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The Effects of Tobacco Outlets on Adolescent Smoking

A recent meta-analysis carried out by the Prevention Research Center of the Pacific Institute for Research and Evaluation shows that the presence of a large number of stores that sell tobacco near where adolescents live may increase their risk for cigarette smoking.

The researchers conducted a meta-analysis to investigate the association between tobacco outlet density around homes and schools and whether adolescents had smoked within the past month.  The meta-analysis combined the results of a number of previous studies to gain an overall picture of the findings. 

Studies included in the meta-analyses were from six different countries (most drawing from the U.S.) and included samples that ranged from 832 to 27,238 adolescents. These studies controlled for individual-, family-, and community-level characteristics that have been associated with adolescent smoking (e.g., age, gender or parental smoking) and tobacco outlet density (e.g., indicators of neighborhood disadvantage). The findings indicate that for homes, but not for schools, there was an association between tobacco outlet density and adolescents’ past-month cigarette smoking, such that a one unit increase in tobacco outlet density around homes was associated with an 8% increase in the odds that an adolescent had smoked within the past month.

Exposure to tobacco outlets may influence adolescents’ cigarette smoking through a few potential processes. These include increased access to cigarettes, exposure to tobacco marketing and exposure to other cigarette smokers (i.e., role models). In addition, to the presence of tobacco outlets may normalize cigarette smoking and tobacco products in the community. Exposure to tobacco outlets may affect adolescents’ cigarette smoking directly or may be mediated through perceived ease of obtaining cigarettes, perceptions of the prevalence acceptability of smoking, or perceptions of the personal consequences associated with cigarette smoking.  It is possible that the environment surrounding the home is more important for the development of perceptions about community norms and personal beliefs and thus adolescents’ smoking behaviors. Alternatively, it may be that outlet density around homes is a better proxy for exposure to tobacco retail outlets than is exposure around schools in part because adolescents may spend more unstructured time around homes than schools.

Study authors pointed out that controls over the number of tobacco outlets (i.e., outlet density per unit area) and their distance from residential areas are potentially effective ways of reducing adolescents’ exposure and access to tobacco and cigarette smoking.

Finan, L. J., Lipperman-Kreda, S., Abadi, M., Grube, J. W., Kaner, E., Balassone, A., & Gaidus, A. (2018). Tobacco outlet density and adolescents’ cigarette smoking: a meta-analysis. Tobacco Control. doi: 10.1136/tobaccocontrol-2017-054065