Assessing the impact, equity, and mechanisms of a novel policy intervention to reduce tobacco retailer density in communities

PROJECT SUMMARY/ABSTRACT Tobacco retailer density is disproportionately high in low-income communities and certain racial/ethnic enclaves, contributing to severe socioeconomic and social disparities in smoking and its resultant health harms. Local, environmental-level interventions that aim to reduce the number of tobacco retailers are a new policy frontier in tobacco control that may be particularly effective in promoting health equity, but the impact of these initiatives is critically understudied in real-world settings. Three major US cities – San Francisco, Philadelphia, and New York City (NYC) – recently enacted novel measures that establish caps on the number of tobacco retail licenses permitted in city districts. Density reduction under this intervention occurs not through license revocation, but gradually through retailer attrition. The effects of these “capping” policies on retailer density reduction and the resultant tobacco product marketplace largely depend on temporal, spatial, and store-level patterns in license forfeiture, which are not well-understood. Moreover, to comprehensively assess public health impact, it is critical to conduct stakeholder analyses after implementation, describe the policy’s impact on and mechanisms of behavior change, and identify potential unintended effects. The proposed mixed-methods, comparative case study will use archival tobacco retail licensing data, annual audits of tobacco retailers, semi-structured interviews with key community stakeholders, and geocoded health survey data to evaluate this intervention and examine differential policy impact across neighborhoods and population subgroups. Specifically, the project will: 1) Measure tobacco retailer density reduction and its association with community demographics across study sites; 2) Longitudinally characterize changes in the tobacco marketplace during policy implementation; 3) Qualitatively assess key stakeholder perceptions of the policy, its mechanisms of action, and its behavioral impact; and 4) Identify associations between tobacco retailer density reduction and smoking trends in NYC neighborhoods using a unique, annual population survey with geocoded respondent data. Given the lack of empirical support for this nascent, environmental-level tobacco control intervention, study results will provide timely, essential, and experiential evidence to inform equitable policy formation and improve implementation in order to maximize impact and reduce persistent health disparities.