Tobacco retail policy innovation to reduce health disparities

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ABSTRACT The significant progress made toward ending the tobacco epidemic has primarily resulted from policy changes, including tobacco tax increases and smokefree policies. However, research suggests that even if progress on existing prevention and cessation programs is accelerated, an end to the tobacco epidemic is unlikely to be achieved without additional policy innovations. The tobacco retail environment has become a focus of current tobacco control policy conversations, with studies exploring the impact of reduced retailer density. An as yet unstudied approach is using the existing infrastructure of states with alcohol (or potentially marijuana) control retail systems to restrict tobacco sales. Transitioning tobacco sales (TTS) to state retail outlets would enable states to increase control over price, point-of-sale advertising, numbers and types of brands, hours, and outlet density. Disadvantaged communities could experience the greatest benefit, given the current concentration of tobacco outlets in lower income and racially diverse neighborhoods. However, no research has assessed the feasibility, obstacles to and potential health and revenue effects of such a move.The overall objective of this project is to evaluate the prospects for and potential impact of implementing TTS as a way to reduce tobacco accessibility, tobacco use, and tobacco-related health disparities. The project's specific aims are: Specific Aim #1: Conduct a comprehensive appraisal of the potential for and obstacles to moving sales of combustible tobacco products to state retail outlets in 12 states with such systems for alcohol control and sales, and in 2 potential marijuana control states; Specific Aim #2: Examine the extent to which economic and other disparities in the retail accessibility of tobacco could be reduced by limiting sales to state-controlled liquor stores; Specific Aim #3: Using a validated tobacco control simulation model, analyze the impact on smoking prevalence, smoking attributable deaths, health-related outcomes, and state revenues of moving tobacco product sales to state-controlled liquor outlets. This research answers a recent call by the Tobacco Control Research Priorities Working Group of the NCI Board of Scientific Advisors for research on innovative tobacco control policy initiatives that are potentially transformative. Pinpointing the health and economic impacts of moving tobacco sales to state-run stores could lay the groundwork for policymaker consideration of this or more incremental retailer reduction measures.