For Smokers Trying to Quit, Proximity’s a Problem
Research done in Mecklenburg County shows more retail shops selling tobacco in black neighborhoods than in white areas.
By Rose Hoban
How far do you have to walk for a smoke?
It turns out that if you live in a dense, minority neighborhood in Mecklenburg County, it’s not far. And in that neighborhood, you’ll be surrounded by many stores selling tobacco products.
But if you live in a white neighborhood, it takes a lot more effort to satisfy a nicotine craving.
That proximity could make all the difference when you’re trying to quit, according to research done by UNC-Chapel Hill public health student Amanda Kong and presented at last month’s Minority Health Conference held at the Friday Center in Chapel Hill.
Kong, who worked as a tobacco-cessation counselor at a community health clinic before returning to school, said she often encountered people who were trying to quit, until they walked into a convenience store.
“I would have a lot of people that would quit, but they would come back in because a pack of their brand was on sale or they walked by a convenience store and went in,” Kong said. “So they would relapse all the time.”
It got Kong thinking about the larger environment smokers encounter, one where exhortations to light up are around many corners.
Using mapping software, Kong looked at the distances to stores in Mecklenburg County that feature tobacco products. She used census data on the race and ethnicity of Mecklenburg residents, plugged in all the addresses in the county and mapped it against data about tobacco retailers.
The results were striking: As the number of black residences in a neighborhood increases, the distance to tobacco sales gets shorter. But in white neighborhoods, the opposite was true: As the number of white residences increases, the number of tobacco retailers drops.
In addition, Kong looked at the average distance to the nearest five and the nearest 10 tobacco retailers. Same thing: Not only were there more tobacco retailers in black neighborhoods, they were, on average, closer to people’s homes than they were in white neighborhoods.
“Those in the lower-income areas are not just closer to one retailer, they’re closer to a cluster of retailers compared to the highest-income areas,” she said.
Basically, Kong found, the environment sets residents of those neighborhoods up to have higher rates of smoking.
“Our environment does impact our behaviors,” she said.
And the research backs her up. Researchers at the Johns Hopkins Bloomberg School of Public Health reviewed literature from around the world on the relationship between “point of sale” marketing by tobacco companies and smoking rates, and the association between more marketing and more smoking was indisputable.
“Targeted marketing (i.e., promoting different products in different socioeconomic areas) increases the power of POS promotion by segmenting customers into groups and tailoring advertising to appeal to them,” the Johns Hopkins team wrote.
“The tobacco industry spends over 90 percent of their advertising and marketing dollars in the retail environment,” said Allison Myers, a researcher from the UNC Gillings School of Global Public Health and the head of Counter Tobacco, an organization that examines tobacco marketing.
“It’s a lot of money,” Myers said, “about a million dollars an hour that they spend in the retail space, keeping tobacco cheap and visible.”
North Carolina’s laws regulating tobacco sales are among the looser ones in the country. According to a database compiled and maintained by the American Lung Association, North Carolina goes easy when it comes to licensing distributors, charging wholesalers only $25 per year.
And Myers pointed out that North Carolina is among a handful of states that requires no retail license to sell tobacco, even though “you need a license to sell alcohol, or cut hair, or to do nails.”
Myers said some regulations on tobacco sales could go a long way toward reducing smoking rates in the state.
“For example, prohibiting sales of tobacco in pharmacies, prohibiting sales of tobacco within 1,000 feet of schools … these could really reverse some of the disparities that you saw in Amanda’s study between proximity and density of retailers and race and ethnicity,” Myers said.
Instead, people walking into tobacco retailers confront a “power wall” of brands and discounts and marketing.
“We … know that for adults who are trying to quit, seeing power-wall displays cues an urge to smoke,” Myers said. “Many people make purchases when they do not intend to, and we see less-successful quit attempts because of what we’re seeing in the retail environment.”
But in North Carolina, municipalities are forbidden to regulate how tobacco gets sold.
“Like in Massachusetts, for example, there are more than 100 communities where you can’t sell tobacco at pharmacies. In Chicago, there have been restrictions on menthol-flavored tobacco products near schools,” Myers said.
Seeing all that tobacco can prompt someone to light up, even if they’re trying to quit.
“That’s what we see with a lot of relapse behavior,” Kong said. “Someone has quit smoking, they go to a store or they go to multiple stores and they see it again and again.
“It’s a cue to start smoking again.”