Proximity and density of tobacco retail locations to Kentucky schools and the relationship to youth perceptions of harm and susceptibility to e-cigarette use

BACKGROUND: With the continued concern of e-cigarette use among youth, it is crucial to understand risk factors that may be associated with 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 associated with increased e-cigarette use and susceptibility among youth, 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 cross-sectional design combining self-reported survey data and geospatial analysis. 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 < 0.05). 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 < 0.05). CONCLUSION: Greater density and proximity of tobacco retailers around schools were associated 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.