A Long Walk for Cigarettes Makes Smokers More Likely to Quit, Study Finds

A commentary accompanying the study assets there's no question that targeted retail advertising makes it more likely that children will start smoking and less likely that adults will quit.

Smokers who had to walk at least a third of mile for cigarettes had an easier time quitting, according to an analysis of data from Finland published today by JAMA Internal Medicine.

The bad news? Distance from a tobacco outlet didn’t seem to make a difference in who relapsed, the authors found.

Anna Pulakka, PhD, and fellow researchers culled data from 2 studies of smokers and ex-smokers to evaluate whether living further from a source of cigarettes. A total of 20,729 men and women ages 18-75 took part in the study. Results were based on a comparison of responses from 2008-2009 and from 2012-2013 for one study, and between 2003 and 2012 for the other study.

They found that a 500 meters between the smoker’s home and the tobacco source was associated with a 16% increase in the odds of quitting in the between individual analysis, and a 57% increase in the within individual analysis, after adjusting for marital and work status.

"We found robust evidence suggesting that among Finnish adults who smoked, increase in the distance from home to a tobacco outlet increased the odds of quitting smoking," the study concludes.

Finland has strict anti-smoking policies, and the authors acknowledged that the findings may not be generalizable to other populations. But in a related commentary, authors based in the United States, Cheryl Bettigole, MD, PhD, and Thomas A. Farley, MD, MPH, said the findings add further evidence that marketing of cigarettes and the availability of retail outlets keep some from quitting.

Bettigole and Farley note that despite long-term efforts by CDC to promote the harms of smoking—as well as the master settlement agreement that called for an end to marketing to children—a 2013 study found that tobacco companies continue to spend $1 million an hour on marketing.

CDC findings have shown that the long-term decline in smoking rates is leveling off, and those who still smoke are more likely to be poor and minorities. Billboard and retail advertising in low-income areas, where children cannot help but be exposed to marketing, have been linked to higher rates of youth who start smoking.

The value of the long-term study from Finland, they write, is that it makes the case that being surrounded by tobacco advertising is inherently harmful. “We can now conclude that tobacco outlets and the heavy dose of tobacco marketing they dump into their communities cause smoking—more precisely, they inhibit quitting among smokers.”

Tobacco companies have not stopped advertising, the commentators note; they have simply fine-tuned their efforts and aimed them directly at the population most likely to smoke. “The Marlboro Man no longer rides on television and radio, but point-of-sale substitutes,” such as discounts, coupons, and other promotions.

Smoking remains the leading preventable cause of death in the United States, causing 6 million deaths per year, according to CDC. At current rates, smoking will cause 8 million deaths per year by 2030.

References

1. Pulakka A, Halonen JI, Kawachi I, et al. Association between distance from home to tobacco outlet and smoking cessation and relapse. JAMA Intern Med., August 2016 DOI: 10.1001/jamainternmed.2016.4535

2. Bettigole C, Farley TA. Retail stores and the fight against tobacco—following the money. JAMA Intern Med, August 2016 DOI: 10.1001/jamainternmed.2016.4544