Advertisement

Tobacco-Free Pharmacies and U.S. Adult Smoking Behavior: Evidence From CVS Health's Removal of Tobacco Sales

  • Fatma Romeh M. Ali
    Correspondence
    Address correspondence to: Fatma Romeh M. Ali, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, S107-7, Atlanta GA 30341.
    Affiliations
    Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

    Department of Economics, Faculty of Economics and Political Science, Cairo University, Giza, Egypt
    Search for articles by this author
  • Linda Neff
    Affiliations
    Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Xu Wang
    Affiliations
    Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • S. Sean Hu
    Affiliations
    Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Anna Schecter
    Affiliations
    Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Margaret Mahoney
    Affiliations
    Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
  • Paul C. Melstrom
    Affiliations
    Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author
Published:November 20, 2019DOI:https://doi.org/10.1016/j.amepre.2019.09.003

      Introduction

      Beginning September 3, 2014, CVS Health stopped selling tobacco products in all of its retail stores nationwide. This study assessed the impact of removing tobacco sales from CVS Health on cigarette smoking behaviors among U.S. adult smokers.

      Methods

      CVS Health retail location data (2012–2016) were linked with data from the Behavioral Risk Factor Surveillance System, a phone-based survey of the non-institutionalized civilian population aged ≥18 years. Using a difference-in-differences regression model, quit attempts and daily versus nondaily smoking were compared between smokers living in counties with CVS stores and counties without CVS stores, before and after CVS's removal of tobacco sales. Control variables included individuals’ sociodemographic and health-related variables, state tobacco control variables, and urban status of counties. Analyses were conducted in 2018.

      Results

      During the 2-year period following the removal of tobacco sales from CVS Health, smokers living in counties with high CVS density (≥3.5 CVS stores per 100,000 people) had a 2.21% (95% CI=0.08, 4.33) increase in their quit attempt rates compared with smokers living in counties without CVS stores. This effect was greater in urban areas (marginal effect: 3.03%, 95% CI=0.81, 5.25); however, there was no statistically significant impact in rural areas. Additionally, there was no impact on daily versus nondaily smoking in either urban or rural areas.

