Table 1

Main characteristics of studies on the associations between tobacco retailer density/proximity and adult smoking outcomes

First authorCountry and data collection periodDesignSample size (n)ParticipantsTobacco productSpatial unitsDensity measureProximity measureMain outcome variablesControl variablesObserved associations
Barnes et al36Australia (Western Australia) 2003–2009CS12 270 (smokers and non-smokers)Adults 18+ (mean age 53)CigarettesEgocentric buffersNumber of tobacco outlets within 1600 m (0.5 mile) street network buffers from homeN/ACurrent smoking (daily or occasional)Individual level: age, sex, highest level of education, household income Socioeconomic Index for AreasIncrease in density positively associated with being a current smoker versus past smoker. OR: 1.01; 95% CI: 1.00 to 1.01
Cantrell et al43USA
CS4288 (smokers and non-smokers)Young adults aged 18–24; 25–34Cigarettes and non-combustible tobacco products (incl. e-cigarettes)Census tractsNumber of tobacco outlets per 10 km of roadwayN/AProduct initiationIndividual level: age, sex, race, education, depression
Census tract level: population, % below poverty, % Hispanic, % non-Hispanic black
State level: smoking prevalence, level of clean indoor air laws
Increase in density positively associated with initiation of cigarette use in ages 25–34. OR: 3.75, 95% CI: 1.18 to 11.90, p<0.05.
No association with initiation of non-combustible products (incl. e-cigarettes).
Cantrell et al45USA 2008–2010L2377 smokersAdults aged 18–49CigarettesEgocentric buffersNumber of tobacco outlets within: (a) 500 m; (b) 1 km and (c) 1.6 km of road network buffers around homesShortest street network distance in metres from participant’s residence to the nearest outlet categorised into quartilesSmoking abstinence >30 daysIndividual level: age, sex, race, marital status, heaviness of smoking, tobacco-related disease, education, awareness of media campaign, living with a smoker, mental health condition
Census tract level: % of African-Americans,% Hispanic, % below poverty
Density within 500 m negatively associated with abstinence (OR: 0.94; 95% CI: 0.90 to 0.98; p<0.01) only in high poverty areas.
Farther distance (proximity) to retailers was positively associated with abstinence only in high-poverty areas (OR: 2.80; 95% CI:1.51 to 5.19; p<0.001 for a proximity of about 900 m vs <500 m).
Chaiton et al25Canada: Ontario 2005–2008; 2011L2414 past month daily smokersAdults 18+ (mean age not reported)CigarettesEgocentric buffersNumber of outlets within 500 m circular buffer with a straight-line radius from participants’ homes
  1. Walking distance from home to the nearest tobacco outlet

  2. Presence of at least 1 tobacco outlet within 500 m from home

Quit attempts, relapseIndividual level: age, sex, marital status, having kids under 18 in household, education, region, perceived addiction, use of quit aids, heaviness of smoking index
Census level: household income, % immigrants
Increased density negatively associated with quit attempts only in high-income neighbourhoods (OR: 0.54, 95% CI: 0.35 to 0.85, p<0.05).
Presence of at least one retailer within 500 m positively associated with relapse (OR: 1.11, 95% CI: 1.00 to 1.23, p<0.05).
Chuang et al46USA: California 1979–1990CS8121 (smokers/non-smokers)Adults aged 25–74Cigarettes
  1. Census tracts, census block groups, combination of both (n=82)

