Using standalone pharmacies to reduce tobacco retailer availability: neighbourhood associations and two competing policy options in four US states

BACKGROUND: This study examines how two competing policy approaches, tobacco-free pharmacies and pharmacy-only tobacco sales, could impact the number of tobacco retailers, retailer availability and neighbourhood disparities in the US. METHODS: We compiled a list of tobacco retailers in 2023 and coded for primary store type in four US states: California, Connecticut, North Carolina and Ohio. We calculated the reduction in tobacco retailer availability defined as the number of tobacco retailers per 1000 people for each hypothetical policy. We used models fitted for count data and addressed overdispersion and possible spatial dependence to assess associations between the availability of pharmacies in census tracts and neighbourhood characteristics (rurality, age, poverty, race/ethnicity and vacant housing). RESULTS: The hypothetical tobacco-free pharmacy policy showed a much smaller reduction in the number of tobacco retailers (California: 3.9%, Connecticut: 3.1%, North Carolina: 3.0% and Ohio: 4.7%) than a hypothetical pharmacy-only tobacco sales policy (California: 96.1%, Connecticut: 96.9%, North Carolina: 97.0% and Ohio: 95.3%). Regarding the potential impact of each policy on neighbourhood disparities, tobacco-free pharmacies would leave neighbourhood disparities largely unchanged or make them worse in some instances. Pharmacy-only tobacco sales policies would disproportionately locate the few remaining tobacco retailers in neighbourhoods with a greater percentage of people living under the poverty line. CONCLUSIONS: Competing pharmacy-based policies about tobacco sales could impact tobacco retailer availability in the US and have different implications for neighbourhood disparities in tobacco retailer availability.