September 26, 2016—In 2014, pharmacy chain CVS Health stopped selling tobacco products at its stores nationwide. In a recent study, Reginald Tucker-Seeley, assistant professor of social and behavioral sciences at Harvard T.H. Chan School of Public Health, and colleagues including Harvard Chan researchers Peter James and Carla Bezold, looked at how this affected access to tobacco in CVS’s home state of Rhode Island.
Why did your study focus on the density of tobacco retailers in neighborhoods?
Neighborhoods can substantially shape the choices that we make in our health behaviors. Studies have shown that when there are a high number of retail tobacco outlets in a neighborhood, the residents in those neighborhoods are more likely to start smoking and less likely to quit. When CVS Health announced it would end the sale of tobacco in all of its retail pharmacy stores, I was curious about the impact of this policy across various neighborhoods and whether such a policy would differentially impact low socioeconomic status and racial/ethnic minority neighborhoods.
Given that CVS Health is located in Rhode Island and that I live in RI and am active in health policy efforts in the state, I investigated the impact of this policy on RI neighborhoods. In looking at neighborhoods in Rhode Island, we found a high number of tobacco retailers—mostly convenience stores—in low-income and minority neighborhoods. The higher the percentage of blacks, Hispanics, and families living in poverty in a neighborhood, the higher the number of stores selling cigarettes. In our analysis to investigate the effect of the removal of CVS Health pharmacy locations as tobacco retailers, the exclusion of CVS locations did not affect this pattern.
I was also interested in the potential impact if other pharmacies in RI followed CVS Health’s lead to end their sale of tobacco products as well. So, next, we conducted an analysis excluding all pharmacies to see what would happen if all pharmacies in the state stopped selling tobacco. There still was no impact on the association between the density of tobacco retailers and neighborhoods with low-socioeconomic status (SES) and high racial/ethnic minority composition, which was initially very surprising. But, when we took a closer look at where pharmacies were located throughout the state, the results were much less surprising. We found a negative association between population density and the count of pharmacies. This negative association suggests that in Rhode Island, pharmacies are more likely to be located in less dense neighborhoods, and these neighborhoods are less likely to be low SES and high racially/ethnically diverse neighborhoods.
You found that the benefits of CVS’s tobacco sales policy may not be spread evenly across all social groups. Could you explain?
While the policy may have reduced the overall number of tobacco outlets—which is commendable—it appears this policy does not to have much impact on reducing racial, ethnic, and socioeconomic disparities in the density of tobacco retailers across neighborhoods in RI. It is important to note that the CVS Health policy to end their sale of tobacco products was NOT put forth as a policy to reduce health disparities; nevertheless, I think it is always important to take note when health policy has overall population health improvements goals (for example the reduction of the overall number of tobacco outlets) that the potential differential impacts across socioeconomic and racial/ethnic groups is also explored.
The retail in neighborhoods is influenced by municipal level zoning policies; and these policies can influence the health of residents through services, policies, and programs that create the social environment within the city. More research needs to be done on the municipal policies that create healthy neighborhoods. That will help us create better choices for the residents. More specifically, tobacco control researchers and policy makers should continue to look at how the presence of tobacco retailers in neighborhoods affects use behaviors and decision-making, so that more targeted interventions can be developed.
How might policy makers reduce the number of tobacco retailers in low-income neighborhoods?
Based on the results of our study, I think policies that focus on reducing the density of tobacco retailers across all neighborhoods might work better than focusing on reducing specific retailers in RI. However, it should be noted that in RI only about 10% of tobacco retailers are pharmacies, so in states where there pharmacies are a greater proportion of total tobacco retailers, the results might differ. Nevertheless, zoning policies that prohibit the number of tobacco retailers within a neighborhood, and near specific locations (for example, schools) might help to reduce the number of new smokers. In Rhode Island, each municipality determines the number and location of tobacco retailers to which it issues a tobacco retailer license. So, rather than focusing on the types of stores selling tobacco, a policy that regulates where tobacco retailers can locate within a city may help to ensure RI continues to see a reduction in smoking rates, especially among adolescents.