a change in the minimum sale age for tobacco products?
Yes	No
If Yes, current minimum age: 19 	 20 	 21
b.	Have there been any changes in state law that impact the state’s protocol for conducting Synar inspections?
	Yes	No
If Yes, indicate change. (Check all that apply.)
 Changed to require that law enforcement conduct inspections of tobacco outlets
 Changed to make it illegal for youth to possess, purchase or receive tobacco 
 Changed to require ID to purchase tobacco
 Changed definition of tobacco products
 Other change(s) (Please describe.)     	
c.	Have there been any changes in state law that impact the following?
Licensing of tobacco vendors	Yes	No
Penalties for sales to minors	Yes	No
Vending machines	Yes	No
Added product 
categories to youth access law	Yes	No

2.	Describe how the Annual Synar Report (see 45 C.F.R. 96.130(e))was made public within the state prior to submission of the ASR. (Check all that apply.)
 Placed on file for public review
 Posted on a state agency Web site (Please provide exact Web address and the date when the FFY 2022 ASR was posted to this Web address.) 
Web address: https://www.mass.gov/info-details/local-state-and-federal-laws-related-to-tobacco#federal-laws-
Date published: December 20, 2021
 Notice published in a newspaper or newsletter
 Public hearing

 Announced in a news release, a press conference, or discussed in a media interview 
 Distributed for review as part of the SABG application process
 Distributed through the public library system
 Published in an annual register
 Other (Please describe.) Initial data from the FFY 2022 Annual Synar Report was presented to Local Boards of Health and Community Partnership Programs on November 4, 2021 at the statewide quarterly meeting of the Massachusetts Tobacco Cessation and Prevention Program (MTCP) . These programs use this data in hearings and presentations to stakeholders.	

3.	Identify the following agency or agencies (see 42 U.S.C. 300x-26 and 45 C.F.R. 96.130).
a.	The state agency(ies) designated by the Governor for oversight of the Synar requirements:
	The Massachusetts Department of Public Health	
Has this changed since last year’s Annual Synar Report? 
Yes No
b.	The state agency(ies) responsible for conducting random, unannounced Synar inspections:
	The Massachusetts Department of Public Health in conjunction with Local Boards of Health.
Has this changed since last year’s Annual Synar Report? 
Yes No
c.	The state agency(ies) responsible for enforcing youth tobacco access law(s):
Massachusetts Attorney General’s Office, Massachusetts Department of Public Health in conjunction with Local Boards of Health	
Has this changed since last year’s Annual Synar Report? 
Yes No

4.	Identify the following agencies and describe their relationship with the agency responsible for the oversight of the Synar requirements.
a.	Identify the state agency responsible for tobacco prevention activities (the agency that receives the Centers for Disease Control and Prevention’s National Tobacco Control Program funding).
Massachusetts Department of Public Health, Massachusetts Tobacco Cessation and Prevention Program (MTCP)	

b.	Has the responsible agency changed since last year’s Annual Synar Report?
	Yes	No

c.	Describe the coordination and collaboration that occur between the agency responsible for tobacco prevention and the agency responsible for oversight of the Synar requirements. (Check all that apply.) The two agencies
 Are the same
 Have a formal written memorandum of agreement
 Have an informal partnership
 Conduct joint planning activities
 Combine resources
 Have other collaborative arrangement(s) (Please describe.)      	
 No relationship

d.	Does a state agency contract with the Food and Drug Administration’s Center for Tobacco Products (FDA/CTP) to enforce the youth access and advertising restrictions in the Family Smoking Prevention and Tobacco Control Act? 
Yes	No(if no, go to Question 5)

e.	If yes, identify the state agency responsible for enforcing the youth access and advertising restrictions in the Family Smoking Prevention and Tobacco Control Act (the agency that is under contract to the Food and Drug Administration’s Center for Tobacco Products (FDA/CTP)).
Massachusetts Department of Public Health, Massachusetts Tobacco Cessation and Prevention Program (MTCP). Molly Butler oversees both the Synar Program and the FDA Tobacco Enforcement Program for MTCP.	

f.	Has the responsible agency changed since last year’s Annual Synar Report?
	Yes	No

g.	Describe the coordination and collaboration that occur between the agency contracted with the FDA to enforce federal youth tobacco access laws and the agency responsible for oversight of the Synar requirements. (Check all that apply.) The two agencies:
 Are the same
 Have a formal written memorandum of agreement
 Have an informal partnership
 Conduct joint planning activities
 Combine resources
 Have other collaborative arrangement(s) (Please describe.)      
 No relationship

h.	Does the state use data from the FDA enforcement inspections for Synar survey reporting? 
	Yes	No

5.	Please answer the following questions regarding the state’s activities to enforce the state’s youth access to tobacco law(s) in FFY 2021(see 42 U.S.C. 300x-26 and 45 C.F.R. 96.130(e)).
a.	Which one of the following describes the enforcement of state youth access to tobacco laws carried out in your state? (Check one category only.)
 Enforcement is conducted exclusively by local law enforcement agencies.
 Enforcement is conducted exclusively by state agency(ies).
 Enforcement is conducted by both local and state agencies.

b.	The following items concern penalties imposed for all violations of state youth access to tobacco laws by LOCAL AND/OR STATE LAW ENFORCEMENT AGENCIES (this does not include enforcement of local laws or federal youth tobacco access laws).Please fill in the number requested. If state law does not allow for an item, please mark “NA” (not applicable). If a response for an item is unknown, please mark “UNK.” The chart must be filled in completely.
PENALTY	Owners	Clerks	TOTAL	
Number of citations issued 	314	0	314	
Number of fines assessed	314	0	314	
Number of permits/licenses suspended	UNK		UNK	
Number of permits/licenses revoked	UNK		UNK	
Other(Please describe.)
     	UNK	UNK	UNK	

c. Are citations or warnings issued to retailers or clerks who sell tobacco to minors for inspections that are part of the Synar survey?
Yes	No
If “Yes” to 5c, please describe the state’s procedure for minimizing risk of bias to the survey results from retailers alerting each other to the presence of the survey teams:
Depending on the municipality, citations or warnings may be issued to retailers that sell during Synar inspections. To minimize the risk of bias to survey results, it is MTCP’s protocol that fines and tickets be issued at the end of the round of compliance checks later the same day of the check or the next day after the check instead of immediately after the sale. This protocol reduces the risk of “phone trees” that could potentially bias subsequent checks. This protocol also helps protect the safety and anonymity of the youth buyer. 
For Synar checks that are completed by FDA Inspectors, the FDA handles all aspects of citations/warnings with their own process for warning letters, Civil Money Penalties and the No Tobacco Sales Orders.

