In a statement released on March 4, 2019, the FDA announced new actions taken by the agency to warn Walgreens and 15 other corporate-owned chains and franchise stores, including Walmart, with violation rates greater than 15%. Since then, we have seen several chains announce actions they plan to take to reduce youth access to tobacco:

  • Walgreens – In an announcement on April 23, 2019, Walgreens Boots Alliance announced it would raise the age of purchase for tobacco products in Walgreens stores nationwide to 21, effective September 1, 2019. While this is a positive step forward, it is not enough. As a pharmacy and a company that claims to be “at the corner of happy and healthy,” Walgreens should not also be selling the only legal product that, when used as intended, kills half its users and is the leading cause of preventable death and disease in the country. Since its rival CVS ended all tobacco sales in 2014, public health groups have been calling on Walgreens to do the same. Its shareholders have called on them to do the same, and their customers would support the move. Still, they have so far only piloted an end to tobacco sales in 17 stores in Gainesville, FL. Their move to raise the age to 21, while seemingly progressive at face-value, came only after being put “on notice” by the FDA for having the highest violation rate (22%) of any pharmacy chain in the country. As of today, 13 states and over 450 localities have passed Tobacco 21 laws, and there are currently several proposals to raise the age to 21 federally. Given that context, Walgreens’ corporate policy move made earlier than required is not so bold, but rather a smart PR move for the company.
  • Rite-Aid: On the same day as Walgreens, Rite-Aid made a similar move and announced they were also raising the age to buy tobacco in their stores to 21, effective 90 days from the announcement (It should be noted that Walgreens recently purchased 1,651 Rite Aid stores nationally.) They also announced that they would stop selling e-cigarettes in their stores. Unless and until e-cigarettes are approved by the FDA as a cessation aid, they along with all other tobacco products should not be sold in pharmacies. However, while they are not safe particularly for youth, young adults, pregnant women, or adults who do not currently use tobacco products, e-cigarette are generally recognized as being safer than cigarettes (though that is a very low bar) and according to the CDC, “have the potential to benefit adult smokers who are not pregnant if used a complete substitute for regular cigarettes and other smoked tobacco products.” Rite-Aid’s decision to stop selling e-cigarettes while continuing to sell more harmful tobacco products like cigarettes and cigars makes no sense, health-wise.
  • Walmart: On May 8, 2019, Walmart announced that they, too, were raising the age to buy tobacco in their stores to 21 starting July 1, 2019. They also announced that they would stop selling “fruit and dessert-flavored” e-cigarettes. This action also came in response to FDA’s request for action and threat of fines for Walmart’s 17% violation rate. Flavors are a large part of the appeal of e-cigarettes for youth, and removing some youth appealing products from their stores is a good step, though a better step would be to remove all flavors other than tobacco. Even better? Remove all flavored tobacco products. And what would be best? Remove all tobacco products. Walmart, like Walgreens and Rite-Aid, has a pharmacy, and continuing to sell tobacco products sends a mixed message to customers about health. Pharmacists and the public overwhelmingly agree that tobacco has no place in pharmacies and support policies to prohibit the sale of tobacco in pharmacies. Some state and local governments have made that a reality: 21 locations in California, 6 locations in New York, and 187 locations in Massachusetts–as well as the state of Massachusetts–all have passed policies that prohibit the sale of tobacco in any pharmacy. Learn more about tobacco-free pharmacy policies here.

It is important to acknowledge Walgreens, Rite-Aid, and Walmart for the steps they are taking to reduce youth access to tobacco products in their stores. Within states, cities, and counties that have not yet raised the minimum legal sales age to 21, these changes could start to make a difference. In 2014 when CVS announced its decision to stop selling tobacco products, becoming the first retail pharmacy chain in the U.S. to take such action, it made an impact. Following the chain’s removal of tobacco products from its stores, total cigarette purchases in states where CVS holds significant market share declined by 1%, and smokers who had previously purchased their cigarettes exclusively at CVS were up to twice as likely to stop buying cigarettes entirely.[Polinkski et al, 2017]. However, single corporations do not operate in a vacuum. In a move in the opposite direction, Family Dollar and Dollar General started selling tobacco in late 2012 and early 2013, which increased tobacco retailer density in some regions, even after CVS ended sales.[Hall et al, 2019] A recent study conducted in six southeastern states found that this resulting increase in retailer density impeded progress in smoking reduction. [Hall et al, 2019] This points to the need for local action to limit access to tobacco in other ways, such as by requiring a license to sell tobacco and setting a cap on the total number of tobacco retailer licenses allowed in a jurisdiction.

Walmart, Walgreens, and Rite-Aid are not the only retail chains with high violation rates. The FDA found the following violation rates amongst all corporate-owned or franchised store inspections since the FDA’s retailer compliance check program began in 2010:

  • Marathon, Exxon, Sunoco, BP, Citgo, and Mobil stores: 35-44%
  • Shell, Chevron, Casey’s General Stores, and 7-Eleven: 25-34%
  • Family Dollar, Kroger, Circle K, Walmart, and Walgreens: 15-24%

The most egregious violators, while not pharmacies, have not yet publicly announced any steps to reduce those rates. Federal, state, and local governments can and should ensure that they are complying with the law.

While voluntary corporate action is welcome, governmental policy can have a bigger impact and a much bigger reach. State and local governments do not need to wait for corporations to do the right thing—nor should they.

The FDA stated that, “Ignoring the law and then paying associated fines and penalties should not simply be viewed as a cost of doing business.” We agree, and we know that tobacco retailer licensing systems, particularly at the local level, allow better monitoring of retailer compliance and allow for a wider range of penalties, including having a retailer’s license to sell tobacco products suspended or revoked for repeated violations.

Let’s keep the pressure on corporations to do more AND let’s keep the pressure on federal, state, and local government to take steps to make these and more comprehensive tobacco control policies a reality across all communities and for all retailers.

 

Walgreens Image credit: http://fortune.com/fortune500/walgreens-boots-alliance/