Where There’s No Smoke There’s Fire

E-cigarettes have blunted any significant downward trend in tobacco sales, according to a new study by UAlbany's Akiko Hosler.

ALBANY, N.Y. (June 27, 2016) -- A new University at Albany-led study finds that while subtle declines in tobacco availability and advertising can be partially explained by local control efforts and the pharmacy industry’s self-regulation of sales, overall tobacco availability remains high, with higher rates in racial/ethnic minority neighborhoods. The rise of electronic cigarettes (e-cigarettes) is a growing concern.

Published in Preventing Chronic Disease, the long-term study tracked 12-year trends in tobacco availability, advertising, and ownership changes in various food stores in Albany, N.Y. Analyzing trends from 2003 through 2015, the study found that subtle declines in tobacco sales could be traced to the increase of state tobacco registration fee. All tobacco retailers are required to complete New York’s tobacco retailer registration.

"The high store ownership turnover rate suggests that a moratorium of new tobacco retailer registrations would be an integral part of a multi-prong policy strategy to reduce tobacco availability and advertising," said Akiko Hosler, associate professor of epidemiology and biostatistics at UAlbany’s School of Public Health and lead author of the study.

The setting of this study encompassed six zip code areas in downtown Albany. The region had been designated as a priority community of University research since 2002 because of elevated chronic disease risks of its residents, including a high prevalence of smoking.

To the best of our knowledge, this study is the first to examine long-term trends of directly measured tobacco availability, tobacco advertising, and ownership changes in retail stores selling food in a defined community,” said Hosler. "A longitudinal design allowed us to investigate how and why tobacco availability and advertising changed over time."

Breaking Down the Data

• Tobacco availability was measured by the presence of any tobacco products for sale in 2003, 2009, 2012, and 2015. The researchers also assessed the availability and advertising of e-cigarettes in 2015, because this new product is now the most used tobacco product among middle- and high-school students.
• In 2009, 2012, and 2015, indoor tobacco advertising was measured by the presence of any objects bearing the name, image, or both of a tobacco brand that were placed inside the store. The platforms of advertising included stickers, posters, plaques, price cards, and banners, as well as free-standing pieces such as counter mats and change trays. Tobacco advertising placed at the eye level of a young child was measured separately and identified in this study as “low tobacco advertising.” Availability of e-cigarettes and indoor advertising for e-cigarettes were measured in 2015 only.
• The number of stores selling tobacco peaked at 107 in 2012 and declined slightly to 102 in 2015. Percentage of stores selling tobacco peaked at 83.8 percent in 2009 and gradually declined to 74.5 percent in 2015, but the trend was not significant.
• E-cigarettes were sold in 47.4 percent of all stores, or 63.7 percent of stores selling tobacco in 2015. Convenience stores were most likely to sell e-cigarettes (63.5 percent), followed by dollar stores (55.6 percent) and pharmacies (50 percent). No supermarkets sold e-cigarettes, and all e-cigarette-selling stores were registered to sell tobacco. All dollar stores that sold e-cigarettes (5 of 5) and nearly all convenience stores that sold e-cigarettes (52 of 54) had indoor advertising of the product; supermarkets, pharmacies, and specialty stores had no advertising for e-cigarettes. Some pharmacies strategically placed e-cigarettes next to tobacco cessation products. Common platforms of e-cigarette advertising were manufacturer-supplied display cases and brand-name stickers. Low advertising of e-cigarettes was rare and found only in 2 convenience stores.

During the study period, New York State enacted legislation aimed at reducing tobacco users, including expanding the comprehensive New York State Clean Indoor Air Act in 2003, substantial increases in the state tobacco excise tax in 2008 (from $1.50 to $2.75 per pack) and again in 2010 (to $4.38 per pack), and several amendments of the Youth Access Tobacco Control Law.

In 2011, the annual tobacco retailer registration fee was also raised from $100 to $300. Despite this anti-tobacco legislation, tobacco remained widely available in this study community. Estimated per 10,000 population, tobacco retailer densities were 16.4 in 2003, 18.2 in 2009, 19.7 in 2012, and 18.7 in 2015.

"Our study community experienced a net increase of 15 tobacco retailers in the 12-year period," said Hosler. "We also noted persistent tobacco advertising and a wide availability of e-cigarettes in convenience stores and dollar stores."

Because stores selling tobacco have a high ownership turnover rate, the researchers argue that legislation to enforce a moratorium on new tobacco registrations may be a feasible approach to curb the excess availability of tobacco in the community.

UAlbany’s School of Public Health, created through a memorandum of understanding between the University at Albany and NYSDOH, has advanced biomedical research, public health policy and program development, peer-reviewed scholarship, and teaching. This year, SPH is celebrating the 30th anniversary of this unique model of graduate public health education. The School, initially located within NYSDOH with its staff as the founding faculty, has evolved to have an independent campus and full-time academic faculty, but remains closely linked with the Department of Health. The School and the Department work together to improve the health of the New York’s citizens by providing an academic focus to problems faced in health department practice settings.

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