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Previous research investigating associations between adolescent tobacco/nicotine use and exposure to tobacco outlets in their daily lives is limited and data are mixed. First, it has only considered tobacco outlets around adolescents’ schools or homes. Therefore, it fails to capture exposure to tobacco outlets in the broader environment where the youths spend their time such as community centers, parks, or malls (i.e., activity spaces). Results of a pilot study we conducted suggest that traditional measures of tobacco outlet density around and proximity to homes and schools may misrepresent youth environmental exposures. Second, no previous research has reported on real-time data from youths about exposure to tobacco outlets and tobacco/nicotine use. Time-ordered data on youth exposure to tobacco outlets within their natural activity spaces and their tobacco/nicotine use is important for understanding how and why exposure to tobacco outlets influences youth tobacco/nicotine initiation and use. Moreover, real-time data can reduce recall error and increase applicability to youths’ natural environments. Finally, investigations have focused on smoking; less is known about the association between exposure to tobacco outlets and youth use of other tobacco/nicotine products such as smokeless tobacco, little cigars/cigarillos, and e-cigarettes.
To address these shortcomings, we will use geographical momentary assessment (GMA) methods that integrate GPS and ecological momentary assessment (EMA) to assess youth exposure to tobacco outlets in their broader activity spaces and obtain detailed information about their daily tobacco/nicotine use. The proposed study will be conducted in 8 midsized cities in Northern California. Observations of tobacco outlets in these cities will provide detailed data about outlet addresses, tobacco/nicotine products sold and retail marketing. We will recruit 120 youths (ages 16-20) and use smartphones with a GPS application and a survey application to track their movements and obtain data about daily exposures to tobacco outlets, perceptions of exposure, and use. Each youth will complete an initial survey, daily surveys, and carry the phone for two weeks. GPS data (i.e. latitude and longitude) and other geographical data will be geocoded and used to construct youth activity spaces as well as measures of exposure to tobacco outlets and to tobacco/nicotine products and marketing. We will link these measures to youth data about tobacco/nicotine use, beliefs and perceptions of exposure.
The specific aims are to: (1) describe youth activity spaces and exposure to tobacco outlets and to tobacco/nicotine products and retail marketing within these spaces; (2) compare youth exposure to tobacco outlets, tobacco/nicotine products and retail marketing within activity spaces with such exposures using traditional measures of tobacco outlet density and proximity of outlets to schools or residential areas and to compare the cross-sectional associations of the different exposure measures with adolescent tobacco/nicotine use and beliefs; (3) examine associations between youths’ daily exposure to tobacco outlets, tobacco/nicotine products and retail marketing within activity spaces and their daily tobacco/nicotine use and perceptions of exposure, and (4) explore whether different youths (e.g., low income) are more responsive to exposure to tobacco outlets in their activity spaces, and therefore at greater risk for tobacco/nicotine use. The proposed research addresses a timely topic in the field of tobacco control for which existing scientific data are mixed and more nuanced research is needed to fill knowledge gaps and to guide prevention efforts to reduce youth tobacco/nicotine use. |
