The Impact of the CVS Removal of Tobacco Products on Cigarette Consumption and Smoking Cessation

Tobacco smoking remains the leading preventable cause of death in the United States. An estimated 1 in 7, or more than 35 million, U.S. adults are current cigarette smokers; however, nearly 7 in 10 of these smokers want to quit smoking. Eliminating the sale of tobacco products in the same places where tobacco users seek and purchase cessation medications and products could help support quit attempts and facilitate sustained cessation among these smokers. In September 2014, CVS Health stopped selling tobacco products in its more than 7800 retail stores in 47 states. As of 2017, CVS Health is the only top five retail pharmacy chain in the U.S. to not sell tobacco products. The Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health (OSH) examined the impact of the removal of tobacco products from CVS Health retail stores on frequency of smoking and smoking cessation among U.S. adult cigarette smokers.

For this analysis, we linked the 2012-2016 CVS Health retail location data with data on adult smoking behaviors from the Behavioral Risk Factor Surveillance System (BRFSS), an annual, telephone-based survey of U.S. adults aged 18 years of age and older. We computed a density measure for each county by dividing the number of CVS Health retailers by county population size. A difference-in-differences (DID) approach was used to compare quit attempts and frequency of cigarette smoking (daily vs. some days) between smokers living in counties that fell in the second to fourth quartiles of the CVS Health density measure versus those living in counties with no access to CVS Health retailers (i.e. first quartile of the density measure) before and after September 3^rd, 2014, when CVS implemented its tobacco-free policy.

In the DID regression analyses, we controlled for individual sex, age, education, race/ethnicity, marital status, employment status, annual household income, body mass index, and general health status. The analyses also were adjusted for state-level confounding factors, including per-capita appropriations for tobacco control programs, cigarette excise taxes, state fixed effects, and comprehensive smoke free-air policies that prohibit smoking in all indoor areas of worksites, restaurants, and bars.

The findings suggest that following the implementation of CVS Health’s decision to stop selling tobacco products, the probability of making a quit attempt increased by 1.1 percentage points among adult cigarette smokers who lived in the top 25% of counties with the highest density of CVS Health retailers compared to smokers living in counties with no CVS retailers. This effect was more pronounced among cigarette smokers aged ≥45 years (1.5 percentage points), and cigarette smokers aged ≥65 years (3.0 percentage points). There were no significant effects on frequency of cigarette smoking.

These findings suggest that prohibiting tobacco sales in retail pharmacies could help promote cessation among U.S. adult smokers. Further evaluation research on the relationship between individual smoking behaviors and tobacco product sales restrictions in pharmacies is important to help inform tobacco control policy, planning, and practice.