In New York, the reduction in tobacco outlets should reduce consumption and social inequalities

A study evaluated New York City's 2017 policy of limiting tobacco outlets and found that the policy worked best in neighborhoods with black and disadvantaged populations, which are most affected by social inequalities in smoking.

The concentration of tobacco outlets in a geographical area is a known factor in maintaining smoking.[1]. It promotes accessibility to tobacco products, in particular by reducing the distances to places of purchase, and helps to maintain the normalization of tobacco. It also encourages young people to start smoking, and more generally to consume. It also makes products more affordable and, in the United States, exposes consumers to promotions by manufacturers.

Several studies have shown a disparity in the location of points of sale in the United States: they are more numerous in the most disadvantaged neighborhoods and in those with a predominantly black or Hispanic population.[2]. These different populations also show a higher smoking rate than the national average. While in the general adult population, the smoking prevalence was 12 % in 2021, it was 18 % among people living below the poverty line and 20 % among those who stopped studying at college.

Limitation on the number of sales licenses granted

In New York City, the anti-smoking policy adopted in 2017 included, among other things, a reduction in the number of points of sale. This reduction in the number of points of sale concerned in particular disadvantaged neighborhoods. To achieve this, the city limited the renewal of tobacco sales licenses, with only one license being granted for every two returned. Other provisions of the city's anti-smoking policy included an increase in local taxes on tobacco products, an increase in the price of tobacco sales licenses (from US$110 to US$200), and the introduction of a license for the sale of electronic cigarettes.

A recent study looked at the effectiveness of this policy of reducing the number of points of sale. It analyzed the distribution of these according to the geographical areas of the city, and compared it with demographic data.[3].

Reduction of points of sale in disadvantaged neighborhoods

By restricting the number of sales licenses issued, New York's anti-smoking policy has managed to significantly reduce the number of points of sale in just 4 years. From the 9,304 points of sale listed in 2010, there were only 5,107 left in 2022, a decrease of 45,%. The decline in the number of points of sale had already begun before 2018, at an overall rate of -14,%. However, it accelerated from 2018 (-34,%), which would suggest a strong influence of this anti-smoking policy. The analysis of geographic sites confirms that points of sale are more concentrated in disadvantaged neighborhoods. It also reveals that the reduction in points of sale has more affected the most disadvantaged neighborhoods and those with a black population. The authors believe that this reduction in points of sale should, in the long term, influence the prevalence of smoking among the populations of these districts.

The authors of the study put forward several hypotheses to explain these results. They assume that businesses in disadvantaged neighborhoods experience faster turnover than other neighborhoods, as suggested by another study[4] ; this would mathematically lead, under the effect of the restrictive policy, to a lower renewal of points of sale in these districts. Another explanation would be that businesses in these districts more frequently see their sales licenses withdrawn due to infringement of regulations.

Since the researchers' work is based on the number of licenses granted, they questioned the number of points of sale that would sell or continue to sell tobacco products without a license. However, local data on the sale of tobacco products without a license are non-existent. The effect of the COVID-19 crisis, which has hit disadvantaged neighborhoods harder, seems to be ruled out: the decrease in the number of points of sale was in fact faster between 2018 and 2020 than between 2020 and 2022.

This municipal policy of reducing points of sale has also been successfully tested in Philadelphia (-20 % in three years), and with less clear results in San Francisco. It confirms the interest of taking into account the commercial determinants of health and acting on the structural causes of smoking, in particular by limiting the trade and accessibility of tobacco products. The authors recall the importance of evaluating the different public policies including this type of provision. They also emphasize that the different measures implemented in a coordinated manner at the level of the city of New York in the field of tobacco control have probably themselves reinforced the effectiveness of the provision of reducing the number of points of sale.

Keywords: United States, New York City, social inequalities, points of sale, tobacco

©Generation Without Tobacco

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[1] Lee JGL, Kong AY, Sewell KB, et al. Associations of tobacco retailer density and proximity with adult tobacco use behaviors and health outcomes: a meta-analysis. Tob Control. 2022;31(e2):e189–e200.

[2] Kong AY, Delamater PL, Gottfredson NC, Ribisl KM, Baggett CD, Golden SD. Sociodemographic inequities in tobacco retailer density: Do neighboring places matter? Health Place. 2021;71:102653.

[3] Giovenco D, Morrison N, Mehranbod C, et al. Impact and Equity of New York City's Tobacco Retail Reduction Initiative, Am Jour Prev Med, published online: October 08, 2023, https://doi.org/10.1016/j.amepre.2023.10.004.

[4] Meltzer R, Capperis S. Neighborhood differences in retail turnover: Evidence from New York City. Urban Stud. 2017;54(13):3022–3057.