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Association between school-based tobacco retailer exposures and young adolescent cigarette, cigar and e-cigarette use
  1. Erika Trapl1,
  2. Andrew Anesetti-Rothermel2,
  3. Stephanie Pike Moore1,
  4. Haley Gittleman1
  1. 1Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
  2. 2PATH Branch, Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
  1. Correspondence to Dr Erika Trapl, Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA; erika.trapl{at}


Background Associations between retail tobacco availability and tobacco use have been mixed. This study examined associations between school-based retail environment exposures and current use of cigarettes, cigar products and e-cigarettes among middle school youth in Cleveland, OH.

Methods Retailers selling tobacco products were identified using the 2015 Cleveland Food Retail Database (n=639 stores). Youth survey data were drawn from the 2016 Cleveland Youth Risk Behavior Survey, administered to all 7th/8th graders across the Cleveland Metropolitan School District (n=3778, response rate=83.0%). Past 30-day cigarette, cigar product and e-cigarette use were assessed. Student demographics, number of days walking to/from school each week and number of times youth stopped at a retailer to/from school each week were included. For each school (n=63), tobacco retail density (TRD) and proximity (TRP) to nearest retailer were calculated for each product. Multiple regression analysis assessed associations between retail exposures and youth tobacco use.

Results Across all schools, 3.9%, 10.2% and 8.6% of students currently use cigarettes, cigar products and e-cigarettes, respectively, and 15.2% currently use at least one tobacco product. TRD and TRP were not associated with current use; frequency of walking to school and stopping at retailers were strongly associated with current use.

Conclusions Although TRD and TRP were not significantly associated with tobacco product use, youth who reported regularly walking to/from school or who reported stopping at a retail store before/after school were significantly more likely to be a current tobacco product user. This may be due to increased exposure to exterior and point-of-sale marketing.

  • non-cigarette tobacco products
  • priority/special populations
  • prevention
  • public policy

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  • Contributors All authors contributed the writing of this study. The study was conceptualised by ET and AA-R. Analysis was conducted by HG and SPM. ET was the lead author of the manuscript. All authors have reviewed the manuscript.

  • Funding This journal article is a product of a Health Promotion and Disease Prevention Research Centre supported by Cooperative Agreement Number 1U48DP005030 from the Centres for Disease Control and Prevention. The findings and conclusions in this journal article are those of the author(s) and do not necessarily represent the official position of the Centres for Disease Control and Prevention. Although author AAR is an FDA/CTP employee, this work was not done as part of his official duties. This publication reflects the views of the author and should not be construed to reflect the FDA/CTP’s views or policies.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The CLE-YRBS protocol was approved by the Institutional Review Board at Case Western Reserve University.

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

  • Data availability statement Data are available upon reasonable request. All of the individual participant survey data is available upon request via data requests or research proposals submitted through the Cleveland Metropolitan School District Office of Research and Evaluation. Individual retailer data from the Cleveland Food Retail Database as well as the data collection tools and protocols can be made available upon request. Data requests and research proposals should be directed to the lead author,

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