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Neighbourhood tobacco supply and individual maternal smoking during pregnancy: a fixed-effects longitudinal analysis using routine data
  1. Tom Clemens,
  2. Chris Dibben,
  3. Jamie Pearce,
  4. Niamh K Shortt
  1. School of Geosciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Tom Clemens, Center for Research on Environment Society and Health, Edinburgh EH8 9XP, UK; tom.clemens{at}


Background Tobacco policy is increasingly focusing on the ‘tobacco endgame’ which commits to eradicating tobacco use (prevalence below 5%) within the next two decades. Strategies for achieving the endgame are likely to include addressing the supply of tobacco products, yet current evidence to support this approach is primarily cross-sectional.

Methods We use longitudinal smoking information from routine maternity records of all women who gave birth in Scotland between 2000 and 2015. We linked this data to the residential density of retailers selling tobacco products and the neighbourhood prevalence of smoking during pregnancy. In the analysis, individual mothers act as their own controls because we compare changes in their smoking behaviour between pregnancies to changes in exposure to tobacco retailing that arises from residential movement between pregnancies.

Results Adjusted ORs showed an increased risk of being a smoker associated with increases in exposure to retailer density (OR 1.67, 95% CI 1.27 to 2.20).

Conclusions The results provide the strongest evidence to date of an association between the neighbourhood availability of tobacco and smoking, and the first to do so among pregnant women. These findings provide supportive evidence for interventions targeting the supply of tobacco products in achieving the endgame.

  • environment
  • priority/special populations
  • socioeconomic status

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors TC conceived the study and methodology, conducted the analysis, assembled the data and wrote the first draft of the paper. CD refined the methodology and JP and NKS produced and provided tobacco retailing data. All authors contributed to final manuscript editing and writing.

  • Funding The work was supported by funding from the Medical Research Council (MR/M501633/2) and the Natural Environment Research Council (NE/N007352/1).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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