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Canty R, Gartner CE, Hoek J, Hefler M. Global policy scan of commercial combustible tobacco product retailing regulations by WHO region. Tob Control 2024:tc-2023-058523. [PMID: 39059815 DOI: 10.1136/tc-2023-058523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/03/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND/AIMS Regulatory schemes for tobacco retailing help restrict the supply and availability of smoked tobacco products. Tobacco retailer density and the proximity of tobacco outlets to youth spaces, such as schools, are greater in more disadvantaged areas. Exposure to tobacco retailing normalises smoking and increases ease of access, thus increasing smoking uptake and undermining quitting. To inform future policy, we conducted a global scan of combustible tobacco retail regulatory schemes (We use the term schemes to refer to any kind of relevant initiative, policy, regulations or legislation that we found). METHODS All types of English language records concerning the regulation of commercial tobacco product availability were considered, including peer-reviewed journal articles, key reports and policy documents. The key features of regulatory schemes were documented. In addition, we contacted key informants in different countries and regions for advice on additional sources and undertook targeted searching in regions where we initially found little data. RESULTS/FINDINGS Although many countries have well-established and comprehensive tobacco control programmes, tobacco retail policy that actively addresses the availability of tobacco is underutilised. Many jurisdictions have implemented a minimum purchase age and restricted point-of-sale advertising and marketing. Other tobacco retailing regulations also included licensing systems with licence fees, caps on licences and restrictions on store location, type and retailer density/proximity. A very small number of jurisdictions have ended tobacco retailing altogether. CONCLUSIONS At a minimum, policy-makers should implement licensing schemes, licence caps and proximity limits and invest in robust monitoring systems and compliance enforcement. Tobacco products' ubiquity is incompatible with its status as a dangerous addictive substance and does not align with tobacco endgame goals.
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Affiliation(s)
- Ruth Canty
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Janet Hoek
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Public Health, University of Otago, Dunedin, New Zealand
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Bulaj G, Coleman M, Johansen B, Kraft S, Lam W, Phillips K, Rohaj A. Redesigning Pharmacy to Improve Public Health Outcomes: Expanding Retail Spaces for Digital Therapeutics to Replace Consumer Products That Increase Mortality and Morbidity Risks. PHARMACY 2024; 12:107. [PMID: 39051391 PMCID: PMC11270305 DOI: 10.3390/pharmacy12040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Melissa Coleman
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Blake Johansen
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah Kraft
- Independent Researcher, Salt Lake City, UT 84112, USA
| | - Wayne Lam
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Katie Phillips
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
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Malone RE, McAfee T. Birthdate-based commercial tobacco sales restrictions: will 'tobacco-free generation' policies advance or delay the endgame? Tob Control 2024:tc-2024-058716. [PMID: 38897727 DOI: 10.1136/tc-2024-058716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
Endgame thinking means transitioning from merely trying to 'control' the tobacco epidemic to developing plans and measures to bring it to an end within a specific time, by changing the underlying dynamics that have created and perpetuated it for more than a century. Among the innovative policies characterised as 'endgame' policies are so-called 'tobacco-free generation' or 'smoke-free generation' policies, which prohibit sales of some or all tobacco products to individuals born on or after a particular date. Such birthdate-based sales restrictions (BSR) have intuitive appeal, largely because they do not appreciably disrupt the status quo of retail sales, which continue unchanged for all those born before the designated cut-off date. They also hold the potential for further denormalising tobacco use and sales by anticipating the long-term end of tobacco sales. In this Special Communication, we analyse BSR policies through an endgame lens and propose questions that should be discussed in jurisdictions considering them. We suggest that this policy has potential underexamined pitfalls, particularly related to equity, and that if enacted, it should include policy guardrails and be part of a package of endgame measures.
