The impact of tobacco retailers density reduction on smoking status of Belgian adults

Abstract Background Smoking being one of most impactful risk factors for causing non-communicable diseases (NCD) and consequently attributable death, represents an enormous public health issue. New policy interventions aimed at reducing smoking prevalence are planned in the Belgian Tobacco Free Generation plan. Within the plan, it is aimed to reduce the number of outlets that sell tobacco products, as a higher tobacco retail density (TRD) is believed to be linked to higher smoking prevalence. Using health impact assessment (HIA), this study aims to evaluate the policy before it is set in place. Methods For this intervention a 17% reduction in density was estimated according to the scoping review would be associated with an 0.39 percentage point reduction in prevalence. The Potential Impact Fraction (PIF) was calculated to assess the change in proportion of current smokers. Time series and projections of the Belgium Health Interview Survey provided data on the smoking status from 1997 untill 2040. The relative risk were retrived from the Global Burden of Disease 2021 study. Using data from the Belgian Burden of Disease Study, the avoidable burden was estimated. Results The policy is expected to reduce the density by 17 % by 2025, which results in a PIF for lung cancer of 0.92%, decreasing to 0.82% in 2040. The smoking prevalence would decrease from 12.62% to 12.23%. We estimated that this intervention would avoid the burden of more than 300 lung cancer cases and around 100 deaths in 2040. Conclusions The HIA in this study suggests that reducing TRD has a potential to contribute to achieving the objectives in Tobacco Free Generation plan. However, it should be noted that the impact is rather small, lower than 1% for most diseases. In addition, the actual impact may vary depending on the specific implementation of the policy and future smoking trends. Further research is needed to refine the effect size estimate based on the actual policy intervention details. Key messages • Reducing tobacco retail density can reduce the burden of smoking. • Modeling limitations need further research to refine HIA results.