The Surprising Relationship Between Retailers and Tobacco Use

Tobacco Stops With Me had the opportunity to speak with Researcher Amanda Kong, Ph.D., MPH, about her work exploring how the number of retailers selling tobacco products in an area – and the distance between them – can impact the number of tobacco users and successful quitters in that area. This July, Dr. Kong will bring her expertise to the TSET Health Promotion Research Center team at Stephenson Cancer Center/OU Health as an Assistant Professor.

What interested you in studying disparities related to neighborhoods and tobacco control policies?

I originally planned on studying medicine but experiences as a tobacco-cessation counselor at a community health clinic in Kansas shifted my focus to public health policy research.

At the clinic, I assisted a lot of individuals who used tobacco products. Often, individuals reported wanting to quit but were unable to do so even after multiple quit attempts. One of the biggest impediments to their success was walking into a neighborhood convenience store or other retailer and noticing advertisements for a sale on their preferred brand, triggering a relapse.

I was thinking about the larger retail environment that individuals who smoke encounter, one where calls to light up are around many corners, and how we could change policy to disrupt this and promote healthier behaviors. That inspired some of my graduate and post-graduate research.

In North Carolina, I examined the distances to stores in a specific county that sold tobacco products, plus the census data on the race and ethnicity of the county’s residents. I plugged in all the addresses in the county and mapped them against data about where tobacco retailers are located. We found that as the percent of Black residences in a neighborhood increases, the distance to tobacco retailers declines. In more white neighborhoods, the inverse occurred. Tobacco products are not health-promoting, and this represents a social justice issue.

Why is the tobacco retail environment an important point of intervention for decreasing tobacco use?

Looking back on the past fifty plus years, we have done a great job addressing the overall prevalence in smoking with all populations. Nationally, the Centers for Disease Control and Prevention reports adult cigarette smoking prevalence has fallen from around 42% in 1965 to 14% in 2019. But we aren’t seeing these successes in all communities, so we need to also focus on policies and strategies that may ameliorate or eliminate these inequities.

As a public health researcher, I focus on retail environments. Multiple systematic reviews and analyses have found that higher retailer density and decreased proximity to tobacco retailers is associated with smoking initiation, smoking continuation and smoking frequency among adults. It is also associated with higher rates of cessation failure (relapse). We know cigarettes are not a health-promoting commodity and having retailers with all this marketing – especially for combustibles – is not a good thing for the neighborhood or for the community.

We know that the majority of youth and adults see marketing in the retail environment. Big Tobacco knows this, too. The industry spends $25 million a day (more than $1 million an hour) on marketing in the retail environment, and numerous studies have documented neighborhood racial, ethnic, and socioeconomic inequities in the presence and amounts of tobacco product marketing.

If you had a magic wand and were able to enact one policy to help solve this problem, what would that policy be?

If I could strip away all practical and political considerations, I suppose I would remove all combustible tobacco and marketing from retailers. Additionally, communities should have access to the resources to design and implement policies to create healthier neighborhoods, free from restrictions dictated by higher levels of government.

Congratulations on joining the TSET Health Promotions Research Center this summer! What will be your primary area of research?

In addition to continuing my work examining how tobacco retailers impact public health, I will be shifting more to focus on unhealthy and healthy commodities as a whole. Big Food and Alcohol have adopted Big Tobacco’s playbook. By researching what policies are in place and how they affect the health of communities, I want to help identify and highlight impactful public health policies that promote healthier communities in an equitable fashion.

Published by Tobacco Stops With Me on March 23, 2021