d. Which one of the following best describes the level of enforcement of state youth access to tobacco laws carried out in your state? (Check one category only.)
 Enforcement is conducted only at those outlets randomly selected for the Synar survey.
 Enforcement is conducted only at a subset of outlets not randomly selected for 	the Synar survey.
 Enforcement is conducted at a combination of outlets randomly selected for the 	Synar survey and outlets not randomly selected for the Synar survey.
e.	Did every tobacco outlet in the state receive at least one compliance check that included enforcement of the state youth tobacco access law(s) in the last year?
Yes	No
f.	What additional activities are conducted in your state to support enforcement and compliance with state youth tobacco access law(s)? (Check all that apply and briefly describe each activity in the text boxes below each activity.) 
 Merchant education and/or training
For FFY21, 199 communities received Board of Health funding to provide merchant education and/or retail visits at each permitted retailer at least once during the fiscal year. Because of the pandemic, many of our partners had to cease conducting some routine activities. They adapted to the pandemic restrictions with informational mailings and phone calls to retailers to inform them of the new state law restricting the sale of flavored tobacco. 
Merchant education visits include checks for state required signage, sales of loose cigarettes, illegal self-service displays, and for current state and local permits. Because these in person education visits were conducted after June 1, 2020,  they involved some education on the new law that removed flavored products and required additional signs. These visits served to educate store managers and clerks about tobacco sales laws and regulations that apply to tobacco products and ENDS, FDA regulations, and local regulations that may be stronger than the state law.  
The Retailer Education is now an online training tool. It is being offered in both English and Spanish.  This training was offline for some of FFY21 because of the law change. It has now been updated to incorporate the new law restrictions. This past summer the newly revised updated training was available. The number of retailers that have taken this training remains low. Efforts are now underway to promote the free retailer training tool that can be shared with their clerks and staff.
MTCP plans to conduct a retailer outreach campaign that includes mailing reminders about the minimum legal sales age of 21 and resources for retailer education. The Massachusetts Health Officers Association Tobacco Program, funded by MTCP, is the entity that provides the online retailer training as well as regional trainings for tobacco retail owners interested in receiving in-person retailer training.  Because of the current pandemic, in person training was not able to happen this year.
Retailer Education and Training materials are available free of charge to all retailers across the state through the Massachusetts Health Promotion Clearinghouse.

 Incentives for merchants who are in compliance (e.g., nonenforcement compliance checks in which compliant retailers are given positive reinforcement and noncompliant retailers are warned about youth access laws)
     

 Community education regarding youth access laws
Community education regarding youth access laws/local regulations is provided on a regular basis in the communities that currently have MTCP funded boards of health.  Technical assistance regarding youth access laws and regulations is provided to any interested board of health through the Massachusetts Association of Health Boards, the Massachusetts Municipal Association, and the Massachusetts Health Officers Association, funded by MTCP. 
Further, our website, makesmokinghistory.org, has a “My Community” tab, where users can select “Learn about the impact Tobacco has on your community?” and select their city or town from the drop-down box to find out tobacco’s impact and obtain information on their local tobacco regulations.  Users can also use the interactive maps and view smoking rates in their community relative to others across the state. Detailed explanations of the key tobacco control regulations such as, permit capping and cigar packaging are provided on makesmokinghistory.org website.

 Media use to publicize compliance inspection results
Earned media is often used by local programs to publicize local compliance check inspection results.

 Community mobilization to increase support for retailer compliance with youth access laws
Strong support for retailer compliance and enforcement of youth access laws exists in the communities that currently have MTCP funded local boards of health.  In some communities without MTCP-funded boards of health, there is also strong support for retailer compliance and enforcement.  Several of these communities have worked with the Massachusetts Health Officers Association and MTCP to determine free and low-cost ways that they can prevent youth access to tobacco in their communities without MTCP funding.  A few communities have been able to use local tobacco permit fees and fines for violations to fund compliance checks and retailer education in their communities. MTCP’s Community Partnership Programs and The 84 Youth Movement also help to increase community mobilization and support for youth prevention activities and regulations in communities across the Commonwealth.

 Other activities (Please list.)      	
This past year, meetings and coordination increased with inspectors at the Department of Revenue. This collaboration has led to more of an understanding of what each agency does in the retail environment. MTCP and DOR staff now coordinate notification of inspection activity so that Local Boards of Health can follow up on any violations found by DOR and the DOR can follow up on any tax violations found by Local Boards of Health. A great outcome of this relationship has been fewer retailers falling through the cracks.

SYNAR SURVEY METHODS AND RESULTS
The following questions pertain to the survey methodology and results of the Synar survey used by the state to meet the requirements of the Synar Regulation in FFY 2021 (see 42 U.S.C. 300x-26 and 45 C.F.R. 96.130).

6.	Has the sampling methodology changed from the previous year?
	 Yes No
The state is required to have an approved up-to-date description of the Synar sampling methodology on file with CSAP. Please submit a copy of your Synar Survey Sampling Methodology (Appendix B). If the sampling methodology changed from the previous reporting year, these changes must be reflected in the methodology submitted.

	a.	If yes, describe how and when this change was communicated to SAMHSA
     

7.  Please answer the following questions regarding the state’s annual random, unannounced inspections of tobacco outlets (see 45 C.F.R. 96.130(d)(2)).
a.	Did the state use the optional Synar Survey Estimation System (SSES) to analyze the Synar survey data? 
 Yes No
If Yes, upload a copy of SSES tables 1–8 (in Excel) to WebBGAS. Then go to Question 8. If No, continue to Question 7b.
b.	Report the weighted and unweighted Retailer Violation Rate (RVR) estimates, the standard error, accuracy rate (number of eligible outlets divided by the total number of sampled outlets), and completion rate (number of eligible outlets inspected divided by the total number of eligible outlets).
Unweighted RVR	     	
Weighted RVR	     				
Standard error (s.e.) of the (weighted) RVR	     				
Fill in the blanks to calculate the right limit of the right-sided 95% confidence interval.

     	+	(1.645 	×	     )	=	     	
RVR Estimate	plus	(1.645	times	Standard Error )	equals	Right Limit	
Accuracy rate					     					
	Completion rate				     					

c. 	Fill out Form 1 in Appendix A (Forms1–5).(Required regardless of the sample design.)
d.	How were the (weighted) RVR estimate and its standard error obtained? (Check the one that applies.)
 Form 2 (Optional) in Appendix A (Forms 1–5) (Attach completed Form 2.)
 Other (Please specify. Provide formulas and calculations or attach and explain the program code and output with description of all variable names.)
     
e.	If stratification was used, did any strata in the sample contain only one outlet or cluster this year? 
	YesNoNo stratification
If Yes, explain how this situation was dealt with in variance estimation.
     
f.	Was a cluster sample design used? 
YesNo
If Yes, fill out and attach Form 3 in Appendix A (Forms 1–5), and answer the following question.
If No, go to Question 7g.
Were any certainty primary sampling units selected this year? 
Yes	No
If Yes, explain how the certainty clusters were dealt with in variance estimation.
     
g.	Report the following outlet sample sizes for the Synar survey.
	Sample Size	
Effective sample size(sample size needed to meet the SAMHSA precision requirement assuming simple random sampling)	     	
Target sample size(the product of the effective sample size and the design effect)	     	
Original sample size(inflated sample size of the target sample to counter the sample attrition due to ineligibility and noncompletion)	     	
Eligible sample size(number of outlets found to be eligible in the sample)	     	
Final sample size(number of eligible outlets in the sample for which an inspection was completed)	     	
h.	Fill out Form 4 in Appendix A (Forms 1–5).

