Identifying rural tobacco point of sale interventions: Analyzing a census of Vermont's tobacco retailers

background:Residents of U.S. rural areas are more likely to smoke, use smokeless tobacco, smoke while pregnant, and be heavy smokers than urban dwellers. While tobacco prevention groups are prioritizing point of sale interventions, progress has focused in urban population centers. There is little evidence regarding effective rural point of sale interventions.

methods: The Vermont Department of Health conducted a census of Vermont’s tobacco retail outlets between October and December 2014. Community prevention groups used a modified Standardized Tobacco Assessment for Retail Settings and the Counter Tools online interface. We used the 2010 Decennial Census and American Community Survey 5-year 2012 data set at the census tract level to define urban clusters and urbanized areas. Using a “percent urban” value, store characteristics were compared between areas that were at most 68% urban to areas that were greater than 68% urban.

results: Auditors completed 981 audits, and 945 (96%) could be assigned a percent urban value. 68% of stores were in rural and 32% in urban jurisdictions. Rural stores were more likely to have price promotions. 46% of rural stores (n=549) had cigarette price promotions as compared to 41% of stores located in urban jurisdictions (n = 246). Menthol price promotions were also disparate: 34% of rural stores (n = 541) had menthol price promotions compared to 26% of stores (n = 246) in urban jurisdictions.

conclusions: The rural tobacco retail landscape differs significantly from urban jurisdictions. Pricing strategies may be more effective than other point of sale interventions in reducing rural tobacco disparities.