摘要：Objectives . We surveyed the availability of tobacco products and nonprescription nicotine replacement therapy (NRT) in pharmacies in New York City, stratified by the race, ethnicity, and socioeconomic status (SES) of the surrounding neighborhoods to determine whether disparities in availability existed. Methods . Surveyors visited a random sample of retail pharmacies to record the availability of tobacco products and nonprescription NRT. We used census data and geographic information systems analysis to determine the SES of each neighborhood. We used logistic modeling to explore relations between SES and the availability of NRT and tobacco products. Results . Of 646 pharmacies sampled, 90.8% sold NRT and 46.9% sold cigarettes. NRT and cigarettes were slightly more available in pharmacies in neighborhoods with a higher SES. NRT was more expensive in poorer neighborhoods. Conclusions . Small disparities existed in access to nonprescription NRT and cigarettes. The model did not adequately account for cigarette access, because of availability from other retail outlets. These results may explain some of the excess prevalence of cigarette use in low-SES areas. Smoking remains the leading cause of preventable death and disease in the United States, where 1 in 5, or 440 000, Americans die each year from a tobacco-related disease. 1 Tobacco-related mortality exceeds the number of annual deaths from alcohol, suicide, homicide, motor vehicle crashes, illegal drugs, and HIV infection combined. In New York City, over 1 million adult residents are current smokers. 2 In 2005, smoking accounted for approximately 10 000 deaths of New Yorkers; smoking costs the city $4.7 billion annually in direct and indirect costs. 2 Smoking prevalence exhibits a strong socioeconomic gradient. 3 In 2007, 26.7% of US adults without a high school diploma smoked, compared with 6.6% of individuals with a graduate degree. 4 Similarly, 30.6% of adults living below the poverty level smoked, compared with 20.4% at or above the poverty level. 4 The reasons for this disparity are likely multifactorial and may reflect decreased health literacy, reduced access to medical care, lower demand for nicotine addiction treatment, and disparities in the use of cessation aids. 5 , 6 Effective treatments for tobacco dependence include counseling and pharmacotherapy. 7 Drug therapy includes nicotine replacement therapy (NRT) products, such as patches, gum, lozenges, inhalers, and prescription tablets such as bupropion and varenicline. NRT is available via prescription or over-the-counter in the form of patches, gum, and lozenges. Over-the-counter pharmacotherapy, which has been available for 2 decades, is safe and effective. 8 Although New York State Medicaid pays for over-the-counter NRT, physicians and patients are often unaware that this coverage exists. 9 Thus, access to nonprescription NRT remains an important, if underused, source of treatment of smokers. This underuse of effective, evidence-based treatment may account for some of the disparity in smoking prevalence across income and education. To evaluate these issues, we studied the availability of nonprescription NRT products in New York City pharmacies and used logistic regression to analyze this availability by the racial, ethnic, and socioeconomic profiles of the communities surrounding the pharmacies. We also studied the availability of cigarettes in these pharmacies, although noting that this would not provide a complete model of overall neighborhood availability of the product.
