Retail Tobacco Marketing in Rural Versus Nonrural Counties: Product Availability, Discounts, and Prices

Abstract

Objectives. To assess tobacco product availability, advertised discounts, and prices in rural and nonrural stores, comparing results for two definitions of rural. Method. This geospatial study linked data from marketing surveillance in a representative sample of licensed tobacco retailers in California ( n = 1,276) and categorized rural/nonrural stores at the county and tract levels. Data were collected from January to March, 2017, and mixed-models analyses tested for differences by location (rural vs. nonrural). Results. Compared to nonrural stores, rural-county stores were 2.1 (95% confidence interval [CI; 1.2, 3.6]) times more likely to sell chewing tobacco and 2.5 (95% CI [1.4, 4.2]) times more likely to sell roll-your-own. Rural-county stores sold larger packs of cigarillos for less than $1 (coefficient = 0.22, 95% CI [0.05, 0.39]) and charged less for the cheapest cigarette pack regardless of brand (estimated mean difference = $−0.21, 95% CI [−0.39, −0.03]). Contrary to expectation, a popular brand of chewing tobacco cost more in rural-county stores. A tract-level definition of rural reclassified only 1 in 10 stores, and did not substantially alter the results. Overall, 32.9% of stores advertised discounts on chewing tobacco, but this was more common in rural than nonrural census tracts (adjusted odds ratio = 1.81, 95% CI [1.14, 2.88]). Discussion. Evidence that $1 buys more cigarillos in rural-county stores than elsewhere adds to health equity concerns that the prevalence of cheap, flavored tobacco is not limited to neighborhoods characterized by socioeconomic disadvantage, higher proportions of African Americans, and higher proportions of school-age youth. Policies that focus on the retail environment for tobacco are needed to make tobacco less attractive and more costly everywhere, including rural areas.

Are California’s Local Flavored Tobacco Sales Restrictions Effective in Reducing the Retail Availability of Flavored Tobacco Products? A Multicomponent Evaluation

“…To do this, we linked data for jurisdictions with local flavor ordinances through January 2019 to population estimates for localities and unincorporated counties obtained from the California Department of Finance, which were derived from the American Community Survey (ACS) 2013–2017 ( United States Census Bureau 2018 ). Rural jurisdictions were defined as those situated in counties classified by local health departments as rural ( Henriksen et al 2020 ). We calculated the proportion of the population covered by a local flavor ordinance for each category as the sum of the population for the category living in a jurisdiction with an ordinance, divided by the total statewide population for that category.…”

Trends and determinants of tobacco use initiation in India: analysis of two rounds of the Global Adult Tobacco Survey

“…As discussed earlier, rural areas have more access to local tobacco products that bypass the legal restrictions, promoting easy access at earlier ages 41. Another geospatial analysis from the USA depicted that more tobacco products are available at a unit cost in rural areas compared with urban settlements as the industry targets disadvantaged populations for their sales 42. Prioritising the strengthening of retail-focused tobacco control measures could counter easy accessibility, even in rural areas.…”

“…41 Another geospatial analysis from the USA depicted that more tobacco products are available at a unit cost in rural areas compared with urban settlements as the industry targets disadvantaged populations for their sales. 42 Prioritising the strengthening of retail-focused tobacco control measures could counter easy accessibility, even in rural areas. Regional differences play a role too, with the northern and northeastern regions showing earlier initiation.…”

Smoking and the widening inequality in life expectancy between metropolitan and nonmetropolitan areas of the United States

“…States that have not adopted these laws also tend to be concentrated in the South and hold a disproportionate share of the rural population ( 39 ). Similarly, tobacco retailer density and tobacco marketing has become more concentrated in rural parts of the country ( 54 , 55 ). States with large rural populations can implement policies that would restrict retail tobacco growth, which would likely have the effect of decreasing nonmetropolitan smoking rates at the national level.…”