Limiting tobacco accessibility by transitioning tobacco sales to state alcohol stores: estimated increases in travel time and changes in associated disparities.

Abstract

Background: Transitioning tobacco sales (TTSs) to state-controlled stores would reduce tobacco retailer density, making tobacco less accessible while also providing infrastructure to support retailer licensing, raise prices and restrict marketing. Using 10 US states with an alcohol retail monopoly as an example, this study estimated population average increases in driving time associated with implementing TTS, reporting changes overall and by race, ethnicity and poverty status.

Methods: This cross-sectional study combined 2020 licensing data, business records and American Community Survey 5-year estimates. Network (road-based) driving times to the nearest tobacco retailer were calculated at the census tract level for the status quo (existing tobacco retailers) and TTS counterfactual (state alcohol stores) in 2020. Travel times were weighted by subpopulations to assess equity reach of decreases in tobacco retailer accessibility.

Results: On average, TTS would more than double travel times to the nearest tobacco retailer, resulting in a mean 119% increase in driving time (range: 30%-232%). The average per cent increase in travel time was slightly greater for black (127%) and Hispanic or Latino people (126%) than for white people (117%), and travel times increased more for black and/or Hispanic or Latino people in all states except Alabama, New Hampshire and Utah. There were larger increases in travel time for persons with incomes below the federal poverty line (vs above) in 7 of the 10 states.

Conclusions: The TTS policy would make tobacco less accessible and reduce racial, ethnic and socioeconomic disparities in tobacco retail accessibility in most of the states examined.