      Conclusions

      Removing tobacco sales in retail pharmacies could help support cessation among U.S. adults who are attempting to quit smoking, particularly in urban areas.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Jones JM
        Record 64% rate honesty, ethics of member of Congress low: ratings of nurses, pharmacists, and medical doctors most positive.
        Gallup. Published 2011;
        • HHS
        The health consequences of smoking—50 years of progress: a report of the Surgeon General.
        HHS, CDC, Atlanta, GA2014
        • Center for Public Health Systems Science
        Point-of-sale report to the nation: realizing the power of states and communities to change the tobacco retail and policy landscape.
        Center for Public Health, St. Louis, MOPublished 2016
        • Seidenberg AB
        • Behm I
        • Rees VW
        • Connolly GN
        Cigarette sales in pharmacies in the USA (2005–2009).
        Tob Control. 2012; 21: 509-510
        • Henriksen L
        • Schleicher NC
        • Barker DC
        • Liu Y
        • Chaloupka FJ
        Prices for tobacco and nontobacco products in pharmacies versus other stores: results from retail marketing surveillance in California and in the United States.
        Am J Public Health. 2016; 106: 1858-1864
        • Babb S
        • Malarcher A
        • Schauer G
        • Asman K
        • Jamal A
        Quitting smoking among adults—United States, 2000–2015.
        MMWR Morb Mortal Wkly Rep. 2017; 65: 1457-1464
        • Hoek J
        • Gifford H
        • Pirikahu G
        • Thomson G
        • Edwards R
        How do tobacco retail displays affect cessation attempts? Findings from a qualitative study.
        Tob Control. 2010; 19: 334-337
        • Droungas A
        • Ehrman RN
        • Childress AR
        • O'Brien CP
        Effect of smoking cues and cigarette availability on craving and smoking behavior.
        Addict Behav. 1995; 20: 657-673
        • Krumme AA
        • Choudhry NK
        • Shrank WH
        • et al.
        Cigarette purchases at pharmacies by patients at high risk of smoking-related illness.
        JAMA Intern Med. 2014; 174: 2031-2032
        • Wang TW
        • Agaku IT
        • Marynak KL
        • King BA
        Attitudes toward prohibiting tobacco sales in pharmacy stores among U.S. adults.
        Am J Prev Med. 2016; 51: 1038-1043
      1. Report of the 2010 APhA House of Delegates: actions of the legislative body of the American Pharmacists Association [editorial].
        J Am Pharm Assoc. 2010; 50: 471-472
        • Polinski JM
        • Howell B
        • Gagnon MA
        • Kymes SM
        • Brennan TA
        • Shrank WH
        Impact of CVS Pharmacy's discontinuance of tobacco sales on cigarette purchasing (2012–2014).
        Am J Public Health. 2017; 107: 556-562
        • CDC Behavioral Risk Factor Surveillance System
        Annual survey data.
        CDC, 2019
        www.cdc.gov/brfss/annual_data/annual_data.htm
        Date accessed: September 18, 2019
        (Updated August 29,)
        • Lavinghouze SR
        • Malarcher A
        • Jama A
        • Neff L
        • Debrot K
        • Whalen L
        Trends in quit attempts among adult cigarette smokers — United States, 2001–2013.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 1129-1135
        • García-Rodríguez O
        • Secades-Villa R
        • Flórez-Salamanca L
        • Okuda M
        • Liu SM
        • Blanco C
        Probability and predictors of relapse to smoking: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
        Drug Alcohol Depend. 2013; 132: 479-485
        • Hughes JR
        • Peters EN
        • Naud S
        Relapse to smoking after 1 year of abstinence: a meta-analysis.
        Addict Behav. 2008; 33: 1516-1520
        • Lipperman-Kreda S
        • Grube JW
        • Friend KB
        Local tobacco policy and tobacco outlet density: associations with youth smoking.
        J Adolesc Health. 2012; 50: 547-552
        • Loomis BR
        • Kim AE
        • Busey AH
        • Farrelly MC
        • Willett JG
        • Juster HR
        The density of tobacco retailers and its association with attitudes toward smoking, exposure to point-of-sale tobacco advertising, cigarette purchasing, and smoking among New York youth.
        Prev Med. 2012; 55: 468-474
        • Pokorny SB
        • Jason LA
        • Schoeny ME
        The relation of retail tobacco availability to initiation and continued smoking.
        J Clin Child Adolesc Psychol. 2003; 32: 193-204
      2. State tobacco activities tracking and evaluation (STATE) system.
        CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, AtlantaGA2019
        www.cdc.gov/statesystem/index.html
        Date accessed: May 31, 2018
        (Updated September 3,)
        • National Center for Health Statistics, CDC
        NCHS urban–rural classification scheme for counties.
        CDC, 2017
        www.cdc.gov/nchs/data_access/urban_rural.htm
        Date accessed: November 5, 2018
        (Updated June 1,)
        • Cameron CA
        • Miller DL
        A practitioner's guide to cluster-robust inference.
        J Hum Resour. 2015; 50: 317-372
        • Katz MH.
        Banning tobacco sales in pharmacies: the right prescription.
        JAMA. 2008; 300: 1451-1453
        • Brown TJ
        • Todd A
        • O'Malley C
        • et al.
        Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation.
        BMJ Open. 2016; 6e009828
        • Dent LA
        • Harris KJ
        • Noonan CW
        Tobacco interventions delivered by pharmacists: a summary and systematic review.
        Pharmacotherapy. 2007; 27: 1040-1051
        • Dent LA
        • Harris KJ
        • Noonan CW
        Randomized trial assessing the effectiveness of a pharmacist-delivered program for smoking cessation.
        Ann Pharmacother. 2009; 43: 194-201
        • Adams AJ
        • Hudmon KS.
        Pharmacist prescriptive authority for smoking cessation medications in the United States.
        J Am Pharm Assoc. 2018; 58: 253-257
        • Chuang YC
        • Cubbin C
        • Ahn D
        • Winkleby MA
        Effects of neighborhood socioeconomic status and convenience store concentration on individual level smoking.
        J Epidemiol Commun Health. 2005; 59: 568-573
        • Reitzel LR
        • Cromley EK
        • Li Y
        • et al.
        The effect of tobacco outlet density and proximity on smoking cessation.
        Am J Public Health. 2011; 101: 315-320
        • Halonen JI
        • Kivimäki M
        • Kouvonen A
        • et al.
        Proximity to a tobacco store and smoking cessation: a cohort study.
        Tob Control. 2014; 23: 146-151
        • Jin Y
        • Lu B
        • Klein EG
        • Berman M
        • Foraker RE
        • Ferketich AK
        Tobacco-free pharmacy laws and trends in tobacco retailer density in California and Massachusetts.
        Am J Public Health. 2016; 106: 679-685
      3. Counter Tobacco. Tobacco free pharmacies. https://countertobacco.org/policy/tobacco-free-pharmacies/. Accessed November 5, 2018.

        • HHS
        E-cigarette use among youth and young adults: a report of the Surgeon General.
        HHS, CDC, Atlanta, GAPublished 2016
      4. Oregon State University. CVS pharmacy. https://pharmacy.oregonstate.edu/cvs-pharmacy%E2%84%A2. Accessed September 18, 2019.

        • Karasek D
        • Ahern J
        • Galea S
        Social norms, collective efficacy, and smoking cessation in urban neighborhoods.
        Am J Public Health. 2012; 102: 343-351
        • Hymowitz N
        • Cummings KM
        • Hyland A
        • Lynn WR
        • Pechacek TF
        • Hartwell TD
        Predictors of smoking cessation in a cohort of adult smokers followed for five years.
        Tob Control. 1997; 6: S57-S62
        • Borland R
        • Yong HH
        • O'Connor RJ
        • Hyland A
        • Thompson ME
        The reliability and predictive validity of the Heaviness of Smoking Index and its two components: findings from the International Tobacco Control Four Country Study.
        Nicotine Tob Res. 2010; 12: S45-S50
        • Pierannunzi C
        • Hu SS
        • Balluz L
        A systematic review of publications assessing reliability and validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004–2011.
        BMC Med Res Methodol. 2013; 13: 49