8.	Did the state’s Synar survey use a list frame? 
	YesNo
If Yes, answer the following questions about its coverage.
a.	The calendar year of the latest Sampling frame coverage study:      	
b.	Percent coverage from the latest Sampling frame coverage study:      	
c.	Was a new study conducted in this reporting period? 
	Yes No
If Yes, please complete Appendix D (List Sampling Frame Coverage Study) and submit it with the Annual Synar Report.
d.	The calendar year of the next coverage study planned:     	

9.	Has the Synar survey inspection protocol changed from the previous year?
 Yes No
The state is required to have an approved up-to-date description of the Synar inspection protocol on file with CSAP. Please submit a copy of your Synar Survey Inspection Protocol (Appendix C). If the inspection protocol changed from the previous year, these changes must be reflected in the protocol submitted.
a.	If Yes, describe how and when this change was communicated to SAMHSA
The protocol updated the ages from 18 to 21 to reflect the federal age change. The protocols were sent to and approved by Clark Hagen on September 14, 2020. Although approved in previous Synar year, this past year was the first time we used minor ages 18-20.
b.	Provide the inspection period: From04/01/2021to9/30/2021
	MM/DD/YYMM/DD/YY
c.	Provide the number of youth inspectors used in the current inspection year:
26

NOTE: If the state uses SSES, please ensure that the number reported in 9b matches that reported in SSES Table 4, or explain any difference.
     The total number of minors reported in Table 4 is listed as 12 Males and 16 Females for a total of 28 which is inaccurate. The actual number of minors used during this Synar period is 26. During this Synar year, 1 Male and 1 Female had a birthday that moved them into the next age group. Because the SSES system thinks it is an error when the minor number has 2 different ages, we had to change the minor number for after they turned 17 to be able to run the report.
d. 	Fill out and attach Form 5 in Appendix A (Forms 1–5). (Not required if the state used SSES to analyze the Synar survey data.)

SECTION II: FFY 2022(Intended Use):

Public Law 42 U.S.C. 300x-26 of the Public Health Service Act and 45 C.F.R. 96.130 (e) (4, 5) require that the states provide information on future plans to ensure compliance with the Synar requirements to reduce youth tobacco access.

1.	In the upcoming year, does the state anticipate any changes in:
Synar sampling methodology	 Yes 	 No
Synar inspection protocol	 Yes	 No
If changes are made in either the Synar sampling methodology or the Synar inspection protocol, the state is required to obtain approval from CSAP prior to implementation of the change and file an updated Synar Survey Sampling Methodology (Appendix B) or an updated Synar Survey Inspection Protocol (Appendix C), as appropriate.

2.	Please describe the state’s plans to maintain and/or reduce the target rate for Synar inspections to be completed in FFY 2022. Include a brief description of plans for law enforcement efforts to enforce youth tobacco access laws, activities that support law enforcement efforts to enforce youth tobacco access laws, and any anticipated changes in youth tobacco access legislation or regulation in the state.
Massachusetts’ Synar sales rate for FFY21 was 13.9% which is an increase from 3.0% in FFY20. 
This RVR is a dramatic increase for Massachusetts but not unexpected. Due to the COVID pandemic, youth compliance check inspections were suspended for over a year. In a normal Synar period, compliance checks happen throughout the year, typically beginning in October and wrapping up the end of June. Because of the pandemic, some of the boards of health programs were not able to work with youth until late spring or summer, when all parties were fully vaccinated. We encouraged local boards of health to follow their city/town’s protocols to determine when it was safe to resume youth compliance checks. In addition, due to the increase in the federal legal sales age to purchase tobacco, when compliance checks were conducted, many were conducted with youth buyers who were 18, 19 or 20 years old. MTCP and Local Boards of Health continue to conduct educational inspections and maintain a presence in the retail environment.  This provides reinforcement that adherence to the laws are a continued priority.
MTCP’s youth access efforts have historically focused heavily on funding local boards of health to provide merchant education and enforcement of youth access laws.  In the beginning of FFY20, MTCP funded 165 of our 351 boards of health (BOH) in the state to do youth prevention work. In the fall of 2020, due to the vaping epidemic and EVALI emergency, MTCP was awarded additional state funds to support 34 more municipal boards of health in their enforcement efforts, bringing the total number of funded BOH to 199. With increased coverage, MTCP anticipates more consistent retail education and enforcement will lead to lower sales rates, especially in the newly funded communities. 
Continuing the current scope of service for the funded board of health programs will include assigned Synar compliance checks that are completed using approved protocols, an additional full round of compliance checks for other tobacco products (little cigars, smokeless or e-cigarettes), and required follow up checks at all locations that have violations. Also included in the scope of service is the requirement to complete one round of merchant education visits/inspections and an MTCP Pricing Survey at each of their permitted tobacco retailers.  The continued presence in the retail environment in addition to consistent compliance checks and enforcement will help to reduce the illegal sales rates to minors.  Board of health programs conduct enforcement on violations and record the results of their enforcement actions in our Counter Tools Point of Sale Toolkit (POST) system.  
In addition to local boards of health efforts, the MA FDA Tobacco Enforcement Program conducts routine FDA youth buyer/compliance checks at 100% of the retailers in the state, with an emphasis in communities that have high sales rates to minors. The FDA program, in place for ten years, is helping to provide strong enforcement and large fines in areas of the state that may not typically have active enforcement of youth access laws.  Over the years, many retailers in Massachusetts have been assessed fines of $5,000 to $11,000 and there have been five no-tobacco-sale-orders (NTSO) issued.  Many of these fines and NTSOs are at retailers in communities that do not receive MTCP funding. 
MTCP will support the continued enforcement and high compliance rates by regularly meeting with the state Department of Revenue (DOR) and the Massachusetts Attorney General’s Office (AGO) to discuss tobacco enforcement issues. Our coordinated efforts strengthen overall compliance with tobacco regulations and laws.
MTCP’s core policy work continues to be done at the municipal level providing support and education for municipalities in passing comprehensive regulations – including cigar packaging restrictions and permit capping - to reduce youth exposure and access to tobacco products.  To garner public and board of health support for these policies, MTCP-funded Community Partnership programs will continue to work with funded and unfunded communities to help mobilize community members to attend public hearings to strengthen tobacco regulations. In FFY20, MTCP’s funded youth group (The 84) conducted community assessments and engaged community members and local decision makers in conversations about the importance of restricting the sale of tobacco products. The 84 youth groups have been learning more about the influence that density of tobacco retail outlets has on their communities and will continue to educate their community stakeholders on the importance of tobacco retailer presence and youth access sales restrictions.  Technical assistance in developing tobacco sales regulations will continue to be provided to boards of health through our Community Assistance Statewide Team (CAST).MTCP will continue to maintain a database to track adopted regulations and to provide tools for community and retailer education to assist with post-enactment and effective enforcement of tobacco retail policies.  
With the state minimum legal sales age at 21, MTCP Epidemiology staff have begun to develop an evaluation plan to look at how raising the MLSA may impact sales rates to minors.  MTCP’s statewide contracts with the Massachusetts Health Officers Association (MHOA), Massachusetts Municipal Association (MMA), and the Massachusetts Association of Health Boards (MAHB) will continue to provide local boards of health with the skills, resources and technical assistance needed to help communities institute and/or strengthen local youth access laws and effectively provide tobacco services to communities.  These statewide TA providers will assist both MTCP funded and unfunded boards of health.  Communities that do not have MTCP funding will be offered technical assistance to help develop a plan to provide evidence-based tobacco services with limited resources.  The goal of this approach is to build the capacity of communities to have a positive effect on the social norms related to youth tobacco use with or without MTCP funding.

