Modelling how age-restricted location policies would impact tobacco retailer density in four US states: California, Connecticut, North Carolina and Ohio

BACKGROUND: Age-restricted location (ARL) policies are a novel tobacco control strategy that restrict in-person tobacco sales to locations that do not allow underage buyers on their premises, such as tobacco shops. This study aimed to examine how ARL policies might impact different US communities. METHODS: Preliminary work geocoded the locations of all tobacco retailers (collected 2023-2024) across four states (California, Connecticut, North Carolina and Ohio) and calculated tobacco retailer density (TRD) at the census tract level. We then simulated an ARL policy by removing all retailers that would no longer be allowed to sell tobacco. Finally, using statistical methods that accounted for varying spatial distributions over census tracts for each state, we conducted pre-post analyses to determine how an ARL policy would reduce TRD overall, and by neighbourhood characteristics (census tract-level poverty, race and ethnicity and rurality). RESULTS: The percentage reduction in tobacco retailers was highest for North Carolina (86.4% reduction in TRD), followed by Ohio (85.8%), California (74.4%) and Connecticut (62.4%). Results also indicated that an ARL policy would generally be equity-neutral, meaning that it would not exacerbate the current disparities that exist in TRD. And, in some cases, the policy would be equity-enhancing, such as in the case of reducing existing rural TRD disparities. CONCLUSIONS: The degree of TRD reduction estimated by these simulation models for an ARL policy is more powerful than what has been found for other retailer-focused strategies (eg, prohibiting tobacco retailers close to schools). ARL policies could be a promising and potentially powerful strategy for reducing TRD in the USA.