Original article| Volume 66, ISSUE 4, P423-430, April 2020

Tobacco Retail Density and Initiation of Alternative Tobacco Product Use Among Teens



      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.


      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.


      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.


      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.


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      Linked Article

      • Retail Outlets and Point-of-Sale Marketing of Alternative Tobacco Products: Another Threat to Tobacco Control
        Journal of Adolescent HealthVol. 66Issue 4
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          The 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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