Poor Neonatal Health Outcomes and Increases in Corporate Tobacco Sales Policies by CVS and Dollar Store Chains

Authors: Jaclyn Hall*, University of Florida, Hee Deok Cho, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Mildred M. Maldonado-Molina, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Lindsay A. Thompson, Department of Pediatrics, College of Medicine, University of Florida, Elizabeth A. Shenkman, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Ramzi G. Salloum, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
Topics: Medical and Health Geography
Keywords: Medical geography, child, health, retailer, tobacco
Session Type: Paper
Day: 4/3/2019
Start / End Time: 12:40 PM / 2:20 PM
Room: Tyler, Marriott, Mezzanine Level
Presentation File: No File Uploaded


Preterm birth (PTB) and low-weight births (LBW) are among the leading causes of infant mortality and morbidity. Rates of both have recently been rising after a decade of decline. Disparities in PTB and LBW have persisted among vulnerable populations, including higher rates for women of higher social vulnerability. Smoking during pregnancy (SDP) contributes to PTB and LBW births. In the US tobacco retail density (TRD) significantly increased in 2013 after, the two largest dollar-store chains (DS) began selling tobacco; TRD decreased in 2014 when CVS, the largest pharmacy chain, discontinued tobacco sales. However, these changes are not distributed equally among neighborhoods of high and low social vulnerability (SVI).We determined the most appropriate method to calculate TRD at the census tract for birth outcomes studies. We then examined the relationship between changes in TRD and changes in PTB and LBW (birth counts obtained from FL state health department) before and after the corporate policy changes in census tracts with high and low SVI. For low SVI areas, TRD increase is associated with a PTB and LBW change of 2.6% and 6.2% in the two years since policy change. For high SVI areas, TRD increase is significantly associated with a PTB and LBW change of 3.0% and 4.5% in the two years since policy change (ANOVA, p= <.001). TRD increase at the census tract, which occurred between 2012 and 2014 due to corporate policy decisions, is associated with a concerning increase in poor birth outcomes regardless of neighborhood social vulnerability.

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