3.	Describe any challenges the state faces in complying with the Synar regulation. (Check all that apply and describe each challenge in the text box below it.)
 Limited resources for law enforcement of youth access laws
     

 Limited resources for activities to support enforcement and compliance with youth tobacco access laws
Resources to cover all cities and towns in Massachusetts continue to be limited.  As of October 1, 2021, 199 of the 351 cities and towns in Massachusetts have MTCP funding for enforcement of youth access tobacco laws.  In the communities without MTCP funding, the enforcement of state youth access laws continues to be limited, often resulting in a higher rate of illegal sales rates to minors. The Massachusetts FDA Enforcement Program complements our statewide efforts by providing inspections at 100% of the state tobacco retailers each year. 

 Limitations in the state youth tobacco access laws
     

 Limited public support for enforcement of youth tobacco access laws
     

 Limitations on completeness/accuracy of list of tobacco outlets
     

 Limited expertise in survey methodology
     

 Laws/regulations limiting the use of minors in tobacco inspections
     

 Difficulties recruiting youth inspectors
In some areas, we have a harder time with recruitment. We have made great connections with some of the vocational schools around the Commonwealth that have criminal justice programs. We look forward to expanding our partnerships with community colleges that also have criminal justice programs. We will explore more on how to reach the 18-20 population in the next Synar year including looking into the platform Handshake that is used by many career development programs at colleges and universities.

 Issues regarding the balance of inspections conducted by youth inspectors age 15 and under
     

 Issues regarding the balance of inspections conducted by one gender of youth inspectors 
     

 Geographic, demographic, and logistical considerations in conducting inspections
     

 Cultural factors (e.g., language barriers, young people purchasing for their elders)
     

 Issues regarding sources of tobacco under tribal jurisdiction
     

 Other challenges (Please list.)The pandemic halted our compliance checks with youth for over a year. Retailers became lax with asking for ID and this year’s RVR reflected that. This was a large increase of our RVR but consistent with what our local boards of health had experienced during their BOH compliance checks.  MTCP plans to conduct a retailer outreach campaign that includes mailing reminders about the minimum legal sales age of 21 and resources for retailer education. We are confident with more consistent retailer education, collection of fines, and steady compliance checks the RVR will begin to decrease again.	

APPENDIX A: FORMS 1–5

FORM 1(Required for all states not using the Synar Survey Estimation System (SSES) to analyze the Synar Survey data)

Complete Form 1 to report sampling frame and sample information and to calculate the unweighted retailer violation rate (RVR) using results from the current year’s Synar survey inspections.

Instructions for Completing Form 1: In the top right-hand corner of the form, provide the state name and reporting federal fiscal year (FFY 2022). Provide the remaining information by stratum if stratification was used. Make copies of the form if additional rows are needed to list all the strata.
Column 1:	If stratification was used:
1(a)	Sequentially number each row.
1(b)	Write in the name of each stratum. All strata in the state must be listed.
If no stratification was used:
1(a)	Leave blank.
1(b)	Write “state” in the first row (indicates that the whole state is a single stratum).
Note for unstratified samples: For Columns 2–5, wherever the instruction refers to “each stratum,” report the specified information for the state as a whole.
Column 2:	2(a) Report the number of over-the-counter (OTC) outlets in the sampling frame in each stratum.
2(b) Report the number of vending machine (VM) outlets in the sampling frame in each stratum.
2(c) Report the combined total of OTC and VM outlets in the sampling frame in each stratum.
Column 3:	3(a) Report the estimated number of eligible OTC outlets in the OTC outlet population in each stratum.
3(b) Report the estimated number of eligible VM outlets in the VM outlet population in each stratum.
3(c) Report the combined total estimated number of eligible OTC and VM outlets in the total outlet population in each stratum.
The estimates for Column 3 can be obtained from the Synar survey sample as the weighted sum of eligible outlets by outlet type.
Column 4:	4(a) Report the number of eligible OTC outlets for which an inspection was completed, for each stratum.
4(b) Report the numbers of eligible VM outlets for which an inspection was completed, for each stratum.
4(c) Report the combined total of eligible OTC and VM outlets for which an inspection was completed, for each stratum.
Column 5:	5(a) Report the number of OTC outlets found in violation of the law as a result of completed inspections, for each stratum.
5(b) Report the number of VM outlets found in violation of the law as a result of completed inspections, for each stratum.
5(c) Report the combined total of OTC and VM outlets found in violation of the law as a result of completed inspections, for each stratum.
Totals:	For each subcolumn (a–c) in Columns 2–5, provide totals for the state as a whole in the last row of the table. These numbers will be the sum of the numbers in each row for the respective column.

