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. 2023 Jun 23;35:102294. doi: 10.1016/j.pmedr.2023.102294

Changes in retail tobacco product sales and market share among retail payroll establishments in the U.S. Economic Census between 1997 and 2017

Alexandria E Reimold a,⁎, Heather D'Angelo a,1, Shyanika W Rose b,c, Kurt M Ribisl a,d
PMCID: PMC10336246  PMID: 37449007

Abstract

The tobacco industry spends the vast majority of their marketing and promotional budget at retail outlets. However, few studies have used publicly available data to examine trends in the number and types of retail establishments where tobacco products are sold. Using the U.S. Economic Census for 1997, 2002, 2007, 2012 and 2017 (the latest year), we examined the number, type, and sales of payroll establishments selling tobacco products. Nine store types accounted for 94% – 99% of tobacco product sales between 1997 and 2017. Gas/convenience stores had the greatest market share (33% – 49% of tobacco sales). The number of warehouse clubs selling tobacco quadrupled; however, market share only increased from 9.6% to 10.3%. Supermarkets experienced the largest decrease in percent of stores selling tobacco. Pharmacy tobacco sales increased in 2012 then decreased in 2017; per store sales volume more than doubled between 1997 and 2012. Online shopping accounted for less than 1% of the market share between 1997 and 2012, but rose to 6.3% in 2017. Between 1997 and 2017, consumers shifted where they purchased tobacco products. Declining tobacco sales in supermarkets is a promising trend for consumers seeking healthy food without exposure to tobacco product marketing; however, the consistently large number of tobacco retailers, and thus widespread tobacco availability, is concerning. Consumer tobacco purchase changes over time support the case for point-of-sale policies that affect different retail types, including pharmacy bans, to reduce tobacco retailer density. Additionally, the rapid shift to online tobacco purchasing in 2017 identifies a new target for enhanced regulation and enforcement.

Keywords: Tobacco, Retail environment, Economic Census, Sales, Commerce, Public Policy

1. Introduction

Smoking prevalence in the United States (U.S.) has declined significantly over the past 50 years, largely due to tobacco control policies, such as strong clean indoor air laws and price increases (Lushniak et al., 2014). A recent focal point for tobacco control advocates includes expanded intervention at the point-of-sale or retail, where cigarette manufacturers spent just over $8 billion in marketing and promotions in 2021 (Commission and Report, 2021). Retail outlets have been the number one venue for tobacco company promotional spending since 1988 (Ma et al., 2022). Knowing where tobacco products are sold, and therefore where consumers are exposed to tobacco marketing, allows for a greater understanding of the potential impact of policies to regulate retail tobacco product sales.

For decades, retail outlets have been a primary channel through which the tobacco industry communicates with current and future smokers through marketing and promotions (Pollay, 2007). Exposure to point-of-sale tobacco marketing has been associated with an increased likelihood of adolescent smoking initiation (Paynter and Edwards, 2009, Slater et al., 2007, Henriksen et al., 2010) and adult tobacco use (Carter et al., 2009). To counter tobacco industry efforts at the point-of-sale, some cities have banned tobacco product sales at pharmacies (Tobacco, 2014) , and CVS Caremark voluntarily discontinued the sale of tobacco products at CVS Pharmacies in 2014 (Brennan and Schroeder, 2014). Understanding trends in tobacco sales at retail outlets provides valuable information for research and advocacy efforts to decrease tobacco product availability and marketing at the point-of-sale.

Without a national tobacco retail licensing system, estimating the number and types of tobacco retail outlets in the U.S. is challenging. Commercial databases that track retail outlets are available for a cost, with different benefits and limitations. A previous study estimated changes in the number and type of likely tobacco retailers using the National Establishment Time Series (NETS) data (Golden et al., 2022) , however, (1) it is not known definitively whether these retailers currently sell tobacco and (2) sales data is not available from NETS. Other studies have used the Nielsen retail store scanner data (Marynak et al., 2017, Wang et al., 2021), however these sources mainly collect data from food, drug, mass merchandise, convenience, and liquor stores, and are therefore useful for estimating trends in sales of particular tobacco products, but not in tracking changes in tobacco sales across a broader set of retail store types.