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Affiliation(s)
- Ruth E Malone
- Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Tim McAfee
- Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, California, USA
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Hoek J, Muthumala C, Fenton E, Gartner CE, Petrović-van der Deen FS. New Zealand community pharmacists' perspectives on supplying smoked tobacco as an endgame initiative: a qualitative analysis. Tob Control 2024:tc-2023-058126. [PMID: 37940403 DOI: 10.1136/tc-2023-058126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Tobacco endgame strategies often include measures to reduce tobacco availability by decreasing retailer numbers. Recently, some US pharmacies have delisted tobacco, though overall retailer numbers have not reduced markedly. Paradoxically, others have suggested limiting tobacco sales to pharmacies, to reduce supply and support cessation. We explored how pharmacists from Aotearoa New Zealand, a country planning to reduce tobacco supply, perceived supplying tobacco. METHODS We undertook in-depth interviews with 16 pharmacists from Ōtepoti Dunedin; most served more deprived communities with higher smoking prevalence. We probed participants' views on supplying tobacco, explored factors that could limit implementation of this policy, and analysed their ethical positions. We used qualitative description to analyse data on limiting factors and reflexive thematic analysis to interpret the ethical arguments adduced. RESULTS Most participants noted time, space and safety concerns, and some had strong moral objections to supplying tobacco. These included concerns that supplying tobacco would contradict their duty not to harm patients, reduce them to sales assistants, undermine their role as health experts, and tarnish their profession. A minority focused on the potential benefits of a pharmacy supply measure, which they thought would use and extend their skills, and improve community well-being. CONCLUSIONS Policy-makers will likely encounter strongly expressed opposition if they attempt to introduce a pharmacy supply measure as an initial component of a retail reduction strategy. However, as smoking prevalence falls, adopting a health-promoting supply model, using pharmacies that chose to participate, would become more feasible and potentially enhance community outreach and cessation support.
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Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Charika Muthumala
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Elizabeth Fenton
- Bioethics Centre, University of Otago Bioethics Centre, Dunedin, New Zealand
| | - Coral E Gartner
- School of Public Health, University of Queensland, Herston, Queensland, Australia
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Reimold AE, Kong AY, Delamater PL, Baggett CD, Golden SD. Urban-rural differences in tobacco product availability in food retailers, United States, 2017. J Rural Health 2023; 39:338-346. [PMID: 35708094 PMCID: PMC9755460 DOI: 10.1111/jrh.12687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Tobacco use prevalence is higher in rural compared to urban settings, possibly due to differences in tobacco availability, including the option to purchase food and other essential items in stores that do not sell tobacco (tobacco-free food retailers). The goal of this research is to determine whether tobacco-free food retailer availability varies by urbanicity/rurality. METHODS Using the 2017 National Establishment Time-Series database, we identified food retailers across all census tracts containing food retailers in the United States (n = 66,053). We used multivariable logistic and linear regression models to test whether tobacco-free food retailer availability varied across 4-levels of census tract urbanicity/rurality (urban, suburban, large town, and small town/rural) for 2 outcomes: (1) the presence of at least 1 tobacco-free food retailer and (2) the percent of all food retailers that were tobacco-free. FINDINGS Compared to urban core census tracts, suburban census tracts had a lower odds (aOR = 0.77, 95% CI = 0.73, 0.81) of having at least 1 tobacco-free food retailer, while small town/rural census tracts had greater odds (aOR = 1.23, 95% CI = 1.15, 1.32). Suburban census tracts (B = -2.29, P < .001) and large town census tracts (B = -1.90, P < .001) also had a lower percentage of tobacco-free food retailers compared to urban census tracts. CONCLUSIONS Compared to urban cores, tobacco-free food retailers were less prevalent in suburban and large town areas, though similarly or slightly more available in rural areas. Future research should assess whether these differences depend on varying store types.
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Affiliation(s)
- Alexandria E. Reimold
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda Y. Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Paul L. Delamater
- Department of Geography, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher D. Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shelley D. Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Lee JGL, Kong AY, Sewell KB, Golden SD, Combs TB, Ribisl KM, Henriksen L. Associations of tobacco retailer density and proximity with adult tobacco use behaviours and health outcomes: a meta-analysis. Tob Control 2022; 31:e189-e200. [PMID: 34479990 PMCID: PMC9421913 DOI: 10.1136/tobaccocontrol-2021-056717] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/21/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to conduct a systematic review and meta-analysis of evidence to inform policies that reduce density and proximity of tobacco retailers. DATA SOURCES Ten databases were searched on 16 October 2020: MEDLINE via PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus, plus grey literature searches using Google and the RAND Publication Database. STUDY SELECTION Included studies used inferential statistics about adult participants to examine associations between tobacco retailer density/proximity and tobacco use behaviours and health outcomes. Of 7373 studies reviewed