  2. Egocentric buffers

  1. Number of convenience stores per 1 square mile divided into tertiles (density)

  2. Number of convenience stores within 1-mile circular buffers divided into tertiles (count)

Straight-line distance from home to the nearest convenience store in milesNumber of cigarettes a dayIndividual level: age, sex, race, SES (education, household income)
Census level: neighbourhood SES
High census-level density positively associated with smoking (β=0.174, SE=0.077, p<0.05).
Density as count in ego-hoods showed no association.
Proximity negatively associated with smoking (β=−0.154, SE=0.066, p<0.05).
No associations for any three measures in a model adjusted for neighbourhood SES.
Fleischer et al26Canada (10 provinces) 2005–2011L4388 smokers (abstinence outcome);
866 smokers (relapse outcome)
Adults (mean age 47 and 53, depending on the wave and sample)CigarettesEgocentric buffersNumber of outlets within 1 km street network buffers around home addresses or postal code centroidsStraight-line distance from home to the nearest outlet in kilometres30-day abstinence, relapseIndividual level: age, sex, education, income
Province level: province, cigarette price, point-of-sale bans
No associations
Halonen et al35Finland
L8751 smokersAdults (mean age 50)CigarettesEgocentric buffers; area-level neighbourhoods as coordinates on the 250 m map squaresNumber of outlets within 0.5 km straight-line and street network buffers around homesStraight-line and walking distances from home to the nearest outletCessationIndividual level: age, sex, occupational status (proxy for SES), marital status, alcohol use, smoking intensity
Registry level: housing tenure (proxy for SES), baseline diseases
Area level: neighbourhood SES, population density
Having one versus no outlets within 0.5 km negatively associated with cessation only in moderate/heavy male smokers (PR: 0.63, 95% CI: 0.49 to 0.81, p<0.05).
Proximity of <0.50 km (vs ≥0.50 km) negatively associated with cessation only in moderate/heavy male smokers (PR: 0.73, 95% CI: 0.60 to 0.88, p<0.05).
Kirchner et al51USA: Minnesota
CS1201 non-daily smokers (NDS)Adults aged 25+
(mean age 41.38)
CigarettesResidential ZIP codes (n=1054)Number of outlets per square mile categorised in quartilesN/A6-month quit intentionsIndividual level: age, race, sex, education, household income, number of cigarettes/day, number of days smoked, time to first cigarettePrice-sensitive NDS residing in areas with higher (vs lower) outlet density less likely to hold quit intentions (likelihood ratio test statistic=G2=66.1, p<0.001).
Kirst et al27Canada: Toronto
CS2412 (smokers and non-smokers)Adults aged 25–54CigarettesCensus tract (n=87)Number of outlets per km2N/APast 30-day smokingIndividual level: income, sex, age, marital status, immigrant status, education level, household income
Census tract level: neighbourhood disorder, neighbourhood income
No association
Marashi-Pour et al3Australia: NSW
CS31 260 (smokers and non-smokers)Adults 16+ (median age 58)CigarettesCensus collection districts (n=11 811)Mean number of outlets per 1000 persons within each census collection district or postal areaN/ACurrent smoking (daily or occasional)Individual level: age, sex, country of birth, Aboriginal status
Census level: neighbourhood SES, % males, % born in Australia, % minors
High density positively associated with smoking (OR=1.11; 95% CI: 1.02 to 1.21; p=0.018).
Pearce et al38Scotland
CS28 751 (smokers and non-smokers)Adults aged 16+ (mean age not provided)CigarettesPostal codes (n=152 400)Proximity-weighted estimate of the outlet density per km2 for each postal codeN/ACurrent smoker, ex-smokerIndividual level: age, sex, ethnicity, education, household income
Area level: rurality
Highest (vs lowest) density positively associated with being a current smoker (dy/dx=0.07; 95% CI: 0.05 to 0.10; p<0.01) and negatively associated with being an ex-smoker (dy/dx=−0.05; 95% CI: −0.09 to –0.02; p<0.01)
Pearce et al32New Zealand
CS12 529 (smokers and non-smokers)Adults aged 15+ (mean age not provided)CigarettesCensus mesh blocks (n=1178) represented by their population-weighted centroidsN/ATravel time by car (min) to the nearest outlet along the road network, categorised in quartiles (worst/worse/better/best access)Everyday smokingIndividual level: age, sex, ethnicity, social class
Census block level: neighbourhood deprivation, rurality
Best access to supermarkets (OR=1.23, 95% CI:1.06 to 1.42) and convenience stores (OR=1.19, 95% CI:1.03 to 1.38) positively associated with smoking.
No associations in a model adjusted for neighbourhood deprivation and rurality.
Pulakka et al34Finland
L20 729 (smokers and ex-smokers)Adults aged 18–75CigarettesN/AChange in walking distance from home to the nearest outlet address (difference between baseline and follow-up distance)Smoking cessation and relapseIndividual level: age, sex, education (proxy for SES), marital status, recent financial hardship, recent death or illness in family, employment status, chronic diseasesIncrease in distance (proximity) positively associated with smoking cessation (pooled OR: 1.16; 95% CI: 1.05 to 1.28; p=0.004) and not associated with smoking relapse.
Shareck et al28Canada: Montreal
CS921 (individuals who smoked at least one cigarette in their lifetime)Young adults aged 18–25CigarettesEgocentric buffersNumber of outlets in 500 m street network buffers from home/across activity spaces (AS), categorised in tertiles (low/medium/high)Walking distance to the nearest outlet from home/AS location, categorised in tertiles (closest/intermediate/furthest)Smoking cessationIndividual level: age, sex, education, time since smoking onset, number of years smoked, occupation
Area level: neighbourhood deprivation
Positive for low (vs high) residential density (PR=1.28; 95% CI: 1.10 to 1.50; p<0.05) and density in AS (PR: 1.28; 95% CI: 1.08 to 1.51; p<0.05).
Positive for the furthest (vs closest) proximity to AS (PR: 1.21; 95% CI: 1.02 to 1.43; p<0.05). No association with proximity to homes.
Shareck et al29Canada: Montreal
CS1994 (smokers and non-smokers)Young adults aged 18–25CigarettesEgocentric buffersNumber of outlets in 500 m street network buffers from home/across AS, categorised in tertiles (low/medium/high)Shortest walking distance to the nearest outlet from home/AS location, categorised in tertiles (closest/intermediate/furthest)Current smoking (defined as smoking daily or occasional)Individual level: age, sex, education status and attainment.
Census level: neighbourhood deprivation
Positive for high (vs low) residential density (PR: 1.53; 95% CI: 1.23 to 1.91; p<0.05) and density in AS (PR: 1.46; 95% CI: 1.26 to 1.70; p<0.05).
Positive for closest (vs furthest) proximity to AS (PR: 1.42; 95% CI: 1.09 to 1.86; p<0.05). No association with proximity to homes.
  • CS, cross-sectional; L, longitudinal; N/A, not applicable; NSW, New South Wales; PR, prevalence ratio; SES, socioeconomic status.