New York City's tobacco-free free pharmacy law substantially reduces tobacco retailer density overall, but the policy's impact is not evenly distributed across neighbourhoods, according to a study at the University of Columbia's Mailman School of Public Health.
The findings are published online in the journal Tobacco Control.
On average, retailer density will decrease by nearly 7 percent, with several "Neighborhood Tabulation Areas" experiencing reductions greater than 15 percent after the policy takes full effect in 2019. Though NYC supplemented this approach by setting a cap on the total number of tobacco retailer licenses in each community district, the impact of this companion law will occur gradually through attrition and may take years to manifest.
Neighbourhoods that benefitted most from the tobacco-free pharmacy policy generally had higher income levels, greater educational attainment and a higher proportion of non-Hispanic white residents – demographic groups with a relatively low burden of tobacco use in NYC.
In contrast, areas with a higher percentage of adults with less than a high school education and a higher proportion of uninsured residents benefitted less from the policy. For example, neighborhoods in the South Bronx, East and Central Harlem, and North and Central Brooklyn – all identified as 'high risk' for tobacco retail by the American Cancer Society – experienced little to no change in retailer density after policy implementation.
"Our study demonstrates that the overall effect of the pharmacy ban on tobacco retailer density is substantial," said Dr Daniel P Giovenco, assistant professor of sociomedical sciences. "In order to minimize disparities in the tobacco retail environment, local governments considering a similar ban should follow NYC's example and create a supplemental, 'retail agnostic' plan to account for differences in retailer types across diverse neighborhoods. The challenge lies in ensuring that the rate of retailer density reduction occurs equitably."
The researchers based their analysis on a 2017 list of all licensed tobacco retailers in the city, including 510 pharmacies that held tobacco licenses. Using geographic information systems software, tobacco retailer density per 1,000 residents was calculated for each of NYC's Neighborhood Tabulation Areas before and after removing pharmacies from the sample.
Results showed that high-income neighborhoods in Manhattan and the more suburban outskirts of other boroughs were most likely to benefit from the new policy, experiencing the largest reductions in retailer density. More disadvantaged neighborhoods in the city frequently experienced little to no change in retailer density as a result of the new law.
Strong evidence exists that tobacco-free pharmacy laws have a positive impact on health, and consumer support for this tobacco control strategy is high. "New York City's newest legislation to ban tobacco sales in pharmacies – retailers that often claim to be centers of health and wellness – has received deserved praise, and is a sensible public health strategy to curb tobacco use," observed Giovenco.
"It is important, however, to continue to monitor the reductions in retailer density and tobacco use prevalence across neighborhoods in the years following the city's new policies to assess their effectiveness and equitable distribution."
The work was supported by the National Institutes of Health.
[link url="https://eurekalert.org/pub_releases/2018-08/cums-ntp082918.php"]Columbia University report on the EurekAlert site[/link]
Evaluating the impact and equity of a tobacco-free pharmacy law on retailer density in New York City neighbourhoods
Authors: Daniel P Giovenco, Torra Spillane, Christine Mauro and Diana Hernandez, all of the Columbia Mailman School.
In 2018, New York City (NYC) implemented a tobacco-free pharmacy law as part of a comprehensive policy approach to curb tobacco use. This study models the reduction in tobacco retailer density following the ban to examine differences in the policy’s impact across neighbourhoods.
Tobacco retailer density per 1000 residents was calculated in July 2017 for each of NYC’s Neighborhood Tabulation Areas (NTAs, n=188) before and after removing pharmacies as licensed tobacco retailers. Pearson correlations and linear regression (with predictors scaled to 10 unit increments) measured associations between the projected change in retailer density after the ban and NTA demographic characteristics.
On average, retailer density decreased by 6.8% across neighbourhoods (SD: 6.3), with 17 NTAs experiencing reductions over 15%. Density reduction was greater in NTAs with higher median household income (r: 0.41, B: 1.00, p<0.0001) and a higher proportion of non-Hispanic white residents (r: 0.35, B: 0.79, p<0.0001). NTAs with a higher percentage of adults with less than a high school education (r: −0.44, B: −2.60, p<0.0001) and a higher proportion of Hispanic residents (r: −0.36, B: −1.07, p<0.0001) benefited less from the policy. These relationships held after assessing absolute changes in density (vs per cent change).
NYC’s tobacco-free pharmacy law substantially reduces tobacco retailer density overall, but the impact is not equal across neighbourhoods. In order to minimise disparities in the tobacco retail environment, local governments considering a similar ban should supplement this strategy with other retailer restrictions to achieve equitable outcomes.
[link url="https://tobaccocontrol.bmj.com/content/early/2018/08/22/tobaccocontrol-2018-054463"]Article in the journal Tobacco Control[/link]