Youths’ Exposure to Tobacco Outlets in Activity Spaces: Daily Associations with Tobacco, Nicotine, and Marijuana Use and Co-Use

We investigated young people’s daily exposure to tobacco outlets in their activity spaces and their tobacco/nicotine and marijuana use and co-use, using Geographical Ecological Momentary Assessment (GEMA). To date, data have been collected from 39 participants (15-20 years old) in 8 California cities for 14 days. In an initial survey, participants reported age, sex, race/ethnicity, and subjective family socioeconomic status. Using GPS-enabled smartphones with a survey application, they responded to brief daily surveys and location coordinates (latitude and longitude) were obtained at one minute intervals throughout the study. Tobacco outlet addresses and GPS locations were geocoded and activity spaces were constructed by joining sequential points. Exposure measures included the number of tobacco outlets within 50m or 100m of these polylines and the amount of time participants were within 50m or 100m of tobacco outlets each day. We excluded days in which participants were tracked for less than 360 min, leaving us with 439 days for analysis. Prevalence of co-use of tobacco/nicotine and marijuana was 21.1%. Controlling for demographics, no associations were found between exposure measures and tobacco/nicotine and marijuana use and co-use in multilevel logistic regression analyses. However, we found interactions between number of outlets within 50m of participants’ polylines and age group (i.e., under 18 years old versus 18 or older) on marijuana use (OR=0.83, p=0.004) and tobacco/nicotine and marijuana co-use (OR=0.87, p=0.07), and between number of tobacco outlets within 100m of participants’ polylines and age group on their daily tobacco/nicotine use (OR=0.91, p=0.09), marijuana use (OR=0.86, p=0.007), and tobacco/nicotine and marijuana co-use (OR=0.90, p=0.05). These interactions indicated that exposure to tobacco outlets was associated with increased risks for tobacco/nicotine and marijuana use and co-use among those under 18 years of age but not older. Our results suggest that younger youth are more susceptible to exposure to tobacco outlets in their daily lives, and that the number of outlets, but not the time they spend around these outlets, matters.

Acknowledgement

This study was funded by grant number 25IR-0029 (S. Lipperman-Kreda, PI) from the California Tobacco-Related Disease Research Program (TRDRP). The content is solely the responsibility of the authors and does not necessarily reflect the opinions of TRDRP.