Cooling down hotspots of retail tobacco products: addressing disparities in the built environment through policy.

Multiple disparities exist in the built environment for retail tobacco. Disproportionate concentrations of retail outlets result in variation in the availability of tobacco products, consumer access, and exposure to tobacco marketing. Neighborhoods with higher tobacco retail density have higher tobacco use than neighborhoods with lower density. Local policies focused on reducing tobacco retail concentration can address systematic disparities in the built environment. Using census-based synthetic populations for 30 US cities and retail tobacco location data, we simulated the disparity-reducing potential of three retail reduction policies: capping the number of available retail tobacco sales licenses, and minimum distance requirements between schools and retail locations and between retail locations themselves. Outcomes included retail concentration in density (stores/km) and proximity for residents (km to nearest retail). We investigated differences across seven demographic and structural indicators in the tobacco retail environment including social, economic, and political dimensions. All the measures for retail concentration and demographic and structural context have considerable variation within and between cities. All three policies addressed disproportionate concentrations to varying degrees. The minimum distance requirements - 600m buffers around schools or retail locations - narrowed differences in the built environment for tobacco more so than halving the number of existing retail outlets through licensing caps. Policy effectiveness is context dependent. Buffer policies, for example, can be effective if retail locations are disproportionately concentrated near schools, near one another, or in low-income or racially/ethnically minoritized neighborhoods. Policy development should be informed not only by generalizable evidence but also by local data and familiarity with communities.