Environmental influences on individuals’ health and health behaviors are widely recognized. For example, alcohol consumption is encouraged by a “wet” environment, in which alcoholic beverages are prominent and easily accessible. In particular, adolescent drinking is associated with a high density of alcohol outlets and with liquor advertising and promotions at the point of sale. Environments with a high concentration of stores that sell tobacco, and the widespread advertising they contain, may similarly encourage adolescent smoking. However, this topic has received little attention. To address this important gap in the literature, the proposed study will describe the density of tobacco outlets and the quantity and nature of retail marketing materials for cigarettes near California high schools. In addition, it will test the hypotheses that:
• Adolescents from school environments with high tobacco outlet density are more likely to smoke than adolescents from school environments with low outlet density.
• Adolescent smokers prefer the cigarette brands advertised most heavily in stores closest to schools.
Estimates of 30-day smoking prevalence, use of menthol-flavored cigarettes, and usual brand smoked will be obtained from the upcoming California Student Tobacco Survey (CSTS), a biannual survey conducted for the Tobacco Control Section of California’s Department of Health Services. The 2005-2006 CSTS will yield responses from approximately 10,000 9th-12th graders attending 140 high schools throughout the state. These secondary data will be combined with two sources of primary data. Our research team will identify and geocode all stores that sell tobacco in the communities with a high school that participated in the CSTS in order to calculate multiple measures of outlet density. Additionally, trained coders will visit a random sample of all stores that sell tobacco within 1/2 mile of the 140 CSTS high schools to count and categorize cigarette marketing materials, such as branded signs, product displays, clocks, hand baskets and other functional items. Coders will indicate whether or not materials advertise menthol-flavored cigarettes and specify the brand (Marlboro, Camel, Newport, other). Outlet density will be represented by the number of tobacco retailers within 1/2 mile of high schools, within the school catchment area, and per 1,000 residents ages 10-17 in each community. Ad density will be represented by the average proportion of cigarette marketing materials for particular brands (e.g., Marlboro, Camel, Newport, or all mentholated brands combined). Regression estimates for current smoking on outlet density and for usual brand choice on ad density will be based on standard errors derived from SUDAAN, with data weighted for the complex sampling design and nonresponse.
Although geocoding and geographic information systems (GIS) are used increasingly in public health research, few studies employ these tools to measure tobacco outlet density or its relationship to adolescent smoking behaviors. This study will provide the first statewide estimate of outlet density in proximity to schools and its relationship to smoking prevalence and brand preference. Evidence of this important environmental influence on youth smoking would aid local governments in using zoning and conditional use permits to reduce the preponderance of retail tobacco outlets and marketing in California communities. |