Centers for Disease Control and Prevention, Office on Smoking and Health 

Summary of Scientific Evidence: 

Tobacco Retail Density, Location, and Licensure 

April 2021 

This information is provided for educational purposes. It is not provided for or against any specific 

legislative proposal; is not intended to be used as testimony; and is not intended to act as an 

endorsement or appearance of endorsement of any specific entity or proposal. 

The Public Health Burden of Tobacco Use 

• The burden of disease and death from tobacco use in the United States is overwhelmingly caused

by cigarettes and other combustible tobacco products.1

o Every year in the United States, approximately 480,0000 deaths and over $300 billion in

healthcare spending and productivity losses are attributable to cigarette smoking.2,3

o For every person who dies from smoking in the United States, at least 30 people live with

a serious smoking-related illness.4

o Worldwide, tobacco use and secondhand smoke exposure causes over eight million

deaths per year.5

o Cigarette smoking causes diseases of almost every organ of the human body, including

cancer, heart disease, stroke, diabetes, and chronic obstructive pulmonary disease

(COPD).6

o Smoking causes cancer of the lung, esophagus, larynx, mouth, throat, kidney, bladder,

liver, pancreas, stomach, cervix, colon, and rectum.7,8,9

o Even occasional or intermittent cigarette smoking still causes considerable harm.10

o Occasional or intermittent smoking is associated with increased risk for cardiovascular

disease, lung and other cancers, and lower respiratory tract infections.11,12

• No tobacco product is harmless.

o Smokeless tobacco use causes cancer of the mouth, esophagus, and pancreas; is

associated with diseases of the mouth; and may increase the risk for death from heart

disease and stroke.13,14,15

o Additional research is needed regarding the health effects of e-cigarettes and other

emerging tobacco products, such as heated tobacco products. However, the current

evidence shows that the e-cigarette aerosol that users breathe from the device and exhale

can contain harmful and potentially harmful substances, including heavy metals like lead,

volatile organic compounds, and cancer-causing agents.16

o Moreover, studies of emissions from heated tobacco products suggest that the products

expose both users and bystanders to some of the same chemicals found in cigarette

smoke, although at lower levels than cigarette smoke.17

• Nicotine is a highly addictive drug found in tobacco products.18

o As with drugs such as cocaine and heroin, nicotine activates the brain’s reward circuits

and reinforces repeated nicotine exposure.19

o Nicotine also increases the risk of cardiovascular, respiratory, and gastrointestinal

disorders, decreases immune response, negatively impacts reproductive health, and has

acute toxicity at high-enough doses.20,21 Nicotine also activates multiple biological

pathways through which smoking increases risk for disease development.22

• Nicotine is a health danger for pregnant women and their developing babies.23

• Youth and young adults are especially vulnerable to the harmful effects of nicotine.24,25
 

 

 

 

 

 

 

 

 

 

 

o Nicotine exposure can harm the developing adolescent brain, which continues to develop 

into the mid-20s. Specifically, using nicotine in adolescence can harm the prefrontal 

cortex, or the part of the brain that controls attention, learning, mood, and impulse 

control.26 

o Each time a new memory is created or a new skill is learned, stronger connections – or 

synapses – are built between brain cells. Young people’s brains build synapses faster than 

adult brains. Nicotine changes the way these synapses are formed.27 

o Using nicotine in adolescence may also increase risk for future addiction to other drugs.28 

Who Uses Tobacco Products 

• Smoking remains a considerable problem among adults and youth. 

o Globally, 1.1 billion adults smoke cigarettes.29 In 2019, 14.0% (34.1 million) of U.S. 

adults currently smoked cigarettes.30 

o Since 2011, the United States has seen declines in youth use of combustible tobacco 

products.31,32 In 2020, however, 1.6% of middle school students and 4.6% of high 

school students reported current (past 30 day) use of cigarettes and 1.5% of middle 

school students and 5.0% of high school students reported current use of cigars.33,34 

o Nearly 9 out of 10 adults who smoke cigarettes daily first tried smoking by age 18,35 

and each day in the United States, 1,600 youth under age 18 try their first cigarette.36 

• Although considerable progress has been made in reducing cigarette smoking among U.S. 

adults and youth,37 the tobacco product landscape continues to evolve to include a variety of 

tobacco products, including smoked, smokeless, and electronic products, such as ecigarettes.38 

o In 2020, 19.6% of U.S. high school students and 4.7% of U.S. middle school students 

