TOBACCO OUTLET DENSITY AND PATHWAYS TO SMOKING AMONG TEENAGERS

Why are adolescents that live in areas with high concentrations of tobacco shops more likely to smoke?

New findings suggest Scottish teenagers living in areas with a high density of shops selling tobacco have greater knowledge about cigarette brands.

Earlier work in Scotland found that adults and adolescents living in areas with high densities of shops selling tobacco were more likely to smoke. Public health researchers have suggested that restrictions on tobacco retail outlet density are a potential ‘new frontier’ in the long-running campaign to achieve a tobacco ‘endgame’. However, the reasons why exposure to greater numbers of tobacco outlets is associated with smoking are unclear and the types of restrictions on retail density that might best support this public health goal are not known.

SALSUS _Q_cover_2A new study by CRESH has explored possible pathways linking tobacco outlet density to smoking among adolescents. Our work used responses from 22,049 13 and 15 year olds to the 2010 Scottish School Adolescent Lifestyle and Substance Use Survey. Data from the Scottish Tobacco Retailers Register were used to calculate a measure of the density of tobacco outlets around the survey respondents’ homes.

We were interested to know whether adolescents in areas with more tobacco outlets had better knowledge of tobacco products, and so assessed how many cigarette brands they could name. We also looked at whether adolescents in high outlet density areas had more positive attitudes about smoking as it has been suggested that exposure to outlets and the tobacco marketing and purchasing found within them may ‘normalise’ smoking. We examined whether in areas where there are more tobacco outlets it may be easier for adolescents to make underage cigarette purchases. Finally, we considered tobacco price, assessing whether in areas with more tobacco shops, and more retail competition, cigarettes were cheaper.

The study found no association between tobacco outlet density in adolescents’ neighbourhoods and their beliefs about smoking, frequency of purchases of cigarettes from shops or the price of their cigarettes.

L&BHowever, the results indicated that Scottish adolescents that lived in neighbourhoods with more tobacco outlets knew the names of slightly more cigarette brands than children in areas with fewer outlets. This relationship was found among smokers and non-smokers but was only statistically significant among those that had never smoked. These results suggests that children who are exposed to cigarette shops, and the marketing within them, absorb information about the cigarette products they see. Brand knowledge may be important as previous research has found familiarity with cigarette brands was associated with intention to smoke and smoking initiation among adolescents.

The survey data used in this analysis was collected before the recent ban on tobacco point-of-sale displays within shops, which required tobacco products to be covered, and the introduction of plain packaging laws for tobacco sold in Scotland. These new restrictions are intended to reduce exposure to tobacco products and marketing. This could mean contact with tobacco retail outlets may have less influence on knowledge of tobacco products among adolescents.

Recent proposals to restrict tobacco outlets have focussed upon different pathways to smoking. Some policies, such as outlawing sales in pharmacies in USA (already banned in UK), centre upon social norms. Other proposals to restrict total numbers or distance between outlets, including policies to restrict outlets close to schools, focus more widely upon reducing contact with tobacco retail. The small positive association found in this analysis between outlet density and knowledge about tobacco products among adolescents perhaps provides more support for policies that aim, more broadly, to reduce adolescents’ contact with tobacco outlets.

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