Law Limiting Tobacco Sales in Pharmacies Could Exacerbate Neighborhood Disparities

A New York City law that bans tobacco products from pharmacies substantially reduces tobacco retailer density overall, but the policy’s impact is not evenly distributed across neighborhoods, according to a new study by researchers at the Columbia Mailman School of Public Health. On average, retailer density will decrease by nearly 7 percent, with several neighborhoods experiencing reductions greater than 15 percent after the policy takes full effect in 2019. The findings are published online in the journal Tobacco Control.
 
New York City neighborhoods 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 contrast, areas with a higher concentration 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.
 
“Banning 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,” said Daniel P. Giovenco, PhD, assistant professor of Sociomedical Sciences. “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 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 (GIS) software, tobacco retailer density was calculated for each of the city’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.
 
The pharmacy law, which has strong support from communities, is one of a suite of new laws targeting tobacco use, which also include a cap on the total number of tobacco retailer licenses in each community, the impact of which will occur gradually through attrition and may take years to manifest.
 
“In order to minimize disparities in the tobacco retail environment, local governments considering a similar ban should follow New York City’s example and create a supplemental, ‘retail agnostic’ plan to account for differences in retailer types across diverse neighborhoods,” said Giovenco. “The challenge lies in ensuring that the rate of retailer density reduction occurs equitably. These considerations are crucial since we know that curbing tobacco use leads to better overall health for a community.”
 
Co-authors are Torra Spillane, Christine Mauro, and Diana Hernandez, all of the Columbia Mailman School. The work was supported by the National Institutes of Health (#DP50D023064).