The U.S. Economic Census, a publicly available data set, provides estimates of both the number of payroll establishments (i.e., businesses with paid employees) and specific product sales for each store type categorized within the Retail Trade industry. Yet few peer reviewed tobacco control studies use publicly available data from the Economic Census, with the exception of two studies examining the retail sources of tobacco products in 1997 and 2002 (Ribisl et al., 2011, Tauras et al., 2006). Our study adds data from 2007, 2012, and 2017, the most recent Economic Census data available, and examines changes in the types of stores that sell tobacco products, tobacco product sales, and the market share of tobacco products by store type. We also present data on tobacco product sales per store for each store type, not previously examined in the study by Tauras and colleagues (Tauras et al., 2006).

2. Methods

We retrieved data on tobacco product sales in the Retail Trade sector using North American Industry Classification System (NAICS) codes 44–45 from the U.S. Census Bureau, Economic Census for 1997, 2002, 2007, 2012, and 2017 (Census Bureau, 2010). The Economic Census includes data on establishments with paid employees (payroll) and is issued every five years. Data are typically released 3–4 years after collection (the 2022 data collection will be released in 2025). Tobacco product sales were identified using product code 20,150 for ‘Cigars, cigarettes, etc. & smokers' access[ories], excluding sales from vending’ and selecting the ‘Product Lines: Product Lines by Kind of Business’ option for 1997 through 2012. For 2017 data, tobacco product sales were identified using NAPCS code 5,000,325,000 for ‘Retail sales of tobacco products and smoking accessories’ and all 6-digit industry codes (NAICS). There is no separate product category for electronic cigarettes or electronic nicotine delivery systems.

The number of stores selling tobacco products and tobacco product sales was obtained overall and for each store type. Product sales included excise taxes paid by manufacturers and passed through to consumers, but not sales taxes paid to local, state, or federal agencies (Census Bureau, 2022). To compare values over time, product sales for 1997, 2002, 2007, and 2012 were adjusted for 2017 inflation by using the U.S. Bureau of Labor Statistics’ online Consumer Price Index (CPI) inflation calculator (U.S. Bureau of Labor Statistics, 2022). Values greater than $10,000,000 exceed the calculator’s maximum limit. For values greater than this limit (indicated in Table 2), we moved the decimal point one place to the left (i.e., $10,000,000 would be input to the calculator as $1,000,000.0) on the original value then moved the decimal point one place to the right on the adjusted value. The market share for each store type was calculated by dividing each store type’s tobacco sales by total tobacco sales for the retail trade industry. Per store sales volume was calculated by dividing the store type’s total tobacco product sales by the number of stores of that type that sold tobacco products.

Table 2.

Tobacco product sales at retail establishments, U.S. Economic Census, 1997 to 2017 (adjusted for inflation based on the 2017 annual consumer purchase index (CPI)).

NAICS Description 1997
 2002
 2007
 2012
 2017
Total ($1,000) Per store ($) Total ($1,000) Per store ($) Total ($1,000) Per store ($) Total ($1,000) Per store ($) Total ($1,000) Per store ($)
Tobacco stores 4,041,240 1,026,424 7,712,548 1,247,715 7,206,230 1,102,306 7,776,426 871,406 7,969,706 765,214
Gas stations with convenience stores 18,253,971b 245,549 28,751,317b 334,355 31,454,178b 351,375 36,377,793b 405,764 38,935,975b 424,755
Convenience stores 4,760,783 199,794 6,153,265 247,368 6,007,690 235,033 4,141,389 180,902 5,046,356 199,745
Warehouse clubs & superstores 5,389,337 3,617,647 8,764,243 3,206,275 8,801,926 2,276,297 10,312,744 2,290,194 8,663,258 1,286,304
Beer, wine, & liquor stores 1,801,726 102,185 1,682,109 127,762 1,666,866 117,517 1,750,672 108,960 2,136,153 114,233
Supermarkets & other grocery stores 13,551,393 248,599 10,443,409 203,875 9,550,402 146,896 5,370,060 124,757 5,080,215 164,867
Pharmacies & drug stores 2,842,632 134,213 2,067,030 116,888 2,209,751 136,319 5,257,055 227,214 4,448,891 231,147
Other gas stations 2,498,808 117,436 1,385,943 159,023 1,600,090 252,661 1,784,081 374,965 1,073,691 288,239
Electronic shopping and mail-order 194,915 1,821,638 541,560 2,472,877 a a 506,620 3,671,161 5,310,456 12,124,329
Retail Trade (all retail stores) 56,156,996b N/A 69,128,529b N/A 69,971,764b N/A 74,207,825b N/A 83,864,435b N/A
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Note. Inflation adjusted values were calculated using the inflation rate formula where the inflation rate equals the ending cost minus the starting cost, divided by the starting cost, multiplied by 100. Per store sales volume indicates sales of tobacco products ($1,000) divided by the number of retailers within each NAICS code selling tobacco products. aThe 2007 economic census does not disclose the sales of tobacco products for electronic shopping and mail-order retailers. bValues greater than $10,000,000 before adjusting for inflation via the inflation rate formula.

