Tobacco Retail Outlets and Vulnerable Populations in Ontario, Canada

Abstract

Interest has been increasing in regulating the location and number of tobacco vendors as part of a comprehensive tobacco control program. The objective of this paper is to examine the distribution of tobacco outlets in a large jurisdiction, to assess: (1) whether tobacco outlets are more likely to be located in vulnerable areas; and (2) what proportion of tobacco outlets are located close to schools. Retail locations across the Province of Ontario from Ministry of Health Promotion data were linked to 2006 Census data at the neighbourhood level. There was one tobacco retail outlet for every 1,000 people over age 15 in Ontario. Density of outlets varied by public health unit, and was associated with the number of smokers. Tobacco outlets were more likely to be located in areas that had high neighbourhood deprivation, in both rural and urban areas. Outlets were less likely to be located in areas with high immigrant populations in urban areas, with the reverse being true for rural areas. Overall, 65% of tobacco retailers were located within 500 m of a school. The sale of tobacco products is ubiquitous, however, neighbourhoods with lower socio-economic status are more likely to have easier availability of tobacco products and most retailers are located within walking distance of a school. The results suggest the importance of policies to regulate the location of tobacco retail outlets.

Tobacco retail availability and risk of relapse among smokers who make a quit attempt: a population-based cohort study

“…Changes to zoning and licensing of tobacco has the possibility of reducing the number of outlets substantially 3–6. For instance, limiting the sale of tobacco within 500 m of schools would have the effect of reducing the number of outlets by over 60% in Ontario 15. This study adds to the growing literature demonstrating an effect of tobacco retail availability and the potential of restrictions on availability as an effective tobacco control intervention.…”

The added value of accounting for activity space when examining the association between tobacco retailer availability and smoking among young adults

“…In addition, the sight of smokers gathering in proximity to retailers could trigger contagion or normalisation effects 18. High retailer counts may be more specifically indicative of a more price-competitive market, as well as of smoking being more socially acceptable as a practice,7 48 while proximity lowers the travel costs of smoking 49. These putative mechanisms linking tobacco retailer availability and smoking have mostly been discussed with regard to residential and school neighbourhoods, but they could also be at play in other settings, as individuals go about their daily activities 19 23…”

“…One avenue of promising population-level tobacco control intervention lies in targeting contextual features such as tobacco retailer availability,6 defined as the degree of convenience in obtaining tobacco products, which is affected by the number and location of retailers 6 7. The density of tobacco retailers around home8–10 or school11 12 has been associated with a higher likelihood of smoking in youth.…”

“…While counts represent the overall number of tobacco retailers encountered in a given area, proximity approximates the ease of physical access to them. It is assumed that, all else being equal, the closer one is to a tobacco retailer, the easier it is to buy cigarettes or the more tempted one might be to smoke 7 31. We hypothesised that young adults who lived or conducted activities in areas with high numbers of (or in close proximity to) tobacco retailers, would be more likely to smoke than those living or conducting activities in areas with fewer tobacco retailers (or farther from such outlets).…”

Walking Distance to Tobacco Outlets in Vulnerable Areas Baltimore City: An Issue of Health Equity

“…In addition, studies have shown that tobacco outlet density tends to be highest in lower socioeconomic neighborhoods or areas, resulting in a signifi cant issue of health equity [8,[10][11][12].…”