FORM 1 (Required for all states not using the Synar Survey Estimation System [SSES] to analyze the Synar Survey data.)
Summary of Synar Inspection Results by Stratum
	State:      	
	FFY: 2022	
(1)	(2)	(3)	(4)	(5)	
STRATUM	NUMBER OF OUTLETS IN SAMPLING FRAME	ESTIMATED NUMBER OF ELIGIBLEOUTLETS IN POPULATION	NUMBER OF OUTLETS INSPECTED	NO. OF OUTLETS FOUND IN VIOLATION DURING INSPECTIONS	
(a)
Row #	(b)
Stratum
Name	(a)
Over-the-Counter
(OTC)	(b)
Vending
Machines
(VM)	(c)
Total
Outlets
(2a+2b)	(a)
Over-the-Counter
(OTC)	(b)
Vending
Machines
(VM)	(c)
Total
Outlets
(3a+3b)	(a)
Over-the-
Counter
(OTC)	(b)
Vending
Machines
(VM)	(c)
Total
Outlets
(4a+4b)	(a)
Over-the-Counter
(OTC)	(b)
Vending
Machines
(VM)	(c)
Total
Outlets
(5a+5b)	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	
RECORD COLUMN TOTALS ON LAST LINE (LAST PAGE ONLY IF MULTIPLE PAGES ARE NEEDED).

FORM 2 (Optional)
Appropriate for stratified simple or systematic random sampling designs.

Complete Form 2 to calculate the weighted RVR. This table (in Excel form) is designed to calculate the weighted RVR for stratified simple or systematic random sampling designs, accounting for ineligible outlets and noncomplete inspections encountered during the annual Synar survey.
Instructions for Completing Form 2: In the top right-hand corner of the form, provide the state name and reporting federal fiscal year (FFY 2022).
Column 1:	Write in the name of each stratum into which the sample was divided. These should match the strata reported in Column 1(b) of Form 1.
Column 2:	Report the number of outlets in the sampling frame in each stratum. These numbers should match the numbers reported for the respective strata in Column 2(c) of Form 1.
Column 3:	Report the original sample size (the number of outlets originally selected, including substitutes or replacements) for each stratum. 
Column 4:	Report the number of sample outlets in each stratum that were found to be eligible during the inspections. Note that this number must be less than or equal to the number reported in Column 3 for the respective strata.
Column 5:	Report the number of eligible outlets in each stratum for which an inspection was completed. Note that this number must be less than or equal to the number reported in Column 4. These numbers should match the numbers reported in Column 4(c) of Form 1 for the respective strata.
Column 6:	Report the number of eligible outlets inspected in each stratum that were found in violation. These numbers should match the numbers reported in Column 5(c) of Form 1 for the stratum.
Column 7:	Form 2 (in Excel form) will automatically calculate the stratum RVR for each stratum in this column. This is calculated by dividing the number of inspected eligible outlets found in violation (Column 6) by the number of inspected eligible outlets (Column 5). The state unweighted RVR will be shown in the Total row of Column 7.
Column 8:	Form 2 (in Excel form) will automatically calculate the estimated number of eligible outlets in the population for each stratum. This calculation is made by multiplying the number of outlets in the sampling frame (Column 2) times the number of eligible outlets (Column 4) divided by the original sample size (Column 3). Note that these numbers will be less than or equal to the numbers in Column 2.
Column 9:	Form 2 (in Excel form) will automatically calculate the relative stratum weight by dividing the estimated number of eligible outlets in the population for each stratum in Column 8 by the Total of the values in Column 8.
Column 10:	Form 2 (in Excel form) will automatically calculate each stratum’s contribution to the state weighted RVR by multiplying the stratum RVR (Column 7) by the relative stratum weight (Column 9). The weighted RVR for the state will be shown in the Total row of Column 10.
Column 11:	Form 2 (in Excel form) automatically calculates the standard error of each stratum’s RVR (Column 7). The standard error for the state weighted RVR will be shown in the Total row of Column 11.
TOTAL:	For Columns 2–6, Form 2 (in Excel form) provides totals for the state as a whole in the last row of the table. For Columns 7–11, it calculates the respective statistic for the state as a whole.
FORM 2 (Optional) Appropriate for stratified simple or systematic random sampling designs.
Calculation of Weighted Retailer Violation Rate	
State:	     	
FFY:	2022	
	
(1)
Stratum
Name	(2)
N
Number of
Outlets
in Sampling Frame	(3)
n
Original
Sample Size	(4)
n1
Number of
Sample Outlets
Found Eligible	(5)
n2
Number of
Outlets
Inspected	(6)
x
Number of
Outlets Found
in Violation	(7)
p=x/n2
Stratum
Retailer
Violation
Rate	(8)
N’=N(n1/n)
Estimated Number of Eligible Outlets in Population	(9)
w=N’/Total
Column 8
Relative Stratum
Weight	(10)
pw
Stratum Contribution to State Weighted
RVR	(11)
s.e.
Standard
Error of Stratum RVR	
     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	
     	     	     	     	     	     	     	     	     	     	     	
Total	     	     	     	     	     	     	     	     	     	     	

N	-	number of outlets in sampling frame 
n	-	original sample size (number of outlets in the original sample)
n1	-	number of sample outlets that were found to be eligible 
n2	-	number of eligible outlets that were inspected
x	-	number of inspected outlets that were found in violation
p	-	stratum retailer violation rate (p=x/n2)
N’	-	estimated number of eligible outlets in population (N’=N*n1/n)
w	-	relative stratum weight (w=N’/Total Column 8)
pw	-	stratum contribution to the weighted RVR
s.e.	-	standard error of the stratum RVR
FORM 3 (Required when a cluster design is used for all states not using the Synar Survey Estimation System [SSES] to analyze the Synar survey data.)

Complete Form 3 to report information about primary sampling units when a cluster design was used for the Synar survey.

Instructions for Completing Form 3:In the top right-hand corner of the form, provide the state name and reporting federal fiscal year (FFY 2022).

Provide information by stratum if stratification was used. Make copies of the form if additional rows are needed to list all the strata.

Column 1:	Sequentially number each row.
Column 2:	If stratification was used: Write in the name of stratum. All strata in the state must be listed. 
	If no stratification was used: Write “state” in the first row to indicate that the whole state constitutes a single stratum.
Column 3:	Report the number of primary sampling units (PSUs) (i.e., first-stage clusters) created for each stratum.
Column 4:	Report the number of PSUs selected in the original sample for each stratum.
Column 5:	Report the number of PSUs in the final sample for each stratum.
TOTALS:	For Columns 3–5, provide totals for the state as a whole in the last row of the table.
Summary of Clusters Created and Sampled	
State:	     	
FFY:	2022	
	
(1)
Row #	(2)
Stratum Name	(3)
Number of PSUs Created	(4)
Number of PSUs Selected	(5)
Number of PSUs in the Final Sample	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
Total	     	     	     	

FORM 4 (Required for all states not using the Synar Survey Estimation System [SSES] to analyze the Synar Survey data)

Complete Form 4 to provide detailed tallies of ineligible sample outlets by reasons for ineligibility and detailed tallies of eligible sample outlets with noncomplete inspections by reasons for noncompletion.

Instructions for Completing Form 4: In the top right-hand corner of the form, provide the state name and reporting federal fiscal year (FFY 2022).