by independent coders, 37 (0.5%) met inclusion criteria. DATA EXTRACTION Effect sizes were converted to a relative risk reduction (RRR) metric, indicating the presumed reduction in tobacco use outcomes based on reducing tobacco retailer density and decreasing proximity. DATA SYNTHESIS We conducted a random effects meta-analysis and examined heterogeneity across 27 studies through subgroup analyses and meta-regression. Tobacco retailer density (RRR=2.55, 95% CI 1.91 to 3.19, k=155) and proximity (RRR=2.38, 95% CI 1.39 to 3.37, k=100) were associated with tobacco use behaviours. Pooled results including both density and proximity found an estimated 2.48% reduction in risk of tobacco use from reductions in tobacco retailer density and proximity (RRR=2.48, 95% CI 1.95 to 3.02, k=255). Results for health outcomes came from just two studies and were not significant. Considerable heterogeneity existed. CONCLUSIONS Across studies, lower levels of tobacco retailer density and decreased proximity are associated with lower tobacco use. Reducing tobacco supply by limiting retailer density and proximity may lead to reductions in tobacco use. Policy evaluations are needed.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education & Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Amanda Y Kong
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kerry B Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, North Carolina, USA
| | - Shelley D Golden
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Todd B Combs
- Center for Public Health Systems Science, Washington University in St Louis, St Louis, Missouri, USA
| | - Kurt M Ribisl
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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Travis N, Levy DT, McDaniel PA, Henriksen L. Tobacco retail availability and cigarette and e-cigarette use among youth and adults: a scoping review. Tob Control 2022; 31:e175-e188. [PMID: 34301839 PMCID: PMC9126034 DOI: 10.1136/tobaccocontrol-2020-056376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/28/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE States and localities are formulating strategies to reduce the widespread retail availability of tobacco products. Evidence of associations between retailer density/proximity and tobacco use outcomes can help inform those strategies. We conducted a scoping review on tobacco retail availability and cigarette/e-cigarette use in adults and youth, and considered variations in spatial units, measures of retailer exposure and outcomes across studies. METHODS A systematic search for studies examining the association between retailer density/proximity and youth and adult cigarette/e-cigarette use was conducted across MEDLINE (PubMed), Web of Science and Google Scholar through 27 August 2020 with no restrictions. RESULTS Thirty-five studies were included in our qualitative synthesis. While there were differences in neighbourhood definitions (eg, egocentric vs administrative), there is evidence for a positive association between higher retailer density in egocentric neighbourhoods around homes and current smoking in adults and adolescents. Administrative unit measures in some studies showed associations with adult current smoking, and adolescent lifetime and current smoking. Studies on tobacco outlet proximity to homes obtained mixed results. Density/proximity of tobacco outlets around schools showed no or inverse association with adolescent smoking, but suggests higher susceptibility to smoking. Evidence of an association between e-cigarette retail availability and e-cigarette use is limited due to a small number of studies. CONCLUSION The current literature provides limited empirical evidence of the association between tobacco retailer availability and smoking or e-cigarette use. More research with uniform measures of environmental exposure to tobacco retailers is needed to allow for greater comparability between studies.
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Affiliation(s)
- Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Patricia A McDaniel
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
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Phillips AZ, Ahern JA, Kerr WC, Rodriguez HP. Cigarettes smoked among daily and non-daily smokers following CVS Health's tobacco-free pharmacy policy. Tob Control 2022; 31:25-31. [PMID: 33082285 PMCID: PMC8499493 DOI: 10.1136/tobaccocontrol-2020-055976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In September 2014, CVS Health ceased tobacco sales in all of its 7700 pharmacies nationwide. We investigate the impact of the CVS policy on the number of cigarettes smoked per day among metropolitan daily and non-daily smokers, who may respond to the availability of smoking cues in different manners. METHODS Data are from the US Census Bureau Tobacco Use Supplement to the Current Population Survey 2014-2015 and the Blue Cross and Blue Shield Institute Community Health Management Hub. Adjusted difference-in-difference (DID) regressions assess changes in the number of cigarettes smoked per day among daily smokers (n=10 759) and non-daily smokers (n=3055), modelling core-based statistical area (CBSA) level CVS pharmacy market share continuously. To assess whether the policy had non-linear effects across the distribution of CVS market share, we also examine market share using tertiles. RESULTS CVS's tobacco-free pharmacy policy was associated with a significant reduction in the number of cigarettes smoked by non-daily smokers in the continuous DID (rate ratio=0.985, p=0.022), with a larger reduction observed among non-daily smokers in CBSAs in the highest third of CVS market share compared with those living in CBSAs with no CVS presence (rate ratio=0.706, p=0.027). The policy, however, was not significantly associated with differential changes in the number of cigarettes by daily smokers. CONCLUSION The removal of tobacco products from CVS pharmacies was associated with a reduction in the number of cigarettes smoked per day among non-daily smokers in metropolitan CBSAs, particularly those in which CVS had a large pharmacy market share.
