Does living near a tobacco retailer impact the efficacy of smoking cessation treatments?: Analysis from a randomized trial

TL;DR

Living near tobacco retailers may reduce the effectiveness of standard smoking cessation treatments but not acceptance-based ones.

Contribution

Shows that acceptance-based treatments are less affected by tobacco retailer proximity than standard treatments.

Findings

Tobacco retailer density did not impact the iCanQuit treatment's efficacy.

Higher retailer density was linked to lower prolonged abstinence in the QuitGuide treatment.

Acceptance-based treatments should be more widely available due to their resilience to environmental factors.

Abstract

•Tobacco retailer density had no effect on the acceptance-based iCanQuit treatment.•Retailer density lowered prolonged abstinence in USCPG-based QuitGuide treatment.•Acceptance-based cessation treatments should be made more available.

Tobacco retailer density had no effect on the acceptance-based iCanQuit treatment.

Retailer density lowered prolonged abstinence in USCPG-based QuitGuide treatment.

Acceptance-based cessation treatments should be made more available.

Whether living near a tobacco retailer impacts the efficacy of smoking cessation treatments remains largely unknown. We used data from a randomized trial comparing two smoking cessation apps among 2415 adults: iCanQuit, based on Acceptance and Commitment Therapy, and QuitGuide, based on standard U.S. Clinical Practice Guidelines. We examined whether tobacco retailer density impacted the efficacy of the treatments on 12-month cessation outcomes.

Data on tobacco retailer density per 1,000 people (i.e., “one unit”) was linked to each participant’s residential ZIP Code. Cessation outcomes included 30-day point prevalence abstinence (PPA) from cigarette smoking, prolonged abstinence, 30-day PPA from nicotine/tobacco products, and relapse. We examined the interaction between density and treatment arm on 12-month 30-day PPA and compared cessation outcomes separately by arm.

The interaction between density and treatment arm on cessation did not reach statistical significance (P = 0.09). For each one-unit increase in density, there was no change in quit rates in the iCanQuit arm (P = 0.62). In the QuitGuide arm, higher density was associated with lower quit rates (OR = 0.54; 95 % CI, 0.27–1.06; P = 0.07), although not-statistically significant. There was a significant interaction between density and treatment arm on prolonged cigarette abstinence (P = 0.03). We found no change in prolonged abstinence in the iCanQuit arm (P = 0.44). In the QuitGuide arm, higher density was associated with lower prolonged abstinence (OR = 0.27; 95 % CI, 0.07–1.02; P = 0.054), although not-statistically significant. Conclusions: Living near tobacco retailers may undermine the effectiveness of standard behavioral treatment but appears to have no impact on the effectiveness of acceptance-based smoking cessation treatments.