– a total of 3.6 million youth – reported using e-cigarettes in the past 30 days.39 

o E-cigarettes have been the most commonly used tobacco product among U.S. youth 

since 2014; thus, in recent years, patterns of e-cigarette use have driven patterns of 

overall tobacco product use among U.S. youth.40 

• Tobacco product use varies among different population groups, including among groups with 

different socioeconomic status. 

o Adults with lower socioeconomic status, such as lower levels of education and income, 

have higher prevalence of cigarette smoking compared to those with higher levels of 

education and income,41 and having a lower socioeconomic status is associated with 

higher prevalence of youth tobacco use.42 

o Tobacco product use also impacts population groups differently. For example, people 

with lower socioeconomic status are just as likely to make quit attempts, but are less 

likely to successfully quit smoking cigarettes than those with a higher socioeconomic 

status.43 

• Tobacco product use also varies among different racial and ethnic groups. 

o For example, higher proportions of non-Hispanic American Indian/Alaska Native adults 

smoke cigarettes or use smokeless tobacco products, and a higher proportion of African 

American adults smoke cigars, as compared to different racial and ethnic groups.44,45 

o The proportion of African American adults who smoke is similar to the proportion of 

White adults who smoke, but African Americans are less successful at quitting, possibly 

because of lower utilization of cessation treatments, higher prevalence of use of menthol 

products that may increase nicotine dependence, and predatory marketing by the tobacco 

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industry.46,47,48 African Americans are more likely to die from smoking-related diseases 

than Whites.49,50 

Tobacco Retailers in the United States 

• There are approximately 375,000 tobacco retailers in the United States; to provide context, this 

means that for every one McDonald’s restaurant, there are 27 tobacco retailers in the United 

States.51 

o Based on these estimates, there are 1.5 tobacco retailers per 1,000 residents, and 6.9 

retailers per 1,000 school-aged youth (i.e. between ages 5 and 17) in the contiguous 

United States.52 

o To compare these numbers with other types of retailers, for every 10,000 residents in 

California, there are approximately 14 liquor stores and 96 tobacco retailers.53 In other 

words, there are 1.4 liquor stores and 9.6 tobacco retailers per 1,000 residents in 

California.54 

o Cigarettes are sold in convenience stores more than any other type of store, and in 2018, 

more than half of current (past 30-day) youth who use tobacco products reported buying 

tobacco products as gas stations/convenience stores.55,56 

o While less information is available about the number of retailers that only sell 

e-cigarettes, a 2016 regulatory analysis estimated that there are an additional 5,000-

10,000 selling only e-cigarettes.57 

• Tobacco retailers are also heavily concentrated in certain areas, especially areas with high 

population density.58 

o Approximately 70 percent of tobacco retailers are located within 1,000 feet of one 

another, or less than 2 blocks apart.59 

o A 2019 study across 30 U.S. cities found that, on average, 63% of public schools were 

located within 1,000 feet of a tobacco retailer, the lowest-income neighborhoods had 

nearly five times more tobacco retailers than the highest-income neighborhoods, and 70% 

of residents across the 30 cities lived within a half mile of a tobacco retailer.60 

o A systematic review found that, like tobacco retailers in general, many e-cigarette 

retailers are located within a quarter mile of schools.61 

The Impact of Tobacco Retail Density and Location 

• Variations in tobacco retailer concentration in certain communities may contribute to disparities 

in tobacco use.62,63,64,65 ,66 

o For instance, research demonstrates that tobacco retailer density is greater in areas with 

higher proportions of households receiving public assistance, as well as counties with a 

higher proportion of African American residents, same-sex couples, and rural 

residents.67,68 

o The U.S. Surgeon General and others have found that proximity to tobacco retail outlets 

and higher retail density is associated with increased tobacco product consumption, 

decreased quit attempts among adults who smoke cigarettes and want to quit, and with 

higher youth initiation of tobacco product use.69,70,71,72 

• In 2012, the Surgeon General found that, “neighborhoods that are more densely populated with 

stores selling tobacco may promote adolescent smoking, not only by increasing access, but also 

by increasing environmental cues to smoke.”73 

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o Studies have found that youth living in areas with the highest density of retail tobacco 

outlets are more likely to have smoked cigarettes in the past month than those in areas of 

the lowest density of outlets.74 

o Moreover, the number of tobacco retailers surrounding a school has also been shown to 