3. Results

About 247,000 payroll establishments sold tobacco products in the U.S. in 2017, an increase of 5.5% over the twenty-year period (Table 1). Although between 28 and 38 unique store types (Supplementary Table 1) sold tobacco products, eight store types represented approximately 95% to 99% of all tobacco product sales between 1997 and 2012, and nine store types represented approximately 94% of sales in 2017 when electronic shopping/mail order sales increased dramatically (Table 2; Fig. 1). Two additional store types, All other miscellaneous store retailers (except tobacco stores), and All other general merchandise stores each accounted for less than 5% of sales yet still had substantial percentages (3.1% and 2.6% respectively) of tobacco market share starting in 2017. However, these store types accounted for less than 0.5% of the market share between 1997 and 2012 and were thus excluded. Total tobacco product sales increased during this time from $56.2 billion (adjusted for inflation) in 1997 to $83.8 billion in 2017, likely in part due to increases in tobacco product excise taxes but also due to changes in the types and amounts of tobacco products sold (Table 2).

Table 1.

Number and percentage of retail establishments selling tobacco productsa, U.S. Economic Census, 1997 to 2017.

NAICS Category Description 1997
N (%)		 2002
N (%)		 2007
N (%)		 2012
N (%)		 2017b
N (%)		 % Change in number of retailers
1997–2017
Tobacco stores 3,884 (100.0) 6,184 (100.0) 6,539 (100.0) 8,924 (100.0) 10,415 (100.0) 168.2
Gas stations with convenience stores 74,564 (91.3) 86,152 (92.0) 89,652 (91.9) 89,718 (91.6) 91,667 (92.8) 22.9
Convenience stores 23,793 (87.9) 24,871 (85.1) 25,510 (100.0d) 22,893 (89.8) 25,264 (88.8) 6.2
Warehouse clubs & superstoresc 1,490 (97.4) 2,734 (93.9) 3,866 (90.8) 4,503 (87.2) 6,735 (82.1) 352.0
Beer, wine, & liquor stores 17,747 (59.9) 13,177 (45.5) 14,168 (45.0) 16,067 (49.7) 18,700 (54.3) 5.4
Supermarkets & other grocery stores 54,473 (78.4) 51,343 (77.6) 64,881 (100.0d) 43,044 (65.2) 30,814 (47.3) −43.4
Pharmacies & drug stores 21,181 (48.6) 17,731 (44.1) 16,267 (38.7) 23,137 (53.4) 19,247 (42.4) −9.1
Other gas stations 21,220 (46.9) 8,745 (31.5) 6,322 (29.8) 4,758 (29.6) 3,725 (22.5) −82.4
Electronic shopping and mail-order 107 (1.1) 219e (1.4) 145e (0.7) 138e (0.5) 438 (1.1) 309.3
Retail Trade (All retail stores) 234,100 (20.9) 221,173 (19.58) 235,707 (20.9) 229,623 (21.6) 247,088 (23.2) 5.5
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Note. Products are ordered by 2017 percentage of stores selling tobacco as a product line. Percentages represent the number of stores within each store type category that sell tobacco products each year.

a

Product code 20150, ‘Cigars, cigarettes, etc. & smokers' access, excluding sales from vending’ at payroll establishments.

b

In 2017, product codes were replaced with NAPCS codes. NAPCS code 5000325000, ‘Retail sales of tobacco products and smoking accessories’.

c

The NAICS code for Warehouse & superstores changed from 452,910 to 452,311 between 2012 and 2017.

d

In 2007, the number of establishments listed as selling product code 20,150 was equal to the total number of establishments.

Fig. 1.

Fig. 1

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Changes in the market share of tobacco product retail sales by store type, U.S. Economic Census, 1997 to 2012. Note. This figure represents the percent of sales of tobacco products for the nine store types that comprised over 90% of tobacco sales within the Retail Trade sector out of total retail tobacco sales by year. The remainder of tobacco product market share for each year was comprised of varying store type categories (see Supplementary Table 1).

