It’s been more than three years since our company decided to stop selling tobacco in all our stores, and it remains a source of great pride for CVS Health. Without question, going tobacco-free was a bold decision that would significantly impact our bottom line—our tobacco exit was estimated to reduce annual sales by $2 billion—but it was the right decision for our brand, our business, and the health of all Americans.
The decision came out of a realization that not only was the sale of tobacco products a barrier to the future growth of the company as a trusted health care provider, but also cigarettes—which remain the leading preventable cause of death—had no place in a setting where health care was delivered. The decision helped validate CVS Health’s evolving role in the health care marketplace and demonstrate our purpose of helping people on their path to better health.
As we looked back on how our company implemented this change and how it led us to new initiatives, including programs for youth smoking prevention, we identified some best practices that might help other companies bring their purpose to life, and drive both social and business impact.
The Challenge
Each day in the United States, more than 3,200 young people smoke their first cigarette, and about 2,100 of them become daily smokers. According to the Centers for Disease Control and Prevention, nearly 9 in 10 cigarette smokers say they tried smoking for the first time by age 18, and 99 percent say they had their first cigarette by age 26. Meanwhile, evidence suggests that if individuals remain non-smokers during adolescence, they will likely never start using tobacco.
Our Approach
While the potential for a $2 billion annual loss in sales was significant, we believed our focus on purpose would ultimately lead to greater loyalty in our customer base and give us more credibility as a health care provider. The fact that companies and consumers now see us as a convenient and affordable point of access for quality care creates longer-term growth opportunities for our business. That’s led us to open up new partnerships. Today, we have dozens more clinical affiliations with some nationally recognized institutions, including the Department of Veterans Affairs, Cleveland Clinic, Dartmouth-Hitchcock, UCLA Health, the Henry Ford Health System, and Emory Healthcare.
To measure the impact of our decision, we completed a study one year after removing tobacco products from our shelves. We found a 1 percent reduction in cigarette-pack sales across all retailers, in states where CVS Pharmacy had a 15 percent or greater share of the retail pharmacy market, reaffirming previous research that availability directly impacts use.
We were encouraged by the early results of our efforts, but we knew we could leverage our size and scale to make an even greater impact, and deliver on the high expectations of our customers, colleagues, business partners, shareholders, and regulators. In 2016, we established Be the First, a five-year initiative to help deliver America’s first tobacco-free generation. It’s a lofty aspiration, and with a $50 million investment through 2020, we knew we had to be smart and deliberate to drive results and make an impact on public health.
As with many initiatives like ours with big goals, research and data collection, as well as a broad range of partnerships, have been important to our success so far.
Start with the Data
Data helps us understand where to focus effort. Before embarking on our journey, we undertook significant research in conjunction with experts in the field, and the data showed that preventing youth from trying tobacco was the biggest opportunity we had for impact. To reach youth at those points in their lives when they will most likely face the decision to use tobacco for the first time, we decided to focus on comprehensive tobacco education in elementary and middle schools that supports the “never start” message.
Develop Strong Partnerships
We have sought out innovative partnerships, collaborations, and alliances in several areas, including prevention, youth advocacy, and behavior change. Today, our partners include the Campaign for Tobacco-Free Kids, American Cancer Society, Truth Initiative, CATCH Global Foundation, and National Urban League. Our goal through this work is to contribute to a 10 percent decline in new youth smokers in the United States by 2020.
Prevention: Awareness and educational programming is an important part of prevention. Through a partnership with Scholastic, a leader in the development of educational materials, we’ve introduced a new school-based tobacco prevention program to teach children about the health consequences of tobacco use. Between this and other partnerships, including with DoSomething.org, we have already reached 4.4 million youth.
Advocacy: Getting your target audience involved in the cause greatly increases your chance for success. We are building partnerships and alliances that increase the tobacco control and advocacy programs needed to support a reduction in youth smoking rates. For example, we’re working with the Campaign for Tobacco-Free Kids to establish youth advocacy programs in all 50 states. We also have partnerships with the American Cancer Society and Truth Initiative to increase the number of tobacco-free colleges and universities nationwide.
Behavior Change: We are also investing in healthy behavior programming that teaches kids positive decision-making habits and resistance skills. In 2016, for example, we partnered with Stanford University School of Medicine to fund the expansion of the Tobacco Prevention Toolkit—a free, online resource for anyone who works with youth. It contains 10 modules with interactive lessons and activities focused on e-cigarettes and vapes, including JUULs, hookah, smokeless tobacco, and cigarettes; messages on nicotine addiction; information and resources concerning positive youth development; and information about school tobacco policies and tobacco control efforts. The toolkit is now being widely used across the United States, both in classrooms and by community-based organizations.
We also partnered with the Yale Center for Health and Learning & Games. The center had a team in the early stages of developing an application for mobile devices, called smokeSCREEN. The game is a highly interactive, narrative-based videogame app, in which players “travel” through life, facing a range of challenges young teens face. One challenge focuses on youth decision-making about smoking and tobacco use, and includes strategies for both smoking prevention and cessation. We were impressed with smokeSCREEN from the beginning, and early results from the pilot have been very promising in affecting healthy behavior change in students. Our funding will help enhance and scale the current pilot program so that smokeSCREEN can reach more students, as well as expand access to the program via the Google and Apple app stores later in 2018.
Results to Date
After two years of Be the First programming, our work has reached 4.4 million youth with tobacco-free messaging, contributed to a 1.3 percent decline in the youth smoking rate, which stands at 8 percent, and a reduction in new youth smokers. With our help, 253 institutions of higher education have gone tobacco-free since 2016.
The magnitude of our decision to remove tobacco, and its ripple effect across the market and patients’ lives, was personally one of the most important and rewarding opportunities of my professional career. As a mother, this issue is very close to my heart. I’m proud to work for a company that is truly committed to its purpose of helping people on a path to better health.
As a company, we’re proud of our partnerships and combined progress. Still, far too many young people are using a variety of harmful tobacco and nicotine products, and our work won’t end until this is no longer the case.
Today, many companies are setting bold goals to improve people’s lives, and these goals don’t need to come at the expense of the bottom line. When companies put purpose at the center of their strategies, they increase customer loyalty and broaden their customer base, they enhance their employees’ engagement, and they drive greater interest by shareholders.
For CVS Health and our partners, we can envision a day when we achieve our goal of delivering the nation’s first tobacco-free generation. And when that day comes, we’ll look back on our exit from tobacco as a truly seminal moment in our company’s history, evolution, and continued success. We hope our continued collaboration will inspire others to set big goals for creating healthier and more sustainable communities.
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Read more stories by Eileen Howard Boone.