Significance Exploring proximity and density of heated tobacco product (HTP) and electronic nicotine delivery system (ENDS) points of sale (POS) to schools is critical for understanding youth marketing exposure and informing policy and enforcement to protect youth. This study examined IQOS and JUUL POS (prominent HTPs and ENDS), specifically their proximity to and density around schools in Israel.
Methods Using geospatial analysis and IQOS/JUUL website data, distance matrices were used to calculate distance from each school in Israel (grades 1–12) to the nearest POS and number of POS within 1 km, accounting for schools’ neighbourhood socioeconomic status (SES) ranking.
Results An average of 8.7 IQOS POS and 5.2 JUUL POS were within walking distance (1 km) from schools. Average distances from schools to nearest IQOS and JUUL POS were 954 m (median=365 m) and 1535 m (median=579 m), respectively. The percentages of schools with at least one IQOS or JUUL POS within 1 km were 86% and 74%, respectively. The average numbers of POS within 1 km of schools in low-SES, middle-SES, and high-SES neighbourhoods were 7.5, 9.9, and 7.6 for IQOS and 4.1, 5.9, and 5.5 for JUUL, respectively. Median distances from schools in low-SES, middle-SES, and high-SES neighbourhoods to nearest POS were 428 m, 325 m, and 403 m for IQOS and 1044 m, 483 m, and 525 m for JUUL.
Conclusions Youth experience high environmental exposure to IQOS and JUUL POS, particularly IQOS. POS were more densely located near schools in middle-SES neighbourhoods. Thus, regulating HTP and ENDS POS near schools and in certain neighbourhoods is key to reducing youth population impact in Israel and elsewhere.
- surveillance and monitoring
- socioeconomic status
- public policy
- electronic nicotine delivery devices
Data availability statement
Data are available upon reasonable request.
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Contributors DE was the lead author for this manuscript. DE lead all stages of the research working with lab director HL throughout. HL was the guarantor of the study and accepts full responsibility for all aspects of the study. YBZ, CJB and LA contributed equally both in planning the research and editing throughout the writing process of the manuscript.
Funding This research was funded with a grant from the Israeli Medical Association for Smoking Prevention and Cessation; and part of a grant by the National Cancer Institute (R01CA239178-01A1; MPIs CJB, HL).
Competing interests YBZ has received fees for lectures from Pfizer, Novartis and GSK Consumer Health (distributors of smoking cessation pharmacotherapy in Israel) in the past (2012–2007/2019). YBZ volunteers (without pay) as chair of the Israeli Medical Association for Smoking Prevention and Cessation. LA receives royalties for the sale of Text2Quit and is a shareholder in Welltok. HL had received fees for lectures from Pfizer Israel (distributor of a smoking cessation pharmacotherapy in Israel) in 2017. HL has been on the board (2017–2021) and chairman (2019–2021) of the Israeli Association of Public Health Physicians, Israel Medical Association.
Provenance and peer review Not commissioned; externally peer reviewed.