Introduction The availability of tobacco is thought to influence smoking behaviour, but there are few longitudinal studies examining if the location and number of tobacco outlets has a prospective impact on smoking cessation.
Methods The Ontario Tobacco Survey, a population-representative sample of Ontario adult smokers who were followed every 6 months for up to 3 years, was linked with tobacco outlet location data from the Ontario Ministry of Health. Proximity (distance), threshold (at least one outlet within 500 m) and density (number of outlets within 500 m) with respect to a smokers’ home were calculated among urban and suburban current smokers (n=2414). Quit attempts and risk of relapse were assessed using logistic regression and survival analysis, adjusted for neighbourhood effects and individual characteristics.
Results Increased density of tobacco outlets was associated with decreased odds of making a quit attempt (OR: 0.54; 95% CI 0.35 to 0.85) in high-income neighbourhoods, but not in lower income ones. There was an increased risk of relapse among those who had at least one store within 500 m (HR: 1.41 (95% CI 1.06 to 1.88). Otherwise, there was no association of proximity with quit attempts or relapse.
Conclusions The existence of a tobacco retail outlet within walking distance from home was associated with difficulty in succeeding in a quit attempt, while the increased density of stores was associated with decreased attempts in higher income neighbourhoods. The availability of tobacco may influence tobacco use through multiple mechanisms.
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Contributors MC and JC conceived the study. GM performed the geographical analyses and retail analyses. MC performed the statistical analysis. JC designed and implemented the OTS survey. All authors contributed to writing and interpretation.
Funding The Ontario Tobacco Research Unit and the Ontario Tobacco Survey is supported by the Ontario Ministry of Health and Long Term Care. This work is supported by Canadian Cancer Society grant #702160 (MC) and the Canadian Institute for Health Research. The funders had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript or the decision to submit the paper for publication.
Competing interests None declared.
Ethics approval University of Toronto; University of Waterloo.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Research teams may apply for access to OTS data through one of the following university-based data libraries: Propel Centre for Population Health Impact – Population Health Data Repository at the University of Waterloo or the University of Toronto Data Library.
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