By Niamh Shortt
Teenagers are more likely to smoke if they live in areas with the highest number of tobacco retailers. Our paper led by Niamh Shortt, published today in Tobacco Control, examined the relationship between tobacco outlet density and smoking habits of 13 and 15 year olds in Scotland. Niamh summarises the work in this short clip:
Smoking is the leading cause of preventable ill-health and premature death in Scotland. Every year 13,000 deaths and 56,000 hospital admissions in Scotland are attributable to smoking. Whilst smoking rates have been falling in Scotland they are falling at a slower pace amongst more deprived groups. Across the whole of Scotland smoking rates average 23%, but this hides the inequalities that exist: rates range from 40% in the most deprived areas to 11% in the least deprived areas. Smoking rates amongst adolescents in Scotland are also falling, from 30% of 15 year olds in 1996 to 13% in 2010. Youth smoking remains an important concern because those who start smoking at a younger age are more likely to become regular smokers in adulthood and those who have not started smoking as a teenager are unlikely to ever become a smoker.
The Scottish Government have set a target to be smoke free (less than 5% of the population smoking) by 2034. The Tobacco Control Strategy, launched in 2013, focuses on ‘doing all we can to encourage children and young people to choose not to smoke’. The Strategy focusses on three themes: prevention, protection and cessation. The first theme, prevention, aims ‘to create an environment where young people choose not to smoke’. But what links ‘environment’ to whether or not people ‘choose’ to smoke?
Previous work by Jamie Pearce (here at CRESH) and colleagues considers how various aspects of the local environment can be important in explaining smoking behaviours. These include levels of social capital and neighbourhood crime, as well as the availability and advertising of tobacco products. One potentially important environmental aspect is the number of retailers in a neighbourhood selling tobacco products. This may be important in several ways. First, living in a neighbourhood with a high number of tobacco retailers increases the ease with which individuals can access tobacco products. Second, tobacco products are normalised in such environments implying that these products are socially acceptable commodities. Third, a large numbers of tobacco retailers can create a competitive local market that keeps the price of cigarettes down. Lastly, a higher number of retailers in a neighbourhood may make it more difficult for individuals to quit.
In our research (supported by the Scottish Collaboration for Public Health Research and Policy (SCPHRP)) we examined the association between smoking behaviours of 13 and 15 year olds in Scotland and the numbers of tobacco retailers within both their residential and school neighbourhoods. Details of our methodology are available in a separate blog post, but in summary we gathered the addresses and postcodes of every outlet in Scotland registered to sell Tobacco (10,161) and used Geographic Information Systems (GIS) techniques to create measures of retail outlet density for every postcode in Scotland: see example map below for Edinburgh. We then joined our density measures to individual responses from the 2010 wave of the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) (n = 20,446). This allowed us to quantify the association between tobacco retail density and levels of current smoking and ever having tried smoking (whilst controlling for other important factors).
Our results demonstrate that:
- Teenagers living in the areas with the highest density of tobacco retailers had 53% higher odds of reporting having ever smoked and 47% higher odds of reporting current smoking.
- Teenagers attending schools in areas of highest retail outlet density had 34% lower odds of ever having smoked and 25% lower odds of current smoking.
- Our study controlled for poverty or deprivation at both the family and area level. As such our results exist regardless of the levels of poverty or deprivation in an area.
Our results show a strong association between tobacco retail outlet density in teenagers’ home neighbourhoods, and their levels of smoking. Teenagers are more likely both to try smoking and to currently smoke in neighbourhoods with the highest numbers of tobacco retailers. This is consistent with international research. Our finding of reduced odds of smoking in school neighbourhoods with the highest number of retailers was somewhat surprising, but may be explained by higher levels of surveillance among retailers in close proximity to schools and the fact that teenagers in Scotland are more likely to wear school uniforms and are therefore visibly underage. This may mean that any policy focussing solely on reducing tobacco retailers around schools is unlikely to reduce smoking amongst teenagers. Our results suggest that we need to look at the total environment and reduce the overall number of retailers – this may help to reduce the rates of teenage smoking.
This research is important for policy. An influential 2012 report, published by the Royal College of Physicians and the UK Centre for Tobacco Control Studies (now the UK Centre for Tobacco and Alcohol Studies), reported little or no evidence base for retail interventions but suggested that restricting the number/density of outlets in a locality, or having a minimum distance between outlets, could have an impact on smoking uptake and perpetuation. Our results support this assertion and confirm that in Scotland the density of tobacco outlets in a neighbourhood is associated with higher odds of smoking in Scottish teenagers. If Scotland is to become ‘smoke-free’ by 2034 then we should consider reducing the numbers of shops in our neighbourhoods that are permitted to sell tobacco products. ‘An environment where young people choose not to smoke’ is not one where tobacco products are sold on every street corner.