States or municipalities can limit where tobacco products are sold, proximity of tobacco retailers to each other, and to homes and schools via zoning regulations, retailer licensing laws, and other regulations (e.g., bans on sales). Licensing laws restrict which businesses can sell tobacco products; zoning regulations prohibit sale of tobacco products in designated zones (e.g., near youth-oriented facilities such as schools, parks, or playgrounds)1. Municipalities may also ban the sale of tobacco products in pharmacies and educational institutions2. Laws can be enacted individually or as part of broader land use and development plans3.
Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.
Expected Beneficial Outcomes (Rated)
Reduced youth smoking
Other Potential Beneficial Outcomes
Reduced tobacco use
Evidence of Effectiveness
Limiting tobacco retail outlets around homes and schools is a suggested strategy to reduce smoking, especially among youth1, 2, 4, 5, 6, 7, 8. Higher tobacco retail outlet density is associated with greater levels of youth experimentation with tobacco9, 10, youth smoking5, 6, 7, 10, 11, 12, and adult smoking6, 13, even when controlling for neighborhood factors such as land use, racial composition, and poverty14. However, additional evidence is needed to confirm effects2, 15.
Studies of regulations in Massachusetts, California, and New York City suggest banning tobacco sales in pharmacies can decrease tobacco retailer density2, 16, 17. Licensing restrictions2, 18 and other regulations2 that set minimum allowable distances between retailers and schools or ban sales near schools may also reduce tobacco retailer density8. Zoning restrictions appear to prevent new retailers from locating in designated areas but are not likely to alter existing tobacco retailer density2. Additional research is needed to determine the impact of tobacco retail outlets located near youth-oriented activity spaces such as parks, urban centers, and malls on youth tobacco use4.
Tobacco retail outlet density is often highest in neighborhoods with residents with low incomes19, 20, 21, 22, 23, 24, neighborhoods with primarily minority residents25, 26, particularly black22, 27, 28 or Hispanic residents23, 28, and high poverty, urban areas29. An evaluation of New York City’s tobacco-free pharmacy law suggests that such legislation can reduce overall tobacco retailer density; however, neighborhoods that benefit the most generally have residents with higher incomes, greater levels of education, or a larger amount of non-Hispanic white residents17. Experts suggest additional restrictions are needed alongside tobacco-free pharmacy laws to reduce tobacco retail outlet density17. A Los Angeles-based study suggests that total crime rates, especially property and violent crimes, increase as tobacco outlet density increases30.
Adults who are attempting to quit smoking and live near tobacco retail outlets appear less likely to quit smoking than adults who live farther from such outlets31.
Retailers that sell Electronic Nicotine Delivery System (ENDS) devices (e.g., e-cigarettes or e-cigs, mods, mod-pods, JUUL, etc.), commonly known as vape shops32, 33, are densely distributed and often closer to schools in school districts with larger numbers of Asian and black residents34.
Impact on Disparities
As of 2021, there are 246 municipalities, primarily in Massachusetts and California, with tobacco-free pharmacy laws in place35. CVS Health voluntarily stopped selling tobacco products in all municipalities in 201416, 36. Effective January 1, 2019, New York City prohibited tobacco sales in pharmacies37.
In California, nearly 60 municipalities adopted local tobacco zoning or conditional use permits (CUP) ordinances to supplement state laws. These ordinances can prohibit tobacco sales within a certain distance from schools, prohibit tobacco retailers from being within a specified distance from other tobacco retailers, and limit the number of tobacco retailers in a community38.
San Francisco and Philadelphia are two examples of cities with tobacco retailer density caps. San Francisco set a cap of 45 tobacco retailer licenses per district in 201539 and Philadelphia set a density cap and banned tobacco retailers from locating within 500 feet of local schools, effective in early 201740. As of 2014, most US states have taken some form of action to reduce tobacco retailer density41.
CTFK-TFR - Campaign for Tobacco-Free Kids (CTFK), Tobacco Free Retailers (TFR). You can shop tobacco-free: find stores that don't sell tobacco products.
PHTPC-TRL - Public Health and Tobacco Policy Center (PHTPC). Tobacco retail licensing (TRL): Promoting health through local sales regulations. Boston: Public Health Advocacy Institute, Northeastern University School of Law; 2018.
PHLC-Tobacco zoning - Tobacco Control Legal Consortium (TCLC). Land use/zoning. Saint Paul: Public Health Law Center (PHLC).
CPHSS TCLC-Brossart 2014 - Brossart L, Moreland-Russell S, Walsh H, et al. Policy strategies: A tobacco control guide. St. Louis: Center for Public Health Systems Science (CPHSS), George Warren Brown School of Social Work, Washington University, Tobacco Control Legal Consortium (TCLC); 2014.