increase students’ susceptibility to future smoking, as well as the likelihood that youth 

would purchase their own cigarettes.75,76 Other studies have found that tobacco retail 

outlets located near schools with higher cigarette smoking prevalence had significantly 

lower cigarette prices, fewer government-sponsored health warnings, and more in-store 

tobacco promotions relative to those located near schools with lower cigarette smoking 

prevalence.77 

o In Chicago, youth in areas with the highest density of retail tobacco outlets were 13 

percent more likely to have smoked cigarettes in the past month than those living in areas 

with the lowest density of outlets.78 

o Moreover, a California study found that prevalence of cigarette smoking was 3.2 

percentage points higher among students in schools with highest density of surrounding 

tobacco retailers compared with students in schools without any tobacco retail outlets.79 

o These findings are not limited to cigarettes; growth in the retail availability of e-cigarettes 

has mirrored increases in e-cigarette use by youth and young adults.80 

• In 2007, the Institute of Medicine (now the National Academies of Sciences, Engineering, and 

Medicine), recommended that “state governments should develop and, if feasible, implement and 

evaluate legal mechanisms for restructuring retail tobacco environments and restricting the 

number of tobacco outlets.”81 

• In addition to preventing youth use, reducing tobacco retailer density throughout a community 

may also help reduce health disparities in tobacco use and tobacco-related diseases.82 

Tobacco Marketing in the Retail Environment 

• Marketing in the retail environment, or at the “point of sale,” is also of public health concern. 

o The 2012 Surgeon General’s report found that retail marketing is an important channel 

for tobacco companies, and tobacco marketing at the point of sale is associated with 

youth tobacco use.83 

o Variations in tobacco retailer concentration in certain communities also contribute to 

disparities in exposure to tobacco marketing, particularly in minority and lower-income 

neighborhoods.84 

o As with greater retailer availability, exposure to retail marketing is associated with 

increased smoking and decreased cessation.85 

o As mentioned above, cigarettes are sold in convenience stores more than any other types 

of stores, and in 2005, about 70 percent of adolescents shopped in convenience stores at 

least weekly.86 

o Convenience stores also have more tobacco advertising and promotions than any other 

type of store, which increases the likelihood of exposing youth to pro-tobacco messages 

while they are shopping, and which can affect initiation rates among those exposed, 

particularly if the stores are near schools.87 

• In 2018, the tobacco industry spent $9.06 billion dollars (or $25 million per day, or more than $1 

million per hour) on marketing and promoting cigarettes and smokeless tobacco, and spent 

92.4% of its cigarette-focused marketing expenses on price discounts and other price-related 

promotions, including payments to cigarette wholesalers and retailers.88,89 

• In addition, e-cigarette companies spent $110 million on advertising in 2018.90 The 2016 Point4 
 

 

 

 

 

 

 

 

 

 

of-Sale Report to the Nation found that “more youth and young adults report seeing 

advertisements for e-cigarettes [in retail stores] than in any other marketing channel.” 91 

• A growing body of evidence has found a relationship between exposure of youth to tobacco 

marketing in stores and smoking initiation.92,93,96,97,98 

o For example, a 2010 longitudinal study of adolescents aged 11 to 14 years found that the 

odds of initiating smoking more than doubled for adolescents reporting that they visited 

the types of stores that contain the most cigarette advertising (convenience stories, liquor 

stores, small grocery stores) two or more times a week.94 

o Given this and other evidence, in 2012, the Surgeon General noted “that the addictiveness 

of tobacco, the severity of the health hazards posed by smoking, the evidence that 

tobacco marketing and promotion encourage children to start smoking, and the 

consistency of the evidence that it influences children’s smoking justify banning 

advertising and displays of tobacco products at the point of sale.”95 

• Reducing the density and number of retailers may also curb exposure to tobacco marketing.96,97 

• Some states and localities have implemented policies that aim to reduce retail marketing in 

general.98,99 

o For example, St. Paul, Minnesota adopted a content-neutral advertising ordinance to 

regulate the amount of window space that can be covered by signs at local businesses.100 

o This new requirement aimed at promoting safety by ensuring the clerk and interior of the 

store are visible from the outside, enhanced neighborhood beauty by reducing cluttered 

storefronts, and had the effect of reducing the amount of advertising for tobacco products 

and other products in the community.101 

Tobacco Retail Licensure 

• States have broad legal authority, through their powers to protect public health and safety, to 

require tobacco retailers to obtain a license before selling tobacco products.102 

o Requiring a license for tobacco retailers ensures that states and localities know who is 

selling tobacco products in their jurisdiction, allowing states and localities to enforce 

policies, including those that prevent youth initiation. 

