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Original research
Cigarettes smoked among daily and non-daily smokers following CVS Health’s tobacco-free pharmacy policy
  1. Aryn Z Phillips1,2,
  2. Jennifer A Ahern3,
  3. William C Kerr4,
  4. Hector P Rodriguez2,3
  1. 1 Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  2. 2 Center for Healthcare Organizatonal and Innovation Research, University of California, Berkeley, Berkeley, CA, USA
  3. 3 School of Public Health, University of California, Berkeley, Berkeley, California, USA
  4. 4 Alcohol Research Group, Emeryville, California, USA
  1. Correspondence to Dr Aryn Z Phillips, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; aryn.phillips{at}northwestern.edu

Abstract

Introduction In September 2014, CVS Health ceased tobacco sales in all of its 7700 pharmacies nationwide. We investigate the impact of the CVS policy on the number of cigarettes smoked per day among metropolitan daily and non-daily smokers, who may respond to the availability of smoking cues in different manners.

Methods Data are from the US Census Bureau Tobacco Use Supplement to the Current Population Survey 2014–2015 and the Blue Cross and Blue Shield Institute Community Health Management Hub. Adjusted difference-in-difference (DID) regressions assess changes in the number of cigarettes smoked per day among daily smokers (n=10 759) and non-daily smokers (n=3055), modelling core-based statistical area (CBSA) level CVS pharmacy market share continuously. To assess whether the policy had non-linear effects across the distribution of CVS market share, we also examine market share using tertiles.

Results CVS’s tobacco-free pharmacy policy was associated with a significant reduction in the number of cigarettes smoked by non-daily smokers in the continuous DID (rate ratio=0.985, p=0.022), with a larger reduction observed among non-daily smokers in CBSAs in the highest third of CVS market share compared with those living in CBSAs with no CVS presence (rate ratio=0.706, p=0.027). The policy, however, was not significantly associated with differential changes in the number of cigarettes by daily smokers.

Conclusion The removal of tobacco products from CVS pharmacies was associated with a reduction in the number of cigarettes smoked per day among non-daily smokers in metropolitan CBSAs, particularly those in which CVS had a large pharmacy market share.

  • prevention
  • public policy
  • environment

Data availability statement

Data may be obtained from a third party and are not publicly available. Some data used for this analysis were proprietary and provided by Blue Cross Blue Shield Institute under a data use agreement.

https://doi.org/10.1136/tobaccocontrol-2020-055976

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Some data used for this analysis were proprietary and provided by Blue Cross Blue Shield Institute under a data use agreement.

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    Footnotes

    • Twitter @ArynZPhillips

    • Contributors AZP conceived the study, designed the methodology, conducted data curation and analysis, and drafted the manuscript. JA, WK and HR advised on methodology, helped interpret the results, and reviewed and edited the manuscript. HR also facilitated the data acquisition.

    • Funding This study was supported by award number T32AA007240 (Graduate research training in alcohol problems: alcohol-related disparities) and award number P50AA005595 (Epidemiology of alcohol problems: alcohol-related disparities) from the National Institute on Alcohol Abuse and Alcoholism.

    • Disclaimer The content of this report is solely the responsibility of the authors and does not necessarily represent the official view of NIAAA or NIH.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.