ANRF-Tobacco-free pharmacies - American Nonsmokers’ Rights Foundation (ANRF). Colleges, hospitals, housing, & more: Municipalities with tobacco-free pharmacy laws. 2018.
CounterTobacco-Licensing and zoning - CounterTobacco.org. Licensing and zoning. University of North Carolina.
* Journal subscription may be required for access.
1 PHLC-Licensing and zoning - Tobacco Control Legal Consortium (TCLC). Using licensing and zoning to regulate tobacco retailers: Tips and tools. Saint Paul: Public Health Law Center (PHLC). 2016.
2 Ackerman 2017 - Ackerman A, Etow A, Bartel S, Ribisl KM. Reducing the density and number of tobacco retailers: Policy solutions and legal issues. Nicotine & Tobacco Research. 2017;19(2):133-140.
3 TCN 2012 - Tobacco Control Network (TCN). Executive summary: 2012 Policy platform on tobacco prevention and control. Atlanta: Tobacco Technical Assistance Consortium (TTAC); 2012.
4 Marsh 2021 - Marsh L, Vaneckova P, Robertson L, et al. Association between density and proximity of tobacco retail outlets with smoking: A systematic review of youth studies. Health and Place. 2021;67(March 2020):102275.
5 Finan 2019 - Finan LJ, Lipperman-Kreda S, Abadi M, et al. Tobacco outlet density and adolescents’ cigarette smoking: A meta-analysis. Tobacco Control. 2019;28(1):27-33.
6 AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514-63.
7 Gwon 2017* - Gwon SH, DeGuzman PB, Kulbok PA, Jeong S. Density and proximity of licensed tobacco retailers and adolescent smoking: A narrative review. The Journal of School Nursing. 2017;33(1):18-29.
8 Myers 2015* - Myers AE, Hall MG, Isgett LF, Ribisl KM. A comparison of three policy approaches for tobacco retailer reduction. Preventive Medicine. 2015;74:67-73.
9 Schleicher 2016* - Schleicher NC, Johnson TO, Fortmann SP, Henriksen L. Tobacco outlet density near home and school: Associations with smoking and norms among US teens. Preventive Medicine. 2016;91:287-293.
10 Adams 2013 - Adams ML, Jason LA, Pokorny S, Hunt Y. Exploration of the link between tobacco retailers in school neighborhoods and student smoking. Journal of School Health. 2013;83(2):112-118.
11 Lipperman-Kreda 2016* - Lipperman-Kreda S, Grube JW, Friend KB, Mair C. Tobacco outlet density, retailer cigarette sales without ID checks and enforcement of underage tobacco laws: Associations with youths’ cigarette smoking and beliefs. Addiction. 2016;111(3):525-532.
12 Lipperman-Kreda 2014* - Lipperman-Kreda S, Mair C, Grube JW et al. Density and proximity of tobacco outlets to homes and schools: Relations with youth cigarette smoking. Prevention Science. 2014;15(5):738-744.
13 Cantrell 2016* - Cantrell J, Pearson JL, Anesetti-Rothermel A, Xiao H, Kirchner TR, Vallone D. Tobacco retail outlet density and young adult tobacco initiation. Nicotine & Tobacco Research. 2016;18(2):130-137.
14 Novak 2006 - Novak SP, Reardon SF, Raudenbush SW, Buka SL. Retail tobacco outlet density and youth cigarette smoking: A propensity-modeling approach. American Journal of Public Health. 2006;96(4):670-6.
15 Nuyts 2021 - Nuyts PAW, Davies LEM, Kunst AE, Kuipers MAG. The association between tobacco outlet density and smoking among young people: A systematic methodological review. Nicotine and Tobacco Research. 2021;23(2):239-248.
16 Jin 2016* - Jin Y, Lu B, Klein EG, et al. Tobacco-free pharmacy laws and trends in tobacco retailer density in California and Massachusetts. American Journal of Public Health. 2016;106(4):679-685.
17 Giovenco 2019 - Giovenco DP, Spillane TE, Mauro CM, Hernández D. Evaluating the impact and equity of a tobacco-free pharmacy law on retailer density in New York City neighbourhoods. Tobacco Control. 2019;28(5):548-554.
18 Coxe 2014* - Coxe N, Webber W, Burkhart J, et al. Use of tobacco retail permitting to reduce youth access and exposure to tobacco in Santa Clara County, California. Preventive Medicine. 2014;67(Suppl 1):S46-S50.
19 Fakunle 2019 - Fakunle DO, Thorpe RJ, Furr-Holden CDM, Curriero FC, Leaf PJ. Does tobacco outlet inequality extend to high-white mid-Atlantic jurisdictions? A study of socioeconomic status and density. Journal of Racial and Ethnic Health Disparities. 2019;6(2):409-418.