o The 2007 Institute of Medicine Report, Ending the Tobacco Problem, recommended 

requiring state licensing of all retail outlets that sell tobacco products.103 Specifically, the 

report found that licensure enhances enforcement of key tobacco control policies, such as 

verifying the age of purchasers, restricting the use of self-service displays and vending 

machines, and selling products only in a face-to-face exchange.104 

o Similarly, in 2012, the Surgeon General found that “research supports the policy option 

of regulatory control over the retail tobacco environment. Studies show that tobacco use 

is associated with both exposure to retail advertising, and relatively easy access to 

tobacco products.”105 Such controls could include restricting the number and location of 

tobacco retail outlets (through licensing, for example) and requiring that tobacco retailers 

obtain nontransferable retail licenses that could be suspended or revoked for failure to 

comply with laws.106 

o A 2014 California study found that “strong local tobacco retail licensing ordinances may 

lower rates of cigarette and e-cigarette use among youth and young adults.”107 

o The 2014 Surgeon General’s report, The Health Consequences of Smoking—50 Years of 

Progress, reiterated these findings, noting that some states have improved enforcement of 

sales to minors restrictions, including revoking store licenses for retailers that violate 

laws and sell to minors.108 

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o The Surgeon General’s report also noted that improving state tobacco licensure 

management can enhance revenue collection from tobacco taxes, as well as minimize tax 

avoidance and evasion.109 In addition, maintaining high prices of tobacco products is a 

key way to reduce initiation and encourage quitting, especially among price-sensitive 

populations such as youth.110 

• States and localities have implemented laws that require retail licensure, including many that tie 

tobacco retail licenses to policy enforcement.111 For example, as of September 2020: 

o Eleven states and three territories require retailers to have a license to sell cigarettes in 

face-to-face transactions. Most of these jurisdictions also require a license to sell 

smokeless tobacco products in face-to-face transactions.

112 The combination of these 

products is referred to below as “conventional tobacco products.” 

o Twenty-seven states, the District of Columbia, and three territories require retailers to 

have a license to sell either conventional tobacco products or e-cigarettes in face-to-face 

transactions.

113 

o Thirty states, the District of Columbia, and two territories allow licenses to either be 

suspended or revoked if a retailer violates the licensing requirements for selling 

conventional tobacco products; twenty-one states, the District of Columbia, and one 

territory allow licenses to be either suspended or revoked for violating the e-cigarette 

retailer licensing requirements; and eighteen states, the District of Columbia, and four 

territories allow these penalties if retailers sell conventional tobacco products or 

e-cigarettes to underage purchasers.

114 

• Appropriate licensing fees that adequately reflect the administration, implementation, and 

enforcement of the retailer license are another potential approach.115 

o As the Institute of Medicine found, “imposing prohibitive application fees [on tobacco 

retailer licenses] can... serve as an indirect limit on the number of retailers in an area.”116 

o As of September 2020, all but four states that require retailers to have a license require 

them to pay a fee.117 Currently, there is a wide range in fees that states and territories 

require stores to pay to sell conventional tobacco products or e-cigarettes.118 Maximum 

license fees range from $5 in Montana to $800 in Connecticut.119 

o Most states and territories require retailers to renew their licenses, and most require them 

to do so annually.120 

Tobacco Retail Licensure as a Strategy to Address Tobacco Retail Density and Location 

• As noted above, high tobacco retailer density is a public health concern because it is associated 

with higher youth initiation of tobacco use, increased tobacco consumption, and lower likelihood 

of successful quitting.121 

o The Institute of Medicine noted that “retailer density can be controlled directly by the 

licensing body either by limiting the total number of licenses distributed or by limiting 

the density of licenses within geographic areas.”122 

o The Institute of Medicine also made the recommendation that “state governments should 

develop and, if feasible, implement and evaluate legal mechanisms for restructuring retail 

tobacco environments and restricting the number of tobacco outlets.”123 Reducing 

tobacco retailer density may also help reduce health disparities in tobacco use and 

tobacco-related diseases.124 

• There are several tobacco retailer reduction strategies, including capping the number of tobacco 

retailers in a defined area (by geographic boundary, city districts, or population density), 

