Associations between Youths’ Daily Exposure to Tobacco Outlets within Their Activity Spaces and Cigarette Smoking Behaviors: Are Some Youths More Susceptible?

Introduction: Exposure to tobacco outlets may be an important risk factor for cigarette smoking among adolescents and young adults. To address shortcomings in the existing research, we examined (1) associations between youths’ daily exposure to tobacco outlets within their activity spaces and cigarette smoking and (2) whether demographic characteristics (e.g., sex, age) moderated these associations.

Methods: Geographical Ecological Momentary Assessment (GEMA) data were collected from youth (N=101; 16-20 years old) in 8 California cities for 14 days (1,483 assessments). Youth responded to brief daily surveys about smoking behaviors using GPS-enabled smartphones with a survey application. Location coordinates (latitude and longitude) were obtained at one-minute intervals across the study. Tobacco outlet addresses and GPS location coordinates were geocoded. Activity spaces were constructed by joining sequential location coordinates. Exposure measures included the number of tobacco outlets within 100m of activity space polylines and the amount of time participants were within 100m of tobacco outlets each day. Each day, youth reported whether they smoked at least one cigarette (yes/no) and the number of cigarettes they smoked. In an initial survey, participants reported age, sex, race/ethnicity, and subjective family socioeconomic status. We used multilevel mixed effects regression models to control for clustering of observations within participants over time.

Results: Controlling for demographics, no associations were found between the likelihood of cigarette smoking on each day and the number of tobacco outlets within 100m of youths’ activity space polylines or the amount of time they were within 100m of tobacco outlets. However, the number of cigarettes smoked each day was associated with both the number of outlets within 100m of youths’ activity space polylines (b=0.02, p<0.001) and the amount of time they were within 100m of tobacco outlets (b=0.002, p<0.01). Moreover, we found a significant interaction between the number of outlets within 100m of youths’ polylines and age group (i.e., under 18 years old) on number of cigarettes smoked (b=-0.04, p<0.001). Also, we found a significant interaction between number of outlets within 100m of youths’ polylines and perceived socioeconomic status on number of cigarettes smoked (b=-0.01, p<0.05). These interactions indicate that daily exposure to tobacco outlets is associated with increased number of cigarettes smoked per day among older youths and among those of lower socioeconomic status.

Conclusions: Results suggest that daily exposure to tobacco outlets within activity spaces may increase youths’ risk for heavier smoking. Young adults and youths of low socioeconomic status may be at greater risk.