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Tobacco outlet density and adolescents’ cigarette smoking: a meta-analysis
  1. Laura J Finan1,
  2. Sharon Lipperman-Kreda1,
  3. Melissa Abadi2,
  4. Joel W Grube1,
  5. Emily Kaner1,
  6. Anna Balassone1,
  7. Andrew Gaidus1
  1. 1Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California, USA
  2. 2Louisville Center, Pacific Institute for Research and Evaluation, Louisville, Kentucky, USA
  1. Correspondence to Dr Laura J Finan, Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA; lfinan{at}


Objective We conducted meta-analyses of studies that investigated the associations between tobacco outlet density around homes and schools and adolescents’ past-month cigarette smoking.

Data sources Systematic literature searches of eight databases were carried out in February 2017. Searches were not limited by date, language, country or peer-reviewed status.

Study selection After screening for quality, studies that examined the relationship between tobacco outlet density and adolescents’ past-month smoking were selected for inclusion.

Data extraction Two investigators screened study abstracts and full texts and independently extracted data. Consensus was reached at each stage.

Data synthesis Random-effects meta-analyses were conducted on 11 studies that provided 13 effect sizes. Results showed that there was a significant association between tobacco outlet density around homes and adolescents’ past-month smoking behaviour, with an overall effect size of OR=1.08 (95% CI 1.04 to 1.13; P<0.001; I2=0%). For density around schools, the association was not statistically significant (OR=1.01, 95% CI 0.98 to 1.03; P=0.53; I2=39%).

Conclusions These findings suggest that exposure to tobacco outlets near home environments may be important for understanding adolescents’ past-month smoking. Restricting access to tobacco outlets and controlling the number of outlets in residential areas may be an effective preventive strategy to help reduce adolescents’ smoking.

  • environment
  • prevention
  • public policy

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  • Contributors LJF and SL-K conceptualised the study. LJF, SL-K and MA reviewed and extracted data from studies. All authors contributed to the writing and editing of the manuscript.

  • Funding This research and preparation of this manuscript were supported by grant 25IR-0029 from the California Tobacco-Related Disease Research Program (TRDRP) and grants P60-AA006282 and T32-AA014125 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the TRDRP, NIAAA or NIH.

  • Competing interests None declared.

  • Patient consent Not required.

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