Column 1(a):	Enter the number of sample outlets found ineligible for inspection by reason for ineligibility. Provide the total number of ineligible outlets in the row marked “Total.”
Column 2(a):	Enter the number of eligible sample outlets with noncomplete inspections by reason for noncompletion. Provide the total number of eligible outlets with noncomplete inspections in the row marked “Total.”
Inspection Tallies by Reason of Ineligibility or Noncompletion	
State:		
FFY:	2022	
	
(1)
INELIGIBLE	(2)
ELIGIBLE	
Reason for Ineligibility	(a)
Counts	Reason for Noncompletion	(a)
Counts	
Out of business	     	In operation but closed at time of visit	     	
Does not sell tobacco products	     	Unsafe to access	     	
Inaccessible by youth	     	Presence of police	     	
Private club or private residence	     	Youth inspector knows salesperson	     	
Temporary closure 	     	Moved to new location 	     	
Unlocatable	     	Drive-thru only/youth inspector has no driver’s license	     	
Wholesale only/Carton sale only 	     	Tobacco out of stock	     	
Vending machine broken	     	Ran out of time	     	
Duplicate	     	Other noncompletion reason(s) (Describe.)
     	     	
Other ineligibility reason(s) (Describe.)
     	     			
Total	     	Total	     	

FORM 5 (Required for all states not using the Synar Survey Estimation System [SSES] to analyze the Synar survey data)

Complete Form 5 to show the distribution of outlet inspection results by age and gender of the youth inspectors.

Instructions for Completing Form 5: In the top right-hand corner of the form, provide the state name and reporting federal fiscal year (FFY 2022).

Column 1:	Enter the number of attempted buys by youth inspector age and gender.
Column 2:	Enter the number of successful buys by youth inspector age and gender.

If the inspectors are age eligible but the gender of the inspector is unknown, include those inspections in the “Other” row. Calculate subtotals for males and females in rows marked “Male Subtotal” and “Female Subtotal.” Sum subtotals for Male, Female, and Other and record in the bottom row marked “Total.” Verify that that the total of attempted buys and successful buys equals the total for Column 4(c) and Column 5(c), respectively, on Form 1. If the totals do not match, please explain any discrepancies. 
Synar Survey Inspector Characteristics	
	 State:	     	
	FFY:	2022	
			
	(1)
Attempted Buys	(2)
Successful Buys	
Male	
15 years	     	     	
16 years	     	     	
17 years	     	     	
18 years	     	     	
19 years	     	     	
20 years	     	     	
Male Subtotal	     	     	
Female	
15 years	     	     	
16 years	     	     	
17 years	     	     	
18 years	     	     	
19 years	     	     	
20 years	     	     	
Female Subtotal	     	     	
Other	     	     	
Total	     	     	

APPENDIXES B & C: FORMS
Instructions

Appendix B (Sampling Design) and Appendix C (Inspection Protocol) are to reflect the state’s CSAP-approved sampling design and inspection protocol. These appendixes, therefore, should generally describe the design and protocol and, with the exception of Question #10 of Appendix B, are not to be modified with year-specific information. Please note that any changes to either appendix must receive CSAP’s advance, written approval. To facilitate the state’s completion of this section, simply cut and paste the previously approved sampling design (Appendix B) and inspection protocol (Appendix C) and respond to Question #10 of Appendix B to provide the requested information about sample size calculations for the Synar survey conducted in FFY 2021.
APPENDIX B: SYNAR SURVEY SAMPLING METHODOLOGY
	State:	MA	
	FFY:	2022	
1.	What type of sampling frame is used?
 List frame (Go to Question 2.)
 Area frame (Go to Question 3.)
 List-assisted area frame (Go to Question 2.)

2.	List all sources of the list frame. Indicate the type of source from the list below. Provide a brief description of the frame source. Explain how the lists are updated (method), including how new outlets are identified and added to the frame. In addition, explain how often the lists are updated (cycle). (After completing this question, go to Question 4.)
Use the corresponding number to indicate Type of Source in the table below.
1 – Statewide commercial business list	4 – Statewide retail license/permit list	
2 – Local commercial business list	5 – Statewide liquor license/permit list	
3 – Statewide tobacco license/permit list	6 – Other	

Name of Frame Source	Type of Source	Description	Updating Method and Cycle	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	

3.	If an area frame is used, describe how area sampling units are defined and formed.
The sampling areas are the 351 cities and town in Massachusetts or smaller subdivided areas within the large cities. These sampling areas are then broken down into zip codes to obtain smaller clusters. Every zip code in Massachusetts is  associated with one of the 351 cities and towns.

a.	Is any area left out in the formation of the area frame?
	YesNo
If Yes, what percentage of the state’s population is not covered by the area frame?
     %

4.	Federal regulation requires that vending machines be inspected as part of the Synar survey. Are vending machines included in the Synar survey? 
	 Yes No
If No, please indicate the reason(s) they are not included in the Synar survey. Please check all that apply.
State law bans vending machines.
State law bans vending machines from locations accessible to youth. 
State has a contract with the FDA and is actively enforcing the vending machine requirements of the Family Smoking Prevention and Tobacco Control Act.
 Other (Please describe.)     	

If Yes, please indicate how likely it is that vending machines will be sampled.

 Vending machines are sampled separately to ensure vending machines are included in the sample
 Vending machines are sampled together with over the counter outlets, so it is possible that no vending machines were sampled, however they are included in the sampling frame and have a non-zero probability of selection
 Other reasons (Please describe.)     	

5.	Which category below best describes the sample design? (Check only one.)
Census(STOP HERE: Appendix B is complete.)
Unstratified statewide sample:
 Simple random sample (Go to Question 9.)
 Systematic random sample (Go to Question 6.)
 Single-stage cluster sample (Go to Question 8.)
 Multistage cluster sample (Go to Question 8.)
Stratified sample:
 Simple random sample (Go to Question 7.)
 Systematic random sample (Go to Question 6.)
 Single-stage cluster sample (Go to Question 7.)
 Multistage cluster sample (Go to Question 7.)
Other(Please describe and go to Question 9.)     	

6.	Describe the systematic sampling methods. (After completing Question 6, go to Question 7 if st	ratification is used. Otherwise go to Question 9.)
n/a

7.	Provide the following information about stratification.
a.	Provide a full description of the strata that are created.
The 13 counties in Massachusetts were organized into five geographic regions of roughly equal size.  The cities and towns in each region are further stratified into two groups according to whether or not the health department receives funding from the Massachusetts Tobacco Control Program (this funding status is updated every year).  Thus, there are 10 strata.
b.	Is clustering used within the stratified sample?
 Yes		(Go to Question 8.)
 No		(Go to Question 9.)

