Abstract
Purpose
The rise of noncigarette, alternative tobacco product (ATP) use among adolescents
may be due in part to an increase in retail availability of ATPs. We examined whether
proximity and density of tobacco retailers near students’ homes are associated with
a higher likelihood of initiating ATP use over time.
Methods
Using data from 728 adolescents (aged 13–19 years at baseline) residing in 191 different
neighborhoods and attending 10 different California high schools, longitudinal multilevel
and cross-classified random effect models evaluated individual-level, neighborhood-level,
and school-level risk factors for ATP initiation after 1 year. Covariates were obtained
from the American Community Survey and the California Department of Education.
Results
The sample was predominantly female (63.5%) and was racially and ethnically diverse.
Approximately one third of participants (32.5%) reported ever ATP use at baseline,
with 106 (14.5%) initiating ATP use within 1 year. The mean number of tobacco retailers
per square mile within a tract was 5.66 (standard deviation = 6.3), and the average
distance from each participant's residence to the nearest tobacco retailer was .61
miles (standard deviation = .4). Living in neighborhoods with greater tobacco retailer
density at baseline was associated with higher odds of ATP initiation (odds ratio =
1.22, 95% confidence interval = 1.07–2.12), controlling for individual and school
factors.
Conclusions
Tobacco retailers clustered in students’ home neighborhood may be an environmental
influence on adolescents’ ATP use. Policy efforts to reduce adolescent ATP use should
aim to reduce the density of tobacco retailers and limit the proximity of tobacco
retailers near adolescents’ homes and schools.
Keywords
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Article info
Publication history
Published online: November 26, 2019
Accepted:
September 6,
2019
Received:
June 5,
2019
Footnotes
Conflicts of interest: The authors declare no conflicts of interest.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. The funding agencies played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; or decision to submit the article for publication.
H.S.A.M. was awarded the Society for Adolescent Health and Medicine's 2019 Charles E. Irwin, Jr. New Investigator Award for her contributions to this article.
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- Retail Outlets and Point-of-Sale Marketing of Alternative Tobacco Products: Another Threat to Tobacco ControlJournal of Adolescent HealthVol. 66Issue 4
- PreviewThe increase in alternative tobacco product use among youth is offsetting declines in cigarette use. Although past month cigarette use declined between 2011 and 2018 among high school students, past month use of any tobacco product rose over the same interval [1]. Most of the overall increase was attributable to the surge in the past month electronic cigarette (e-cigarette) use, which rose from 1.5% in 2011 to 20.8% in 2018 [1]. Among high school students who were current tobacco users, 38% frequently (i.e., used on ≥20 of the past 30 days) used smokeless tobacco, 28% used e-cigarettes, 23% used cigarettes, 16% used cigars, and 16% used hookah in 2018 [1].
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