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Affiliation(s)
- Aryn Z Phillips
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Healthcare Organizatonal and Innovation Research, University of California, Berkeley, Berkeley, CA, USA
| | - Jennifer A Ahern
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | - Hector P Rodriguez
- Center for Healthcare Organizatonal and Innovation Research, University of California, Berkeley, Berkeley, CA, USA
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Seidenberg AB, Henriksen L, Ribisl KM. Cigarette Promotions in U.S. Pharmacies. Nicotine Tob Res 2021; 24:612-616. [PMID: 34624896 DOI: 10.1093/ntr/ntab204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The sale of tobacco products within American pharmacies has generated controversy for several decades, leading two US states and 45 municipalities to adopt tobacco-free pharmacy policies. While previous research has reported cheaper cigarette prices in pharmacies, compared to other retailers, little is known about cigarette promotions in pharmacies, which are associated with increased youth smoking and unplanned cigarette purchases among adults. METHODS Between May and August 2015, trained data collectors conducted store audits at 2128 tobacco retailers located within 97 US counties in 40 states. Observations were made for three types of cigarette promotions: special price (e.g., $0.30 off/pack), multi-pack promotions (e.g., buy one pack, get one free), and cross-product promotions (e.g., buy a pack of cigarettes and a get free can of snus). We calculated weighted estimates of the proportion of pharmacies and other retailer types with cigarette promotions and used weighted multivariable logistic regression to compare cigarette promotions by tobacco retailer type, accounting for clustering at the county level and controlling for county-level demographic characteristics. RESULTS Cigarette promotions were observed in 94.0% of pharmacies, more than any other retailer type (e.g., convenience stores: 82.0%, tobacco stores: 77.0%). All retailer types had lower odds of promotions for Marlboro, Newport, Camel, menthol, or any interior cigarette promotion, compared to pharmacies. CONCLUSIONS Nearly all pharmacies offered in-store cigarette promotions and pharmacies had greater odds of offering cigarette promotions than all other retailer types. Whether voluntarily or legislatively, tobacco-free pharmacies would eliminate a prevalent retail source of cigarette promotions. IMPLICATIONS This is the first known national study to examine prevalence of cigarette promotions in US pharmacies compared to other retailer types. Nearly all pharmacies offered in-store cigarette promotions and pharmacies had greater odds of offering cigarette promotions than all other retailer types. These findings underscore the inherent contradiction of pharmacies serving both as an important component of the healthcare system, but also as purveyors and promotors of addictive and lethal tobacco products. Whether voluntarily or legislatively, tobacco-free pharmacy policies would eliminate a prevalent retail source of cigarette promotions.
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Affiliation(s)
- Andrew B Seidenberg
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Moore JR, Chen Q, Choi NG. Cannabis use, use frequency, and use disorder in large metropolitan, small metropolitan, and nonmetropolitan areas. Drug Alcohol Depend 2021; 221:108631. [PMID: 33647587 DOI: 10.1016/j.drugalcdep.2021.108631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite significant geographical heterogeneity of sociodemographic and clinical characteristics, little is known about potential differences in cannabis use behaviors in U.S. geographic areas. In this study, we examined cannabis use behaviors in large metropolitan, small metropolitan, and nonmetropolitan areas. We focused on interactions between geographic areas and health insurance status and medical cannabis laws (MCL). METHODS Data came from the 2015-2018 National Survey on Drug Use and Health (NSDUH; N = 171,766 adults; N = 36,175 cannabis users). Weighted chi-squares tests of independence and multivariable Poisson regression models were used to examine study questions. RESULTS Past-year use was highest in large metropolitan areas (16.08 %). Frequent use was highest among nonmetropolitan area users (48.67 %). Uninsured adults had a higher likelihood of past-year use (RRR = 1.21, 95 % CI = 1.14, 1.29) and frequent use (RRR = 1.27, 95 % CI = 1.14, 1.41), but a lower likelihood of cannabis use disorder (RRR = 0.77, 95 % CI = 0.66, 0.89). Uninsured adults in nonmetropolitan areas had a higher likelihood (RRR = 1.62, 95 % CI = 1.39, 1.88) of past-year use than insured nonmetropolitan area adults. MCL state residency was associated with a higher likelihood of frequent use among nonmetropolitan (RRR = 1.39, 95 % CI = 1.11, 1.74) and small metropolitan users (RRR = 1.30, 95 % CI = 1.15, 1.47). Cannabis use disorder likelihood did not vary by geographic area. CONCLUSIONS Lack of health insurance and MCL state residency are significant variables affecting cannabis use behaviors in small metropolitan and/or nonmetropolitan areas.
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Affiliation(s)
- John R Moore
- The University of Texas at Austin, Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, United States.
| | - Qi Chen
- The University of Texas at Austin, Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, United States
| | - Namkee G Choi
- The University of Texas at Austin, Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, United States
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