8.	Provide the following information about clustering.
a.	Provide a full description of how clusters are formed. (If multistage clusters are used, give definitions of clusters at each stage.)
Clusters at the first stage are the sampling areas formed by the 351 cities and towns in Massachusetts.  Before the random selection of sampling areas occurs, the 351 Massachusetts cities and towns are broken into applicable zip codes to obtain smaller sampling clusters.
b.	Specify the sampling method (simple random, systematic, or probability proportional to size sampling) for each stage of sampling and describe how the method(s) is (are) implemented.
There are 10 fixed strata that we use in Massachusetts.  These strata are based on geographic region and funding for the Board of Health Tobacco Programs.  All 351 cities and towns in Massachusetts fall into one of the 10 strata and have an equal chance of being selected.  Each city or town is grouped into the appropriate strata and broken into all applicable zip codes.  The zip code is the final unit of sampling. Each zip code is assigned a random number, the zip codes within the strata are chosen sequentially until the estimated number of vendors represented by those zip codes exceeds the target number needed for that stratum.  Thus, the number of clusters used within each stratum changes every year based on the number of retailers in each zip code that is selected.  The data included for each outlet is from the most recent inspection completed during the inspection period.  All zip codes within a stratum are eligible to be selected in the sample each year.  Every outlet within a selected zip code is inspected.  In both the funded and unfunded stratum included in the sample, the whole area covered by the zip code is completely canvassed and every outlet is inspected.  Massachusetts refers to  lists contained in the  POST data systems.  Web searches are conducted for possible additional retailers and a full canvas is done of the geographic area to determine if additional outlets are present.  All outlets within selected zip codes are inspected.  The state calculates sampling weights using the same method for funded and unfunded strata.  The weights are calculated based on the percentage of the entire state population of 12-20 year-olds that live in the strata based on census data.  That percentage is converted to a decimal.  The inverse of the decimal is the respective sampling weight that is used for the strata.  This method of sampling weight calculation was developed with SAMHSA’s assistance in 2005.

9. 	Provide the following information about determining the Synar Sample.

a.	Was the Synar Survey Estimation System (SSES) used to calculate the sample size?
	 Yes	(Respond to part b.)
	 No		(Respond to part c and Question 10c.)

b.	SSES Sample Size Calculator used?
	State Level		(Respond to Question 10a.)
	Stratum Level	(Respond to Question 10a and 10b.)

c.	Provide the formulas for determining the effective, target, and original outlet sample sizes.
     ,

where P is the target retailer violation rate (20 percent). The target sample size () is given by:

,

where d is the assumed design effect of 3.6. The original sample size () is then obtained by:

,

where s is an incremental factor (or safety margin) of 35% to compensate for the loss of the sample during inspection.

10.Provide the following information about sample size calculations for the Synar survey conducted in FFY 2021.
a.	If the state uses the sample size formulas embedded in the SSES Sample Size Calculator to calculate the state level sample size, please provide the following information:

Inputs for Effective Sample Size: 
RVR:     
Frame Size:     

Input for Target Sample Size:
Design Effect:     

Inputs for Original Sample Size:
Safety Margin:      
Accuracy (Eligibility) Rate:      
Completion Rate:     

b.	If the state uses the sample size formulas embedded in the SSES Sample Size Calculator to calculate the stratum level sample sizes, please provide the stratum level information:
     

c.	If the state does not use the sample size formulas embedded in the SSES Sample Size Calculator, please provide all inputs required to calculate the effective, target, and original sample sizes as indicated in Question 9.
     ,

where P is the target retailer violation rate (20 percent). The target sample size () is given by:

,
where d is the assumed design effect of 3.6. The original sample size () is then obtained by:

2352= (1 +.35)1742

where s is an incremental factor (or safety margin) of 35% to compensate for the loss of the sample during inspection.

APPENDIX C: SYNAR SURVEY INSPECTION PROTOCOL SUMMARY
	State:	MA	
	FFY:	2022	
Note: Upload to WebBGAS a copy of the Synar inspection form under the heading “Synar Inspection Form” and a copy of the protocol used to train inspection teams on conducting and reporting the results of the Synar inspections under the heading “Synar Inspection Protocol.” 

1.	How does the state Synar survey protocol address the following?
a.	Consummated buy attempts?
	Required					
	 Permitted under specified circumstances (Describe:     )
	 Not permitted

b.	Youth inspectors to carry ID?
	Required					
	 Permitted under specified circumstances (Describe:     )
	 Not permitted

c.	Adult inspectors to enter the outlet?
	Required					
	 Permitted under specified circumstances (Describe: If an inspector can blend into the surroundings while minor is conducting the compliance check, then it is encouraged. This can typically happen in big box department and grocery stores.)
	 Not permitted

d.	Youth inspectors to be compensated?
	Required					
	 Permitted under specified circumstances (Describe:Some youth are given stipends and some youth are volunteers)
	 Not permitted

2.	Identify the agency(ies) or entity(ies) that actually conduct the random, unannounced Synar inspections of tobacco outlets. (Check all that apply.)
 Law enforcement agency(ies)
State or local government agency(ies) other than law enforcement
 Private contractor(s)
 Other
List the agency name(s):MA Department of Public Health in conjunction with local boards of health, and the Massachusetts Association of Health Boards	

3.	Are Synar inspections combined with law enforcement efforts (i.e., do law enforcement representatives issue warnings or citations to retailers found in violation of the law at the time of the inspection?)?
Always	 Usually 	 Sometimes	 Rarely	 Never

4. 	Describe the type of tobacco products that are requested during Synar inspections.
a.	 What type of tobacco products are requested during the inspection?
		 Cigarettes 
		 Small Cigars
		Cigarillos
		 Smokeless Tobacco
		 Electronic Cigarettes/Electronic Nicotine Delivery Systems (ENDS)
		 Other       

b.	Describe the protocol for identifying what types of products and what brands of products are requested during an inspection.
Depending on the location, the minor could ask for cigarettes, small cigars/cigarillos or ENDS/e-liquids.  The minor is instructed to ask for the most commonly found and popular brands of each product.  When asking for cigarettes, minors ask for Marlboro or Newport Reds.  Cigars/cigarillos requested are flavored Black & Mild, Phillies, Swisher Sweets or GAME if available.  When requesting ENDS, minors typically request flavored JUUL, but they may also request Blu, Logic, NJOY, and VUSE. If one of these preferred brands is not available, the minor is trained to ask for a flavored e-liquid that contains nicotine. 

