Abstract

Significance: Heated tobacco products (HTPs) are “heat-not-burn” products that heat tobacco rather than burning it. Tobacco retailers surrounding environments of adolescents offer exposure to tobacco products that influence smoking behaviours. The novelty of HTPs and their subsequent marketing in student environments may attract youth to use these products. There is a lack of research on whether HTP retailer proximity/density within schools can impact smoking behaviours. The objective of this study is to examine the association between current HTP use in adolescents and retailer proximity/density to secondary schools across 4 Canadian provinces.

Methods: Online surveys from the 2019-2020 COMPASS study were administered to grade 9-12 students (n=36,807) from 102 secondary schools in four Canadian provinces to analyze HTP behaviours. A search of IQOS and HEETS retailers was conducted between November 2020 and March 2021, with distance buffers of 500m, 1000m, and 1500m. Multilevel regression models were then used to analyze the association between HTP retailer density/proximity and adolescent HTP use.

Results: <1% of students currently used HTPs in 2019-20. The IQOS search displayed that while only a few schools had an IQOS retailer within walking distance, many schools had HEETS retailer within walking distance. The average school had 3.8 HEETS retailers and 0.1 IQOS retailers within 1000m. Multilevel regression models identified no significant association between current adolescent HTP use and HTP retailer proximity or density.

Conclusions: This is the first study to examine the association between HTP retailer proximity and density and current adolescent HTP use. As HTP popularity begins to rise, further studies should be conducted on current HTP practices as well as further research on tobacco and tobacco-related retailer proximity/density to adolescent environments such as schools.