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Association of Outlet Density with Smoking and Pack Price

Institution: Stanford University
Investigator(s): Lisa Henriksen, Ph.D.
Award Cycle: 2008 (Cycle 17) Grant #: 17RT-0152 Award: $515,010
Subject Area: Public Health, Public Policy, and Economics
Award Type: Research Project Awards

Initial Award Abstract
The tobacco industry’s primary venues for marketing cigarettes to current and future smokers are convenience stores, small grocery or “corner” stores, liquor stores, gas stations, supermarkets and pharmacies, all of which we refer to as tobacco outlets. Beginning with the award for “Effects of Outlet/Ad Density on Teen Smoking and Brand Choice,” our goal has been to understand whether the concentration of tobacco outlets in a neighborhood, and the widespread cigarette advertising these stores contain, create an environment that promotes smoking. Our research linked data from the 2005-2006 California Student Tobacco Survey with retailer licensing data to measure the density of tobacco outlets near schools and with observations of tobacco marketing in a random sample of those outlets. Within walking distance of schools we found an average of five tobacco outlets and one cigarette ad for every four residents ages 10-17. As predicted, smoking prevalence was higher at schools in neighborhoods with more tobacco outlets and cigarette ads, adjusting for both school and neighborhood characteristics.

This proposal seeks continued funding to better understand the relationship between tobacco outlet density and tobacco use. A revised title illustrates a change in outcome (from adolescent to adult smoking) and the inclusion of more detailed data about cigarette prices and promotions (e.g., multi-pack discounts).

Given that retail outlets are more important sources of cigarettes for adult than for adolescent smokers, it is surprising that so little research examines whether and how tobacco outlet density promotes adult smoking. Two studies are proposed to remedy this concern.

Study 1 links tobacco use data from the California Health Interview Survey (CHIS) (n=36,857 adults) with retailer licensing data and Census data to describe the respondents’ neighborhoods (n=1,072 census tracts). Multilevel modeling will test whether higher tobacco outlet density is associated with greater odds of current smoking, adjusting for other individual and neighborhood characteristics. It will test whether the association of density with smoking is greater in low income or ethnic minority neighborhoods than in other neighborhoods, and whether it is equal for all neighborhood residents or more problematic for residents of particular racial/ethnic groups.

Higher tobacco outlet density may promote smoking, in part, by making cigarettes more available. Shorter distances between stores reduce search costs and competition between stores in close proximity reduces actual costs. However, our analysis of pack prices in school neighborhoods found that higher tobacco outlet density was associated with higher pack prices for all brands we examined. This unexpected finding raises concerns that the goal of policies to decrease tobacco outlet density could be undermined if they led to lower cigarette prices. A better understanding of the relationship between tobacco outlet density and cigarette price is needed. Study 2 links observations of price and promotions from a random sample of convenience stores (n=300) with data about the location and type of tobacco outlets in each store neighborhood. Multilevel modeling will test whether cigarettes cost less in neighborhoods with higher tobacco outlet density, adjusting for both store and neighborhood characteristics. This evidence would provide a stronger rationale for using land use planning and zoning laws to limit tobacco outlet density. Evidence that cigarettes cost less in neighborhoods with lower tobacco outlet density would suggest that policies to limit tobacco outlet density cannot substitute for policies to control cigarette pricing.

Although geo-spatial techniques are used increasingly to examine the complex relationships between environment and health, few studies apply these tools to study adult smoking. The proposed research will advance our understanding of the health risks associated with the availability and visibility of cigarettes and provide a scientific rationale for public policies to reduce them.