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Progress on the Path to Delivering the First Tobacco-Free Generation
Two years ago, as part of the promise to deliver the first tobacco-free generation, CVS Health announced that it would no longer sell cigarettes or tobacco products in its stores. But can such a decision – restricting access by removing it from stores – really reduce overall tobacco use?
A new study published today in the American Journal of Public Health shows that removing tobacco from CVS Pharmacy locations was associated with a significant decrease in overall cigarette purchasing, including at other retail locations.
Smoking accounts for more than 480,000 deaths annually and is a leading cause of preventable morbidity and mortality in the U.S. More than 16 million Americans are living with a disease caused by smoking and the economic costs attributable to smoking include more than $170 billion in medical costs, and $156 billion in lost productivity each year.
Although overall rates have been declining, nearly 17 percent of Americans still smoke and the Office of the Surgeon General estimates that 24.7 trillion cigarettes were smoked between 1964 and 2012.
Given the staggering statistics, reducing tobacco use continues to be a major public health priority. This study shows that by restricting access to tobacco, a health care-focused company like CVS Health can help bring about a meaningful reduction in overall use and put people on the path to better health.
Annual Cigarette Consumption in the U.S.
Source: U.S. Department of Health and Human Services, The Health Consequences of Smoking - 50 Years of Progress.
For the study, the CVS Health Research Institute team analyzed both household and state-level data on cigarette purchases. Households that had purchased cigarettes exclusively at CVS Pharmacy were 38 percent more likely to stop buying cigarettes after CVS stopped tobacco sales, and those consumers that bought more cigarettes (>3 packs a month) were more than twice as likely to stop buying them, likely reflecting the greater disruption in their tobacco use and purchasing behaviors when CVS removed tobacco.
While there was no change in cigarette pack purchases short-term (one month), over the eight month follow-up period, smokers in states where CVS Pharmacy stopped selling tobacco reduced their purchases by an additional 5.3 packs per smoker as compared to smokers in the control states. In addition, a 5 percent increase in CVS market share (percentage of retail sales) was associated with a decrease of 0.15 packs per smoker per month over the eight month follow-up period.
Household data was obtained from a self-reported panel survey by market research firm IRI using June-August 2014 as the baseline months and September 2014-February 2015 as the follow-up months.
The state-level analysis compared 26 states with a CVS Pharmacy location to three without, and included 40 monthly measurements for each state including 32 pre-tobacco removal months from January 2012-August 2014 and eight post-removal months (September 2014-April 2015).
Why It Matters
The study results clearly demonstrate that restricting tobacco access is an effective approach on the path to helping deliver the first tobacco-free generation. This is the first study to evaluate the impact of a large retail company’s decision to end tobacco sales on unique household and population-level cigarette purchasing. The study showed a meaningful change in purchasing – and presumably consumption of – cigarettes.
The significance of the results is striking. In the 13 states where CVS Pharmacy locations had more than 15 percent of the market share, consumers purchased 95 million fewer packs of cigarettes over the eight months subsequent to tobacco removal representing a 1 percent reduction in sales in these states.
Findings Consistent with Other Research
The findings are in line with multiple studies examining the impact of restricting tobacco access on smaller scales. New York City’s sales ban on flavored non-cigarette tobacco products resulted in a 10.2 percent greater absolute decrease in sales compared to sales in 10 nearby counties. In one suburban Massachusetts community, raising the tobacco purchasing age from 18 to 21 was associated with a 6 percent decline in smoking prevalence (13 percent in 2006 to 7 percent in 2010) among high school youth, compared with a 3 percent decline in 16 surrounding communities.
Currently, many large retailers, including multiple pharmacy chains, sell cigarettes. Our research indicates that if these retailers, particularly pharmacies, stop selling cigarettes, there would be an overall reduction in tobacco consumption, and as a result a substantial health benefit.
Removing tobacco from CVS stores is just one of multiple approaches to the public health epidemic of smoking. CVS pharmacists and MinuteClinic providers are also trained to help support and educate patients who want to stop smoking. In addition, CVS Health has a $3.6 million, multi-year partnership with the American Cancer Society to provide grants to help 125 college and university campuses around the country go tobacco-free. In the first year of the program, 20 schools received grants and second-year applications are being accepted now.
This program is part of ‘Be the First,’ a five-year, $50 million initiative to help deliver the nation’s first tobacco-free generation. The CVS Health Foundation also offers grants to organizations committed to implementing public health strategies to reduce youth tobacco use and exposure to second-hand smoke. Other approaches, such as employer-sponsored, financial incentive-based smoking cessation programs have also been successful.
Approaches to Helping Reduce Cigarette Use
- Removal of tobacco from retail sales
- Employer-sponsored incentive-based cessation programs
- Grants to colleges and universities
- Support organizations working to reduce youth tobacco use
Optimizing prescription therapy is key to improving outcomes for chronic conditions that drive a majority of health care spend.
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