Pharmacy stores are positioned to cultivate health and wellness among patrons. However, many U.S. pharmacies sell and advertise tobacco, the nation’s leading preventable cause of death and disease.¹ This is an established concern among pharmacists, whose professional obligation is to promote their patients’ health.^2–4

Just as pharmacists’ attitudes can shape tobacco-free practices,⁵ public attitudes toward tobacco control interventions can inform policy development, implementation, and sustainment. Previous studies have documented general public favorability toward tobacco-related sales restrictions in pharmacy stores at national and local levels, and variations in favorability by sociodemographic characteristics and cigarette smoking status.^6,7 However, increasingly more communities across the U.S. have since implemented policies that prohibit the sale of tobacco products in these settings.⁸ Moreover, the tobacco product landscape continues to diversify, and no study has assessed variations in public attitudes toward such policies by other forms of tobacco product use beyond cigarettes. Accordingly, this study assessed the prevalence and determinants of favorability toward prohibiting the sale of tobacco products in pharmacy stores among a nationally representative sample of U.S. adults in 2014.

Overall, 66.1% of U.S. adults favored (“strongly” or “somewhat”) prohibiting tobacco product sales in pharmacy stores; 20.1% “somewhat opposed” and 13.8% “strongly opposed” the idea (Table 1). Prevalence of favorability was 62.2% among men and 69.7% among women. Favorability ranged from 63.7% among adults aged 25–44 years to 72.2% among adults aged ≥65 years; from 64.6% among non-Hispanic blacks to 70.4% among non-Hispanic other races; from 61.7% among adults with less than a high school education to 70.1% among those with a college degree; from 48.0% among adults with annual household income <$15,000 to 69.0% among adults with income ≥$60,000; and from 63.9% in the South to 70.2% in the West. Favorability was 46.5% among current cigarette smokers, 66.3% among former smokers, and 71.8% among never smokers. Favorability was 47.8% among current non-cigarette tobacco users, 63.2% among former non-cigarette tobacco users, and 71.4% among never non-cigarette tobacco users.

The adjusted likelihood of favorability was greater among women than men (APR=1.08, 95% CI=1.03, 1.14) (Table 2). The likelihood of favorability was lower among those aged 25–44 years (APR=0.91, 95% CI=0.86, 0.98) and 45–64 years (APR=0.94, 95% CI=0.88, 0.99) than those aged ≥65 years; among those with annual household income <$15,000 (APR=0.82, 95% CI=0.71, 0.94) than those with income ≥$60,000; among current cigarette smokers (APR=0.73, 95% CI=0.65, 0.82) than never smokers; and among current (APR=0.80, 95% CI=0.70, 0.92) or former (APR=0.93, 95% CI=0.87, 0.99) non-cigarette tobacco users than never users.

This study reveals that two thirds of U.S. adults, including nearly half of cigarette smokers and non-cigarette tobacco users, favor prohibiting the sale of tobacco products in retail pharmacy stores. A majority of all assessed sociodemographic groups favored prohibiting tobacco sales in pharmacies, but the likelihood of favoring such a policy was lower among adults aged 25–44 years and 45–64 years, and among adults with annual income <$15,000. These findings are generally consistent with previous surveys, which indicate cigarette smokers are less likely to have favorable attitudes toward tobacco-related sales restrictions in pharmacies.^6,7 However, this study is the first to document that current users of non-cigarette tobacco products are also less likely to demonstrate favorability for such policies than never users. Non-cigarette tobacco product users are an important subgroup to consider, as tobacco-free pharmacy policies typically address the diversity of tobacco products available on the market.¹⁰

The sale of tobacco products in retail pharmacies has the potential to undermine the promotion of patient health, especially among combustible tobacco users. More than 16 million Americans currently live with a smoking-related illness,¹ and cigarette smoking can complicate chronic disease management and increase the risk of adverse drug events.^11–13 Fortunately, approximately seven in ten cigarette smokers want to quit.¹⁴ Although pharmacies can serve as a conduit for patients to obtain evidence-based cessation support and U.S. Food and Drug Administration–approved medications, the concurrent sale and advertisement of tobacco products might counteract these resources by triggering cravings, stimulating impulse purchases,¹⁵ and hindering smokers’ quit attempts.

To reduce pharmacy tobacco sales, states and communities can implement policies prohibiting tobacco product sales in this environment. As of January 1, 2016, a total of 134 municipalities in California and Massachusetts had enacted tobacco-free pharmacy laws.⁵ Implementation of comprehensive tobacco sales prohibitions, including cigarettes and other tobacco products, could help reduce access to tobacco products and exposure to tobacco product advertising, as well as denormalize tobacco use. Initiatives to discontinue tobacco sales could also positively reinforce pharmacy stores’ commitment to health care. In addition, by eliminating concurrent tobacco product sales, pharmacies may help bring public awareness to the health consequences of smoking, and provide enhanced clinical management of tobacco-related diseases.^16,17 Moreover, preliminary evaluation findings suggest such policies do not adversely affect business. For example, in 2014, CVS Caremark rebranded as CVS Health, and became the first national retail pharmacy chain to cease tobacco product sales. Following policy implementation, CVS reported increased year-over-year net revenues, with positive gains in pharmacy services.¹⁸

A majority of U.S. adults favor prohibiting tobacco sales in retail pharmacy stores. Eliminating tobacco product sales in these settings may reinforce pharmacy stores’ efforts to promote wellness, and further cultivate social climates that reduce the desirability, acceptability, and accessibility of tobacco. Prohibiting tobacco sales in pharmacies, along with the implementation of proven population-level tobacco control interventions, could help reduce tobacco-related death and disease.