Neighbourhood tobacco retail access and tobacco use susceptibility in young adolescents in urban India

BackgroundNeighbourhood tobacco retail access may influence adolescent tobacco use. In India, we examined the association between neighbourhood tobacco retail access and cognitive risks for tobacco use during early adolescence.MethodsIn 2019–2020, a population-based sample (n=1759) of adolescents aged 13–15 years was surveyed from 52 neighbourhoods in Mumbai and Kolkata. Neighbourhood tobacco retail access was measured as the frequency of visits to tobacco retailers, mapped tobacco retailer density and perceived tobacco retailer density. We estimated associations between neighbourhood tobacco retail access and cognitive risks for tobacco use (perceived ease of access to tobacco, perceived peer tobacco use and intention to use tobacco).ResultsThere was high neighbourhood tobacco retail access. Tobacco retailer density was higher in lower income neighbourhoods (p<0.001). Adolescent frequency of tobacco retailer visits was positively associated with cognitive tobacco use risks. Mapped tobacco retailer density was associated with perceived ease of access in Kolkata but not in Mumbai, and it was not associated with perceived peer tobacco use nor intention. Perceived tobacco retailer density was associated with perceived ease of access and perceived peer use, but not with intention. In Kolkata, higher perceived retailer density and frequency of tobacco retailer visits were negatively associated with perceived ease of access.ConclusionsEfforts to reduce neighbourhood tobacco retail access in India may reduce cognitive tobacco use risk factors in young adolescents. The frequency of tobacco retailer visits and perceived tobacco retailer density increased cognitive risks, though there were some exceptions in Kolkata that further research may explain.

Improving Retailer Compliance for Tobacco Purchases: Pilot Study Findings

Objectives: Those underage should not use tobacco products, including electronic nicotine delivery systems. A technologically-based solution developed by Juul Labs Inc to restrict underage access seeks to automate transactions, structurally mandate age-verification, and limit the quantity of JUUL products purchased per transaction. A pilot of this standards-based approach, referred to as RACS™ (Retail Access Control Standards), was conducted to assess efficacy. Methods: RACS was implemented at 171 stores within 3 retail chains selling tobacco products in 3 states. "Secret shopper" compliance audits, in which a mystery shopper attempted to purchase JUUL products, were conducted at participating stores before and after implementation of RACS, to test compliance with age-verification and product-quantity limits. Audit failure rates were compared pre- and post-RACS implementation to assess effectiveness. Comparisons were made overall, by chain, state, and failure type. Results: A total of 3990 audits were conducted. We found large, statistically significant reductions (p < .001) in failure rates for age-verification and compliance with product-quantity limits after implementing RACS, as compared to pre-RACS rates, declining to near zero. Conclusions: Utilizing enhanced access controls can be part of a comprehensive, evidence-based tobacco-control strategy to address underage use of all tobacco products, including JUUL.

Evaluating the Impact of the Synar Program: Tobacco Access and Use among Youth in Mississippi, the South, and the U.S.

(1) Background: This study examines the impact of Synar policy adoption on youth commercial access to tobacco products in Mississippi, the South, and the remaining U.S. The principal focus on youth commercial access is complemented by analyses of Synar’s impact on minors’ non-commercial access to tobacco and tobacco use patterns. Mississippi has been especially aggressive in implementing Synar, as evidenced by its unusually low retailer violation rates (RVRs). Synar, a mandatory, enforceable regulation meant to limit youth’s retail access to tobacco, was implemented nationwide in 1997. This study is governed by a combination of conceptual insights from a diffusion of health innovation perspective and structuration theory. (2) Methods: Repeated cross-sectional data from 1995 to 2011 from the CDC Youth Risk Behavior Survey are analyzed using a pre/post-implementation, quasi-experimental analytic strategy. Tobacco access and use in the pre-Synar era (1995–1997) are compared with two post-Synar periods (1999–2005 and 2007–2011), thereby highlighting diffusion effects related to this policy innovation within Mississippi, the South, and the remaining U.S. (3) Results: Analyses of temporal trends reveal that Mississippi and other study regions effectively restricted commercial access to tobacco. Positive outcomes associated with Synar adoption were observed several years after initial implementation, thus supporting a diffusion of innovation perspective. However, results also reveal that Mississippi youth were more inclined than their counterparts elsewhere to gain access to tobacco through non-commercial means after Synar implementation, and that declines in tobacco use among Mississippi youth were less robust than those observed elsewhere. Such variegated effects are in line with expectations linked to structuration theory. (4) Conclusions: Synar policy implementation has been generally effective at deterring youth access to tobacco and, in many cases, has yielded declines in tobacco use. However, there is no evidence that especially aggressive retailer compliance checks in Mississippi have yielded distinctive benefits for youth in this state.

Epilogue

This epilogue focuses on Chicago's changing racial geography, arguing that this change is creating not only gentrification in parts of the city, but also openings for Black Chicagoans to augment their geography. Since the mid-1990s abandoned lots all over Chicago have been turned into spaces of agricultural production. Not limited to middle-class white neighborhoods, urban gardens have sprung up in poor and working-class communities on the South and West Sides of the city. This is not the first time Chicagoans have performed agriculture in the city. The city has a long history of urban agriculture. This epilogue shows that green spaces can undo the consequences of carceral space by enabling Black Chicagoans to eat fresh fruits and vegetables in places with little retail access to them and creating environments of stress reduction for the entire community. It also demonstrates that the poor and the working class can be architects and planners, that they can augment their geographies in ways that produce healthy people and vital, vibrant communities—on their own terms.