Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools?

Abstract

Objective

To examine the quantity (density) and location (proximity) of tobacco outlets and retail cigarette advertising in high school neighborhoods and their association with school smoking prevalence.

Methods

Data from the 135 high schools that participated in the 2005–2006 California Student Tobacco Survey were combined with retailer licensing data about the location of tobacco outlets within walking distance (1/2 mi or 805 m) of the schools and with observations about the quantity of cigarette advertising in a random sample of those stores (n = 384). Multiple regressions, adjusting for school and neighborhood demographics, tested the associations of high school smoking prevalence with the density of tobacco outlets and retail cigarette advertising and with the proximity of tobacco outlets to schools.

Results

The prevalence of current smoking was 3.2 percentage points higher at schools in neighborhoods with the highest tobacco outlet density (> 5 outlets) than in neighborhoods without any tobacco outlets. The density of retail cigarette advertising in school neighborhoods was similarly associated with high school smoking prevalence. However, neither the presence of a tobacco outlet within 1000 ft of a high school nor the distance to the nearest tobacco outlet from school was associated with smoking prevalence.

Conclusions

Policy efforts to reduce adolescent smoking should aim to reduce the density of tobacco outlets and retail cigarette advertising in school neighborhoods. This may be achieved through local zoning ordinances, including limiting the proximity of tobacco outlets to schools.

Introduction

An estimated one half million stores sell cigarettes in the U.S., approximately one for every 11 smokers under the age of 18 (DiFranza et al., 2001). In California, where this study was conducted, approximately 36,000 stores are licensed to sell cigarettes — one store for every 8 smokers under the age of 18. Tobacco outlets are more highly concentrated in neighborhoods where a larger proportion of residents are under 18 (Novak et al., 2006), and adolescents are routinely exposed to the widespread advertising for cigarettes that these stores contain (Henriksen et al., 2004a, Pucci et al., 1998). Because the risk of moving from experimentation to habitual smoking is greatest for adolescents, new policies are needed to reduce both the availability of cigarettes and the visibility of cigarette ads in adolescents' environments.

Using zoning ordinances to limit the concentration of alcohol retailers (i.e. outlet density) in communities has reduced alcohol consumption (National Research Council and Institute of Medicine, 2003). There is considerable interest in adapting this strategy to benefit tobacco control (Institute of Medicine, 2007, Schneider et al., 2005). For example, Ashe and her colleagues recommend that local governments use zoning laws to (a) limit tobacco outlet density, which would reduce the availability of cigarettes and the visibility of cigarette ads in a community, and (b) require that tobacco outlets be located away from places frequented by children, such as schools and playgrounds (Ashe et al., 2003). The study we report here describes the density of tobacco outlets and retail cigarette advertising near California high schools and their association with school smoking prevalence. School neighborhoods are the focus of this study because adolescents frequently visit tobacco outlets near school (Feighery et al., 2006, Henriksen et al., 2004a), and because outlets near schools have been found to contain more cigarette advertising than outlets farther from schools (Pucci et al., 1998, Rogers et al., 1995).

The expectation that limiting tobacco outlet density in school neighborhoods would reduce adolescent smoking assumes the two variables are positively correlated, but the three studies to date yield dissimilar findings. The number of tobacco outlets was unrelated to school smoking prevalence in one study of Canadian high school neighborhoods (Lovato et al., 2007), but positively correlated in another (Leatherdale and Strath, 2007). Tobacco outlet density near 11 middle schools was associated with higher odds of students' ever trying smoking, but not with current smoking (Pokorny et al., 2003). Not all of these studies considered confounders such as neighborhood income and race/ethnicity, which are correlated with tobacco outlet density and tobacco use (Hyland et al., 2003, Novak et al., 2006, Schneider et al., 2005). To address several shortcomings in the literature, the study reported here examined tobacco outlet density near a larger sample of high schools, adjusted for both school and neighborhood demographics, and observed the quantity of retail cigarette advertising near schools.

Neighborhoods with higher tobacco outlet density may promote adolescent smoking not only by making cigarettes more accessible, but also by increasing environmental cues to smoke. Higher odds of trying smoking were associated with the proportion of stores near schools that advertised cigarette promotions (Lovato et al., 2007, Slater et al., 2007) and with higher levels of self-reported exposure to retail cigarette advertising (Feighery et al., 2006, Henriksen et al., 2004b). Based on these findings, we hypothesized that the prevalence of current smoking would be greater at schools in neighborhoods with more retail cigarette advertising.

A precedent for limiting the proximity of tobacco outlets to schools may derive from the establishment of drug-free school zones, which intend to safeguard children from drug activity in a designated area, typically 1000 ft from schools (Greene et al., 2006). Living in close proximity to a tobacco outlet is associated with tobacco use by adults: The shorter the distance from home to the nearest convenience store, the more cigarettes California adults reported smoking in the previous month (Chuang et al., 2005). This study is the first we are aware of to examine whether the proximity of tobacco outlets to high schools is associated with the prevalence and frequency of adolescent smoking.