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restricting the types of businesses that can sell tobacco products, and regulating where tobacco 

retailers can be located.125 

o With regard to capping the number of tobacco retailers, a number of communities in 

California have limited the number of tobacco retailer licenses issued annually or stopped 

renewing a certain number of retailer licenses.126 In 2015, San Francisco, California 

implemented a tobacco retail density policy which “caps the number of tobacco sales 

permits in each of the City’s 11 Supervisorial Districts at 45, limiting the citywide total to 

495.”127 Within the first 10 months that the policy took effect, the number of retailer 

licenses decreased by 8%, and all Supervisorial Districts experienced a decrease in the 

number of tobacco retailers.128 

o Other cities have capped the number of allowable retailers.129 For example, in 2017, 

Philadelphia implemented a population density cap of one tobacco retailer per 1,000 

residents for each of its 18 districts.130 Three years after Philadelphia implemented its 

policy, tobacco retail density declined by 20.3%.131 Further, the study found that declines 

were significantly greater in low-income districts, and observed a 12% decline in the 

rates of tobacco retailers near schools.132 

• Research also suggests that restricting the types of business that can sell tobacco products can 

influence tobacco retailer density. 

o For example, a study examined the impact of local tobacco-free pharmacy laws in 

California and Massachusetts. It found that although tobacco-free pharmacy laws are 

primarily designed to affect social norms, cities with tobacco-free pharmacy laws had 

greater reductions in tobacco retailer density over time compared to cities without such 

laws.133 

o Moreover, in 2018, New York City implemented a tobacco-free pharmacy law; and an 

examination of the policy found an overall reduction in retailer density, but greater 

declines in neighborhoods with higher median household incomes and a higher 

proportion of non-Hispanic White residents.134 

• Regulating where tobacco retailers can be located can also influence tobacco retailer density. 

o For example, Santa Clara, California implemented a minimum distance requirement 

between tobacco retail outlets of 500 feet, and has prohibited retailers from being located 

1,000 feet from a school.135 After that policy took effect, 30% (11 of 36) of retailers in 

the county stopped selling tobacco; one of these retailers was within 500 feet of another 

retailer and three were within 1,000 feet of a school.136 Overall 10 of the 11 retailers who 

stopped selling tobacco were non-traditional tobacco product retailers, such as camping 

stores; restaurants and bars; sport and country clubs; and bait and tackle stores.137 

o Additionally, some states and localities have limited the number of tobacco retail outlets, 

especially in proximity to places where youth frequent, such as schools, parks, libraries, 

and playgrounds.138 Communities have also used zoning regulations to prevent the sale of 

tobacco products in certain areas, such as residential zones.139 Examples of these 

communities include Santa Clara, Santa Barbara, and Baldwin Park, California; and New 

Orleans, Louisiana.140 

• A review of retailer density approaches found that all tobacco retailer reduction strategies 

examined demonstrated actual or predicted reductions in retailer density.141 However, depending 

on the community, some strategies may be more effective than others at reducing tobacco use 

among all populations. 

o For instance, school-based tobacco retailer reduction strategies have been shown to be 

more equitable in reducing tobacco retailer density for low-income, African American, 

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and urban neighborhoods as compared to higher-income, lower prevalence of African 

American, and rural neighborhoods. 

o Capping-based reduction strategies have been shown to be more equitable in reducing 

tobacco retailer density for rural neighborhoods as compared to urban neighborhoods.142 

o Because pharmacy-based reduction strategies are important for social norm change, but 

have demonstrated inequitable impacts, they may be most impactful when adopted in 

conjunction with other retail policies.143 

Conclusion 

• The retail environment contributes to access and availability of tobacco products. 

• There are hundreds of thousands of tobacco retailers in this country. Their proliferation and 

proximity to communities can exacerbate disparities and make it harder for people who use 

tobacco products to quit. They can also make it more likely that youth will initiate tobacco use. 

• Research supports licensing tobacco retailers, limiting retailer density, and limiting proximity to 

youth-oriented places. 

• Retailer-focused strategies are a complement to, but not a replacement for, evidence-based 

tobacco control strategies; thus, such strategies are best implemented as part of a comprehensive 

approach to tobacco prevention and control.144 However, compliance and equitable enforcement 

are also critical to ensure efficacy.145,146 

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