3.1. Store types increasing in market share

The number of stores that sold tobacco products remained relatively stable with a slight increase from 234,100 in 1997 to 247,088 in 2017. There were varying changes among certain store types in both the number of stores that sold tobacco products and in the share of the tobacco retail market by store type. For example, the number of tobacco stores (e.g., discount cigarette stores, smoke shops) increased by 168% over 20 years and their share of the tobacco retail market increased from 7.2% to 9.5%.

The number of gas/convenience stores that sold tobacco products increased by 23% and had the highest proportion of retail tobacco sales each year, reaching a peak at 49% of the retail tobacco market in 2012 (a 99% increase over 1997) and declining to 46% in 2017 (Table 2; Fig. 1). About 93% of all payroll gas/convenience stores sell tobacco products, and, on average, each gas/convenience store that sells tobacco in the U.S. generates about $425,000 in tobacco product sales annually (in 2017) (Table 2). The number of warehouse clubs that sold tobacco products more than quadrupled over 20 years (Table 1); however, warehouse clubs only increased slightly in market share, from 9.6% to 10.3% of total retail tobacco sales and the sales volume per warehouse club actually decreased between 1997 and 2017 (Table 2).

The number of pharmacies that sold tobacco declined until 2007, increased in 2012, then decreased again in 2017 (Table 1). Tobacco sales at pharmacies climbed from $134,000 per store in 1997 (in 2017 inflation adjusted dollars) to over $230,000 per store in 2017 (Table 2). Pharmacies’ tobacco market share was similar in 1997 and 2017, though it decreased from 5.1% to 3.2% between 1997 and 2007, then increased to 7.1% in 2012 (Table 2).

Electronic shopping (i.e., online stores) accounted for less than 150 stores each year between 1992 and 2012 but accounted for almost 450 stores in 2017 (Table 1). While the percent of online stores that sold tobacco products experienced little variation, consistently remaining at or below 1.1% (Table 1), sales of tobacco products through online stores increased dramatically from $194,915,000 in 1997 (in 2017 inflation adjusted dollars) to $5,310,456,000 in 2017 (Table 2). Electronic shopping did not have a sizeable market share until 2017. This store type accounted for less than 1% of the market share between 1997 and 2012, but accounted for 6.3% in 2017. In 2012 and 2017, per store sales volume for tobacco products was highest for online retailers, surpassing even warehouse clubs which previously had the highest per store tobacco product sales volume.

3.2. Store types decreasing in market share

Four out of the nine major store types that sold tobacco products decreased in the market share of tobacco product sales. The number of supermarkets that sold tobacco products decreased by about 43% and only 47% of supermarkets sold tobacco products in 2017, down from 78% in 1997 (Table 1). The market share of tobacco products sold in supermarkets decreased by 75% (Fig. 1). Convenience stores (without gas) increased slightly in number but decreased in the market share of tobacco products by 29%. The number of other gas stations (i.e. gas stations without convenience stores) dropped by 82%, and their market share decreased by 71%. The number of Beer, wine and liquor stores increased by a small amount (5%) but lost nearly a quarter of their market share, declining from 3.2% to 2.5%.

4. Discussion

We used a publicly available, national, longitudinal dataset representative of small, medium and large payroll retail establishments to examine retail tobacco product sales over 20 years. Between 1997 and 2017, there appears to have been a shift in where tobacco products were available, with a notable increase in Electronic shopping. Despite declines in cigarette sales (Seidenberg et al., 2012), consumption, and adult smoking prevalence (Centers for Disease Control and Prevention, 2012, Jamal et al., 2015), the current study found that the overall tobacco retail market has had a modest 5% increase in number of retailers over 20 years. Changes in tobacco product market share over time also varied by store type, with market share declining at supermarkets, convenience stores, other gas stations, and beer/liquor stores, and increasing at gas/convenience stores, warehouse clubs/supercenters, tobacco stores, pharmacies, and electronic shopping.