20 Galiatsatos 2018 - Galiatsatos P, Kineza C, Hwang S, et al. Neighbourhood characteristics and health outcomes: Evaluating the association between socioeconomic status, tobacco store density and health outcomes in Baltimore City. Tobacco Control. 2018;27(e1):E19-E24.
21 Frick 2013* - Frick M, Castro MC. Tobacco retail clustering around schools in New York City: Examining “place” and “space.” Health & Place. 2013;19(1):15-24.
22 Ribisl 2017* - Ribisl KM, Luke DA, Bohannon DL, Sorg AA, Moreland-Russell S. Reducing disparities in tobacco retailer density by banning tobacco product sales near schools. Nicotine & Tobacco Research. 2017;19(2):239-244.
23 D’Angelo 2016* - D’Angelo H, Ammerman A, Gordon-Larsen P, et al. Sociodemographic disparities in proximity of schools to tobacco outlets and fast-food restaurants. American Journal of Public Health. 2016;106(9):1556-1562.
24 Fakunle 2016* - Fakunle DO, Milam AJ, Furr-Holden CD, et al. The inequitable distribution of tobacco outlet density: The role of income in two Black Mid-Atlantic geopolitical areas. Public Health. 2016;136:35-40.
25 Peterson 2011* - Peterson NA, Yu D, Morton CM, et al. Tobacco outlet density and demographics at the tract level of analysis in New Jersey: A statewide analysis. Drugs: Education, Prevention, and Policy. 2011;18(1):47-52.
26 Siahpush 2010* - Siahpush M, Jones PR, Singh GK, Timsina LR, Martin J. Association of availability of tobacco products with socio-economic and racial/ethnic characteristics of neighbourhoods. Public Health. 2010;124(9):525-9.
27 Lee 2017e - Lee JGL, Sun DL, Schleicher NM, et al. Inequalities in tobacco outlet density by race, ethnicity and socioeconomic status, 2012, USA: Results from the ASPiRE Study. Journal of Epidemiology and Community Health. 2017;71(5):487-492.
28 Loomis 2013* - Loomis BR, Kim AE, Goetz JL, Juster HR. Density of tobacco retailers and its association with sociodemographic characteristics of communities across New York. Public Health. 2013;127(4):333-338.
29 Davis 2015a* - Davis B, Grier S. A tale of two urbanicities: Adolescent alcohol and cigarette consumption in high and low-poverty urban neighborhoods. Journal of Business Research. 2015;68(10):2109-2116.
30 Subica 2018 - Subica AM, Douglas JA, Kepple NJ, Villanueva S, Grills CT. The geography of crime and violence surrounding tobacco shops, medical marijuana dispensaries, and off-sale alcohol outlets in a large, urban low-income community of color. Preventive Medicine. 2018;108(July 2017):8-16.
31 Reitzel 2011 - Reitzel LR, Cromley EK, Li Y, et al. The effect of tobacco outlet density and proximity on smoking cessation. American Journal of Public Health. 2011;101(2):315-20.
32 US FDA-Vape shops - US Food and Drug Administration (US FDA). Center for Tobacco Products. The “Deeming Rule:” Vape shops. 2016.
33 CDC-E-cig dictionary - Centers for Disease Control and Prevention (CDC). E-cigarette, or vaping, products visual dictionary.
34 Venugopal 2020 - Venugopal PD, Morse AL, Tworek C, Chang HW. Socioeconomic disparities in vape shop density and proximity to public schools in the conterminous United States, 2018. Health Promotion Practice. 2020;21(1_suppl):9S-17S.
35 ANRF-Tobacco-free pharmacies - American Nonsmokers’ Rights Foundation (ANRF). Colleges, hospitals, housing, & more: Municipalities with tobacco-free pharmacy laws. 2018.
36 CVS-Tobacco-free - CVS Health. Be the first tobacco-free generation.
37 Truth Initiative-Retailers - Truth Initiative. How some local governments are keeping the number of tobacco retailers in check. 2017.
38 CDPH-CTCP 2017 - California Department of Public Health (CDPH). California Tobacco Control (CTCP). Density of tobacco retailers fact sheet. 2017.
39 SF Tobacco-free - San Francisco Tobacco-Free. Reducing tobacco retail density in San Francisco. 2016.
40 PDPH-Tobacco retailing - City of Philadelphia, Department of Public Health (PDPH). Commissioner’s Office: Regulation relating to tobacco retailing.
41 Luke 2016 - Luke DA, Sorg AA, Combs T, et al. Tobacco retail policy landscape: A longitudinal survey of US states. Tobacco Control. 2016;25(Suppl 1):i44-i51.
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