Harlow Alyssa F, Thompson Laura K, Eckel Sandrah P, Leventhal Adam M, Haley Danielle F, Roberts Megan E, Cockburn Myles G, Barrington-Trimis Jessica L
Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA.
Tob Control. 2025 Jan 8. doi: 10.1136/tc-2024-058974.
Tobacco retailer density might influence youth e-cigarette use due to increased access and exposure to point-of-sale marketing. There is a need for longitudinal investigations on the association of tobacco retailer density with youth e-cigarette use, with consideration of contextual factors such as neighbourhood walkability that could enhance retailer exposure.
Five semi-annual waves (Fall 2021-Fall 2023) of a Southern California school-based cohort of youth who never vaped at baseline (n=3401; mean baseline age=15 years [range=12-17]) were merged with spatial data on tobacco retailers corresponding to each school year. Time-varying measures of retailer exposures included count of retailers within circular home buffers (800 m/1600 m buffers) and retailer density/km within home census tracts. Discrete-time survival analyses estimated associations of time-lagged and time-varying retailer exposures with vaping initiation at each 6-month follow-up, adjusting for race/ethnicity, parental education, neighbourhood walkability and an Area Deprivation Index. Secondary analyses examined moderation by neighbourhood walkability based on a National Walkability Index.
The incident rate of vaping initiation was 3.8% per 6-month follow-up. After covariate adjustment, only associations with census tract retail density were statistically significant (risk ratio (RR) highest vs lowest quartile=1.36, 95% CI=1.01 to 1.84). In moderation analyses, count of retailers within 800 m home buffers was positively associated with vaping initiation for youth who lived in the most walkable neighbourhoods (RR=1.08, 95% CI: 1.01 to 1.16), with no association for youth in less walkable neighbourhoods (RR=1.00, 95% CI:0.95 to 1.05; interaction p-value=0.0238).
Findings highlight the potential role of restricting retailer density in preventing youth vaping, particularly in areas characterised by both greater walkability and tobacco retailer density.
烟草零售商密度可能会因青少年更容易接触到烟草零售商以及接触到销售点营销活动，从而影响青少年电子烟的使用。有必要对烟草零售商密度与青少年电子烟使用之间的关联进行纵向调查，并考虑诸如邻里步行便利性等可能增加零售商曝光度的背景因素。
对南加州一个以学校为基础的青少年队列进行了五个半年期的随访（2021年秋季至2023年秋季），这些青少年在基线时从未使用过电子烟（n = 3401；平均基线年龄 = 15岁[范围 = 12 - 17岁]），并将其与每个学年对应的烟草零售商空间数据合并。零售商接触的时变测量包括圆形家庭缓冲区（800米/1600米缓冲区）内的零售商数量以及家庭普查区每平方公里的零售商密度。离散时间生存分析估计了在每次6个月随访时，滞后和时变的零售商接触与开始使用电子烟之间的关联，并对种族/族裔、父母教育程度、邻里步行便利性和地区贫困指数进行了调整。基于国家步行便利性指数的二次分析研究了邻里步行便利性的调节作用。
在每次6个月的随访中，开始使用电子烟的发生率为3.8%。在进行协变量调整后，仅与普查区零售密度的关联具有统计学意义（风险比（RR）最高四分位数与最低四分位数相比 = 1.36，95%置信区间 = 1.01至1.84）。在调节分析中，对于居住在步行便利性最高社区的青少年，800米家庭缓冲区内的零售商数量与开始使用电子烟呈正相关（RR = 1.08，95%置信区间：1.01至1.16），而对于步行便利性较低社区的青少年则无关联（RR = 1.00，95%置信区间：0.95至1.05；交互p值 = 0.0238）。
研究结果突出了限制零售商密度在预防青少年电子烟使用方面的潜在作用，特别是在步行便利性较高且烟草零售商密度较大的地区。