Supermarkets showed the greatest decline in the market share of tobacco product sales. During this time period, national and regional chain supermarkets (e.g., Wegman’s, Raley’s) voluntarily stopped selling tobacco products, starting largely after 2007 (McDaniel et al., 2014). Changes in the number of pharmacies selling tobacco products are of particular interest, given recent voluntary changes in that sector (Brennan and Schroeder, 2014) and the burgeoning number of state laws and local ordinances banning the sale of tobacco products in pharmacies (Katz, 2013). Pharmacies initially showed signs of declining tobacco product sales, but then increased their sales in 2012, with a slight decline in 2017. The increase is most likely due to the large growth in the number of pharmacies between 2007 and 2012 from 16,000 retailers to 23,000. This result is consistent with another study that found a 22.7% increase in cigarette sales in pharmacies between 2005 and 2009 using AC Nielsen ScanTrack data (Seidenberg et al., 2012). However the decrease observed between 2012 and 2017 is likely due to CVS Pharmacy discontinuing the sale of tobacco products and many municipalities in Massachusetts, California and New York banning pharmacy tobacco sales prior to 2017. With Massachusetts enacting a state-wide ban in 2018 and New York following in 2020 (Jin et al., 2016 Apr, Tobacco-free, 2019, NY State Senate, 2020), along with potential voluntary efforts to end tobacco sales in other large pharmacy chains (Repko and Roz, 2021), there will likely be further declines in the number of retailers in this category. A recent study estimated that pharmacy bans in North Carolina would reduce tobacco retailer density by about 14% (Myers et al., 2015). Though CVS Pharmacy discontinued the sale of tobacco products in 2014, Dollar General and Family Dollar began selling tobacco around the same time. Previous research indicates that this change increased tobacco retailer availability (Hall et al., 2019, Raskind et al., 2022). Though not included in this study due to small market share over the entire study period, in 2017 the NAICS category All Other General Merchandise Stores (452319), in which dollar stores belong, reported higher tobacco sales ($2,163,000) than Beer, Wine, and Liquor Stores (445310; $2,136,000) and Other gas stations (447190; $1,074,000). As such, future research should include this category when studying likely tobacco retailers.

Both convenience stores (without gas) and gas stations also declined in tobacco market share. It is likely that these store types have shifted categories, whereby many stand-alone gas stations added convenience stores, accounting for the 20% increase in gas/convenience stores that sold tobacco. Warehouse clubs and supercenters also have increased their market share. Because they sell in bulk (cartons) at lower prices per pack, the trends observed may reflect smokers turning to price minimization strategies as cigarette prices have increased over the years (Pesko et al., 2014, Golden et al., 2016). Since some warehouse clubs also sell tobacco products in bulk to smaller retailers that do not buy from a distributor, a small portion of the total sales may be overestimated. Although warehouse clubs and supercenters increased their market share, it is worth noting that Sam’s Club, owned by Walmart, has discontinued the sale of tobacco products at many of their locations (Meyersohn, 2022).

Perhaps most notable was the dramatic increase of the market share for online stores selling tobacco products between 2012 and 2017. A content analysis of online tobacco vendor websites indicated that the majority of online e-cigarette vendors are US based and sell flavored products (Williams et al., 2018), a major concern for both youth access and youth appeal. Furthermore, more than half of online vendors were found to use ineffective age verification or no verification at all before purchase (Williams and Derrick, 2018, Williams et al., 2018). In 2019, industry analysts estimated that online retailers for e-cigarettes comprised 19% of the e-cigarette market (Herzog, 2019). In 2021, Congress updated the Preventing All Cigarette Trafficking (PACT) act to prevent the online sale of e-cigarettes in addition to the online sale of standard cigarettes and smokeless tobacco products (Bureau of Alcohol, Tobacco, Firearms and Explosives, 2023). Though this occurred after our study timeframe, it is worth noting that this amendment may limit the future growth of online tobacco product sales. However, we do note that some tobacco products such, as cigars, are not subject to the PACT Act. Examining changes over time for individual tobacco product categories is also of interest given the emergence of newer tobacco products, such as electronic nicotine devices (ENDS). For instance, ENDS were available in 34% of U.S. tobacco retailers in 2012 and at 79% of retailers in 2015 (Rose et al., 2014, D'Angelo et al., 2020).