5a.	Describe the methods used to recruit, select, and train adult supervisors.
Adult supervisors for MTCP funded boards of health are the staff or consultants of the local funded Boards of Health. The adult supervisors are hired by the local municipalities or agencies using municipal hiring practices.  FDA full time adult supervisors are recruited and selected following the guidelines provided by the Department of Public Health Human Resource Department.  
The training for adult supervisors working with MTCP funded board of health programs includes 2.5 hours in conducting compliance checks and 1.5 hours in tobacco control inspections and enforcement.  Youth access issues-especially related to enforcement-are discussed at multiple program meetings during the year.  DPH staff and attorneys from Mass Municipal Association or Mass Association of Health Boards are available as resources during these meetings.  The adult supervisor training for board of health staff was updated in the fall of 2019.  The training is conducted by a team of experienced professionals.  New board of health inspectors shadow experienced inspectors prior to conducting inspections on their own.  FDA adult supervisors take the required FDA inspector online training (approximately 12 hours), along with a 1.5 hour in-person training.  After trainings are completed, FDA inspectors shadow experienced FDA inspectors for several days before completing inspections on their own.
In May 2021, we conducted a “Back to Basics” training as local boards of health were getting ready to get back in the field for compliance checks. This training covered how the field should handle recruitment, procedures for before/during/after check, database reminders and what resources are available to the field to answer additional questions.

5b.Describe the methods used to recruit, select, and train youth inspectors.
     A variety of youth recruitment strategies are used including making presentations at schools and local community-based organizations and working with community-service projects.  Current youth inspectors receive referral bonuses for referring a friend or relative that works doing compliance checks.  Recruitment is also done in conjunction with The 84.  The 84 is a statewide movement of youth fighting tobacco in Massachusetts.  Youth job opportunities are posted as a tab on the84.org website, and recruitment events happen at the annual 84 Youth Power Summits and at Kick Butts Day at the Massachusetts State House.  
During the mandatory compliance check training for adult supervisors, the trainers review techniques for recruiting, screening and training youth inspectors.
Youth must take the required online minor training which was updated in the Spring of 2021. The training includes an online portion as well as “show and tell” and “Role Playing” sections.  During this training, youth inspectors learn about compliance check procedures as well as policies and practices that may be unique to the program and area where they are working. During the “Show and Tell” portion, youth have an opportunity to look at and touch the products they will be requesting and do several role plays practicing various scenarios that can occur during compliance checks. Prior to conducting compliance checks on their own, it is best practice for new youth to observe experienced youth conducting checks so that they can become more comfortable with the job.  When possible, the more experienced youth is asked to help lead the training with the adult inspector.

6.	Are there specific legal or procedural requirements instituted by the state to address the issue of youth inspectors’ immunity when conducting inspections?
a.	Legal	
	 Yes No 
	(If Yes, please describe.)
     	
b.	Procedural	
	 Yes No 
	(If Yes, please describe.)
     

7.	Are there specific legal or procedural requirements instituted by the state to address the issue of the safety of youth inspectors during all aspects of the Synar inspection process?
a.	Legal	
	 Yes No 
	(If Yes, please describe.)
     
b.	Procedural	
	 Yes    No 
	(If Yes, please describe.)
     Minors are always accompanied by trained adult inspectors during compliance checks.  If the adult or youth feels that an establishment is unsafe to enter to attempt a buy, the check is aborted.  Parents are given descriptions of the protocols and their permission is obtained. Additionally, minors are trained and encouraged to bring their personal cell phone into each establishment. Minors have been able to alert the inspector over text that they are in a long line or request that the inspector enter the establishment. 

8.	Are there any other legal or procedural requirements the state has regarding how inspections are to be conducted (e.g., age of youth inspector, time of inspections, training that must occur)?
a.	Legal	
	 Yes No 
	(If Yes, please describe.)
     Funded Boards of Health use Synar protocol and attend required trainings.

b.	Procedural	
	 Yes No 
	(If Yes, please describe.)
MTCP requires that funded Boards of Health use the MTCP Compliance Check Protocol. For compliance checks conducted in FFY21, MTCP’s updated approved protocols include young people aged 18-20 years old.  All adult supervisors must attend a compliance check training organized by MTCP. All youth buyers must be trained before conducting checks.  Minors must take online training while working with inspector. Inspectors are also required to provide additional training to youth buyers that includes a “Show and Tell” and role-playing activities. In addition, recommended best practice is for a more experienced youth to help lead this training with the inspector. 

APPENDIX D: LIST SAMPLING FRAME COVERAGE STUDY
(LIST FRAME ONLY)
	State:	MA	
	FFY:	2022	
1.	Calendar year of the coverage study:      

2.	a.	Unweighted percent coverage found:     %
	b.	Weighted percent coverage found:	     %
	c.	Number of outlets found through canvassing:      
	d.	Number of outlets matched on the list frame: 	     

3.		a.	Describe how areas were defined.(e.g., census tracts, counties, etc.)
     

b.	Were any areas of the state excluded from sampling? 
		 Yes    No
		If Yes, please explain.
     

4.	Please answer the following questions about the selection of canvassing areas.
a.	Which category below best describes the sample design? (Check only one.)
Census(Go to Question 6.)
Unstratified statewide sample:
 Simple random sample (Respond to Part b.)
 Systematic random sample (Respond to Part b.)
 Single-stage cluster sample (Respond to Parts b and d.)
 Multistage cluster sample (Respond to Parts b and d.)
Stratified sample:
 Simple random sample (Respond to Parts b and c.)
 Systematic random sample (Respond to Parts b and c.)
 Single-stage cluster sample (Respond to Parts b, c, and d.)
 Multistage cluster sample (Respond to Parts b, c, and d.)
Other(Please describe and respond to Part b.)     

b.	Describe the sampling methods.
     

c.	Provide a full description of the strata that were created.
     

d.	Provide a full description of how clusters were formed. 
     	

5.	Were borders of the selected areas clearly identified at the time of canvassing?   
 Yes    No

6.	Were all sampled areas visited by canvassing teams?
 Yes (Go to Question 7.) No (Respond to Parts a and b.)
a.	Was the subset of areas randomly chosen?
 Yes    No
b. Describe how the subsample of visited areas was drawn. Include the number of areas sampled and the number of areas canvassed.
     

7.	Were field observers provided with a detailed map of the canvassing areas?
 Yes    No
If No, describe the canvassing instructions given to the field observers.
     

8.	Were field observers instructed to find all outlets in the assigned area?
 Yes    No 
If No, respond to Question 9. 
	If Yes, describe any instructions given to the field observers to ensure the entire area was canvassed, then go to Question 10. 
     

9.	If a full canvassing was not conducted:
a.	How many predetermined outlets were to be observed in each area?      
b.	What were the starting points for each area?      
c.	Were these starting points randomly chosen? 
 Yes    No
d.	Describe the selection of the starting points.
     

e.	Please describe the canvassing instructions given to the field observers, including predetermined routes.
     

10.	Describe the process field observers used to determine if an outlet sold tobacco.
     

11.	Please provide the state’s definition of “matches” or “mismatches” to the Synar sampling frame? (i.e., address, business name, business license number, etc.)
     

12.	Provide the calculation of the weighted percent coverage (if applicable).