# 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.

## Key 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.