Using multiple cross sections from the Economic Census enables this study to track changes in tobacco retailer availability and sales over time from a non-proprietary and easily accessible dataset. Not only is this dataset considered a gold standard in relation to business and economics in the United States (Abraham et al., 2018), but it also allows for straight forward replicability. However, a limitation of the current study is that sales for individual tobacco product categories (e.g., cigars separate from cigarettes, or e-cigarettes) were unavailable in the data source. Still, it is likely that newer types of tobacco products, such as ENDS sales, are captured in these overall trends. Another limitation is that the Economic Census only includes payroll establishments, which may undercount the true number of tobacco retail establishments. Non-payroll establishments are likely to be smaller, non-chain or family-owned establishments, and therefore these types of establishments are not counted in our analyses. A rigorous study using NETS data estimated that there were approximately 356,000 likely tobacco retailers in the U.S. in 2017 (Golden et al., 2022), including both payroll and non-payroll establishments, which suggests that approximately one-third, or 110,000, non-payroll tobacco retailers in the U.S are not included in the most recent, 2017 Economic Census. Though the Economic Census includes fewer tobacco retailers, general trends in the count of tobacco retailers by store type are similar to those in the NETS data, with the majority of tobacco retailers falling into the Gas, Convenience, or Grocery categories and fewer falling into the Alcohol, Tobacco store, or Warehouse categories.

While some tobacco retailers may not be captured in this data source, more total retailers are likely captured with the Economic Census than with retail scanner data. A study published by the USDA-ERS comparing five national retail data sources (InfoScan, Economic Census, County Business Partners, TDLinx, NETS) found that the Economic Census included more total retailers than all other datasets included (Levin et al., 2018). For example, Nielsen’s retail scanner data is largely dominated by food, drug, mass merchandise, convenience, and liquor stores and, in 2012, reported data from roughly only half the number of retailers as reported in the Economic Census (Levin et al., 2018). A final limitation is that sales are averaged across jurisdiction so we cannot account for differences in excise tax rates across different states when accounting for variation in per store sales volume.

Tracking trends over a longer time period can help to assess whether continued cigarette smoking declines lead to concurrent reductions in the tobacco retail category. Consumers who are seeking healthy food options without exposure to tobacco products and marketing will benefit from declines in the percentage of supermarkets that sell tobacco, however, recent increases in tobacco sales in pharmacies and warehouse club stores is a concern. Shifts in tobacco product sales at retail outlets and differences in where consumers purchase tobacco products over time may support the case for stronger point-of-sale policies that affect select retail types. Policies that restrict tobacco sales in certain retail types, like pharmacies, or retailer density reduction strategies are likely to reduce the overall accessibility of tobacco along with the number of retailers in a community. Other point-of-sale policies, such as restricting tobacco product flavors or prohibiting discounts may reduce tobacco sales in stores and tobacco use rates, however, these policies are unlikely to reduce the overall availability of tobacco in communities (Luke et al., 2017). Knowing the overall trend of tobacco product sales in certain store types, combined with local, store-specific data on the availability of tobacco products, and tobacco product promotions can help communities advocate for stronger tobacco control policies at the point-of-sale. Moreover, data on tobacco product revenue at stores (>$400,000 at each gas/convenience store on average) may be helpful in policymaking when retailers push against licensing fees that can cost between $6 and $800 (Centers for Disease Control and Prevention. State System Licensure Fact Sheet. Centers for Disease Control and Prevention. Published, 2023). In addition to policies aimed at curtailing the number of retailers selling tobacco, community-engaged approaches to holistically assess local tobacco retail environments could increase public support for and facilitate the implementation of complementary tobacco control efforts such as enforcement of existing policies, increased access to cessation services and strong prevention efforts.

5. Ethical compliance

This study is based on publicly available data that does not contain individual-level data. Thus it is exempt from ethical approval.

6. Disclosure

KMR is a paid expert scientist in litigation against e-cigarette and tobacco companies. The authorship team reports no other conflicts of interest or ties to commercial interests.

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award number P01 CA225597. The funders had no involvement in the study design, collection, analysis, writing, or interpretation.

CRediT authorship contribution statement

Alexandria E. Reimold: Methodology, Validation, Formal analysis, Data curation, Writing – review & editing, Visualization, Project administration. Heather D'Angelo: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing – original draft, Supervision. Shyanika W. Rose: Conceptualization, Validation, Writing – review & editing, Visualization, Supervision. Kurt M. Ribisl: Conceptualization, Validation, Writing – review & editing, Visualization, Supervision.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Footnotes

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.pmedr.2023.102294.

Appendix A. Supplementary data

The following are the Supplementary data to this article:

Supplementary data 1
mmc1.docx (14.5KB, docx)

Data availability

Data will be made available on request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary data 1
mmc1.docx (14.5KB, docx)

Data Availability Statement

Data will be made available on request.

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