Geographic variation in the diverse tobacco retail environment and its impact on tobacco use disparities

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ABSTRACT Amid declining cigarette consumption, sales of non-cigarette tobacco products remain strong. Importantly, the diverse products available in the current tobacco marketplace pose different levels of harm to the user. Combustible products such as cigarettes and cigars are higher on the tobacco risk continuum than non- combustible products such as smokeless tobacco and electronic cigarettes (e-cigs). Conceivably, smokers who switch to a non-combustible product may reduce their risk of smoking-related disease. This behavior, however, is significantly more common among whites compared to blacks, who have the highest rates of combustible tobacco use of any racial or ethnic group. Indeed, cigarette smoking rates are declining faster among whites than blacks, potentially driven by e-cig uptake. Differential rates of quitting smoking by switching to e-cigs or other non-combustible products may exacerbate existing health disparities between whites and blacks. Although tobacco use is influenced by several individual, interpersonal, and societal factors, the retail environment is known to play a critical role in shaping smoking behaviors, particularly among racial minorities, whom the tobacco industry has historically exploited. Despite the growing popularity of e-cigs and other non- cigarette tobacco products, little is known about the promotion of these products at the point-of-sale. This project will examine how the retail of diverse tobacco products varies across the U.S. and the extent to which it is associated with use behaviors of community residents. Specifically, this study will 1) investigate the relationship between regional tobacco product sales, tobacco control policies, and community demographics using Nielsen market scanner data and census data, 2) document the association between the local tobacco retail environment and tobacco product use using geocoded data from the National Health Interview Survey (NHIS) and store audits, and 3) model smoking-related disparities attributed to changes in tobacco use behaviors using repeated cross-sectional NHIS data and longitudinal data from the Population Assessment of Tobacco and Health (PATH) study.