Word Count: 2,082 words Key Words: Tobacco outlets; Activity space; Youth tobacco use
ABSTRACTWe explored whether exposure to tobacco outlets in youths' broader activity spaces differs from that obtained using traditional geographic measures of exposure to tobacco outlet within buffers around homes and schools. Youths completed an initial survey, daily textprompted surveys, and carried GPS-enabled phones for one week. GPS locations were geocoded and activity spaces were constructed by joining sequential points. We calculated the number of tobacco outlets around these polylines and around homes and schools. Results suggest that activity spaces provide a more accurate measure of tobacco outlet exposures than traditional measures. Assessing tobacco outlet exposure within activity spaces may yield significant information to advance the field.KEY WORDS: Tobacco outlets; Activity space; Youth tobacco use
BACKGROUNDExposure to tobacco outlets may be an important factor in initiation and use of tobacco by adolescents. In particular, such exposure may increase access to tobacco, exposure to tobacco advertising and promotion, and exposure to others who use tobacco. All of these factors are related to youth tobacco use (Botello-Harbaum et al., 2009;Carpenter & Cook, 2008;DiFranza, Savageau, & Fletcher, 2009;Ding, 2003;Henriksen, Feighery, Wang, & Fortmann, 2004;Henriksen, Schleicher, Feighery, & Fortmann, 2010;Lipperman-Kreda, Grube, & Friend, 2012;Wakefield & Chaloupka, 2000). Controls over the number of tobacco outlets and their distance from residential areas or schools are frequently advocated approaches to reduce youth exposure and access to tobacco products and thus their tobacco use.A modest body of cross-sectional research has investigated the association between exposure to tobacco outlets around schools or residential areas and tobacco use among youths (Chan & Leatherdale, 2011;Henriksen et al., 2008;Leatherdale & Strath, 2007; LippermanKreda et al., 2014b; Lovato, Hsu, Sabiston, Hadd, & Nykiforuk, 2007;McCarthy et al., 2009;Novak, Reardon, Raudenbush, & Buka, 2006;Pokorny, Jason, & Schoeny, 2003;West et al., 2010). Results of these studies are mixed. Some studies have found no or small effects (Leatherdale & Strath, 2007; Lovato et al., 2007;McCarthy et al., 2009;Pokorny et al., 2003) and others have shown stronger associations with youth smoking (Chan & Leatherdale, 2011;Henriksen et al., 2008; Lipperman-Kreda et al., 2014b;Novak et al., 2006;West et al., 2010).The existing research, however, has considered exposure to tobacco outlets based on defined administrative units (e.g., census tract or ZIP code) or buffers (typically 0.5 to 1 mile) surrounding youths' homes or schools. These approaches fail to capture exposure to tobacco outlets in the broader environment where youths spend their time (i.e., activity spaces). For example, outlets that sell tobacco to youths may not be located near schools or homes, but rather located on the travel paths from schools to homes or around other important spaces such as com...