Global sale of tobacco products and electronic nicotine delivery systems in community pharmacies

Cigarette Promotions in U.S. Pharmacies

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.

Electronic cigarettes: Emerging trends and research hotspots

INTRODUCTION

Research on electronic cigarettes is an emerging field, with the number of articles in this field noted to have grown exponentially over recent years. We used a bibliometric analysis method (co-word analysis) to analyze the emerging trends and research hotspots in this field.

METHODS

Publication data on electronic cigarettes from 2010 to 2018 were retrieved and downloaded from the PubMed database. Theme trends and knowledge structures were analyzed on the relevant research fields of electronic cigarettes by using a biclustering analysis, strategic diagram analysis, and social network analysis methods. Research hotspots were extracted and compared from three periods.

RESULTS

Core topics that have continuously develop between the years 2010 and 2018 include: tobacco use cessation devices; tobacco products; tobacco use cessation devices/adverse effects; smoking prevention and adverse effects; electronic nicotine delivery systems/economics; and public health. Some currently undeveloped topics that could be considered as new future research directions include: tobacco use disorder/therapy; tobacco use disorder/epidemiology; students/psychology; students/statistics and numerical data; adolescent behavior/psychology; nicotine/toxicity; nicotinic agonists/administration and dosage; and electronic nicotine delivery systems/legislation and jurisprudence.

CONCLUSIONS

Results suggest that some currently immature topics in strategic coordinates and emerging hotspots in social network graphs can be used as future research directions.

Restricting tobacco sales to only pharmacies combined with cessation advice: a modelling study of the future smoking prevalence, health and cost impacts

OBJECTIVE

Restricting tobacco sales to pharmacies only, including the provision of cessation advice, has been suggested as a potential measure to hasten progress towards the tobacco endgame. We aimed to quantify the impacts of this hypothetical intervention package on future smoking prevalence, population health and health system costs for a country with an endgame goal: New Zealand (NZ).

METHODS

We used two peer-reviewed simulation models: 1) a dynamic population forecasting model for smoking prevalence and 2) a closed cohort multi-state life-table model for future health gains and costs by sex, age and ethnicity. Greater costs due to increased travel distances to purchase tobacco were treated as an increase in the price of tobacco. Annual cessation rates were multiplied with the effect size for brief opportunistic cessation advice on sustained smoking abstinence.

RESULTS

The intervention package was associated with a reduction in future smoking prevalence, such that by 2025 prevalence was 17.3%/6.8% for Māori (Indigenous)/non-Māori compared to 20.5%/8.1% projected under no intervention. The measure was furthermore estimated to accrue 41 700 discounted quality-adjusted life-years (QALYs) (95% uncertainty interval (UI): 33 500 to 51 600) over the remainder of the 2011 NZ population's lives. Of these QALYs gained, 74% were due to the provision of cessation advice over and above the limiting of sales to pharmacies.

CONCLUSIONS

This work provides modelling-level evidence that the package of restricting tobacco sales to only pharmacies combined with cessation advice in these settings can accelerate progress towards the tobacco endgame, and achieve large population health benefits and cost-savings. :.