Proximity and Density of Tobacco Retail Locations to Kentucky Schools and the Relationship to Youth Perceptions of Harm and Susceptibility to E-cigarette Use

Abstract Background With the continued concern of e-cigarette use among youth, it is crucial to understand risk factors that may increase susceptibility to e-cigarette use and current use. Tobacco retailer placement and youth exposure to advertisements and products through brick-and-mortar locations may be a contributing risk factor to youth's e-cigarette use and susceptibility, yet youth exposure to tobacco retail locations as a potential influential factor for tobacco use is largely under-researched. The purpose of this study is to explore the potential relationship between tobacco retailer proximity/density around Kentucky elementary, middle, and high schools, and students’ perceptions of harm, perceived norms, susceptibility to, and use of e-cigarettes. Methods This study used a mixed-methods analysis of youth’s self-reported survey results and geographical data collection. Participants (N = 7,823) consisted of a convenience sample of students from 106 Kentucky elementary, middle, and high schools which participated in a tobacco education program between September 2023 and May 2024. Items assessing e-cigarette use, susceptibility, perceptions, and perceived norms were measured through an online survey. ANOVA tests were used to compare responses of elementary, middle, and high school students. Chi-squared tests were used to compare measures in proximity and density groups. Results High density of tobacco retailers around schools was positively associated with greater rates of susceptibility and lower perceived risks of e-cigarette use compared to lower density groups (p < .05). Students within one mile of a retailer were more likely to report positive perceptions of e-cigarettes compared to students further than one mile (p < .05). Conclusion Greater density and proximity of tobacco retailers around schools correlates with higher e-cigarette use, susceptibility, and positive perceptions of use. Identifying areas of influence for youth e-cigarette use, and implementation of appropriate restrictions may sufficiently decrease youth exposure to tobacco products and advertising, lowering future health inequalities among young people in Kentucky.