Tobacco Outlet Availability, Density, and Proximity in Rural Areas in the Netherlands: An Ex ante Evaluation of the Impact of Tobacco Sales Bans

INTRODUCTION: The Netherlands will ban tobacco sales from supermarkets in 2024 and from petrol stations and small outlets after 2030 (tobacco specialist shops exempted). Previous studies showed that this will reduce outlet availability, density, and proximity in Dutch urban areas. AIMS AND METHODS: This study assessed the distribution of tobacco outlets in Dutch rural areas, and potential outlet reductions after implementation of these bans. A cross-sectional quantitative audit of tobacco outlets was conducted in seven rural municipalities in the Netherlands. Tobacco outlet availability (N), density (per 10 000 capita and km2), and proximity (average distance of a street or city block to the closest tobacco outlet meters) were calculated, as well as predicted changes after implementation of upcoming sales bans. RESULTS: 97 tobacco retailers were identified. There were 5.00 outlets per 10 000 capita and 0.09 per km2. The tobacco sales ban in supermarkets is expected to reduce availability by 57 outlets, and density by 2.94/10 000 per capita and 0.05/km2, while increasing average distance by 824 m. A tobacco sales ban in petrol stations is expected to further reduce availability (-26), density/10 000 capita (-1.34), and density/km2 (-0.02), while increasing distance (+1595 m). For small outlets, these numbers are -12, -0.62, and -0.01, respectively, while the closest tobacco outlet will be mostly outside municipality borders. CONCLUSIONS: Assuming no new tobacco outlets will emerge in response to future tobacco sales bans, the bans could nearly eliminate tobacco outlets in rural areas. To meet the demand for tobacco, there is a risk that new tobacco specialist shops will be established. IMPLICATIONS: This study shows the potential impact of tobacco sales bans in, sequentially, supermarkets, petrol stations, and small outlets on tobacco outlet density and proximity in rural municipalities in the Netherlands. A ban on tobacco sales in supermarkets, petrol stations, and small outlets could reduce the number of tobacco outlets in rural areas of the Netherlands to nearly zero. As a result, supermarkets may be inspired to open tobacco specialist shops, which are exempt from the bans. To prevent the proliferation of such shops, retail licensing schemes may need to be established.