PT - JOURNAL ARTICLE AU - Joseph G L Lee AU - Amanda Y Kong AU - Kerry B Sewell AU - Shelley D Golden AU - Todd B Combs AU - Kurt M Ribisl AU - Lisa Henriksen TI - Associations of tobacco retailer density and proximity with adult tobacco use behaviours and health outcomes: a meta-analysis AID - 10.1136/tobaccocontrol-2021-056717 DP - 2021 Sep 03 TA - Tobacco Control PG - tobaccocontrol-2021-056717 4099 - http://tobaccocontrol.bmj.com/content/early/2021/09/03/tobaccocontrol-2021-056717.short 4100 - http://tobaccocontrol.bmj.com/content/early/2021/09/03/tobaccocontrol-2021-056717.full AB - Objective We sought to conduct a systematic review and meta-analysis of evidence to inform policies that reduce density and proximity of tobacco retailers.Data sources Ten databases were searched on 16 October 2020: MEDLINE via PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus, plus grey literature searches using Google and the RAND Publication Database.Study selection Included studies used inferential statistics about adult participants to examine associations between tobacco retailer density/proximity and tobacco use behaviours and health outcomes. Of 7373 studies reviewed by independent coders, 37 (0.5%) met inclusion criteria.Data extraction Effect sizes were converted to a relative risk reduction (RRR) metric, indicating the presumed reduction in tobacco use outcomes based on reducing tobacco retailer density and decreasing proximity.Data synthesis We conducted a random effects meta-analysis and examined heterogeneity across 27 studies through subgroup analyses and meta-regression. Tobacco retailer density (RRR=2.55, 95% CI 1.91 to 3.19, k=155) and proximity (RRR=2.38, 95% CI 1.39 to 3.37, k=100) were associated with tobacco use behaviours. Pooled results including both density and proximity found an estimated 2.48% reduction in risk of tobacco use from reductions in tobacco retailer density and proximity (RRR=2.48, 95% CI 1.95 to 3.02, k=255). Results for health outcomes came from just two studies and were not significant. Considerable heterogeneity existed.Conclusions Across studies, lower levels of tobacco retailer density and decreased proximity are associated with lower tobacco use. Reducing tobacco supply by limiting retailer density and proximity may lead to reductions in tobacco use. Policy evaluations are needed.Data are publicly available in the East Carolina University dataverse, https://doi.org/10.15139/S3/6175L7.