Tobacco retailer density surrounding schools and youth smoking behaviour: a multi-level analysis

Data were collected in 2005-2006 from grade 9 to 12 students attending 76 secondary schools in Ontario, Canada, as part of the SHAPES-On study. A series of multi-level logistic regression analyses were performed to understand how student- and school-level factors are associated with three smoking behaviour outcomes: smoking susceptibility among never smokers, occasional smoking, and daily smoking.The number of tobacco retailers surrounding a school was found to be associated with the likelihood of a never smoker being susceptible to future smoking (OR 1.03, 95CI% 1.01, 1.05). We also identified that being surrounded by smoking social influences, specifically family and close friends, can substantially increase the likelihood that never smokers are at risk for future smoking or that youth are already occasional or daily smokers.We identified that the number of tobacco retailers surrounding a school was associated with an increased odds of being susceptible to future smoking among male never smokers. Smoking social models surrounding youth also appears to have an important impact on their smoking behaviour regardless of their smoking status. It is important for youth smoking prevention programs to begin early, interrupt youths' susceptibility to future smoking, and focus on subgroups that are at higher risk of smoking. The government should consider the impact of tobacco retailer density on youth smoking behaviour, and be cautious when granting licenses for establishments to sell tobacco products.The prevalence of current smoking among youth aged 15-17 in Canada was 10% in 2008 [1]. This is cause for concern as youth who smoke are more likely to smoke as adults [2], and more likely to engage in other health risk behaviours [3-6]. Youth smoking prevention should be a public health priority.Youth smokers can generally be categorized as being non-smokers, occasional smokers, or daily smokers [7,8]. Research has previously identified factors associated with occasional and