Assessing youth exposure to tobacco retailing near schools in kunming, China using geographic information systems and on-site observation

Globally, 88% of smokers begin smoking before age eighteen. Tobacco retailing near schools constitutes an important environmental determinant of youth smoking initiation. The Chinese tobacco industry has increased retail investments following stricter advertising prohibitions. Yet few studies in China have investigated tobacco retailing near schools. We characterize youth exposure by mapping tobacco retailer density and proximity to elementary and middle schools in Kunming, the heart of China's tobacco industry. Between April-May 2012, trained observers mapped tobacco retailer density and proximity to forty-eight schools in five districts in Kunming's urban core using geographic information systems technology. Focus groups with eighty-eight students probed youth perceptions of school-proximate tobacco retailing. Structured, on-site observation after the school day documented youth interactions with retailers and catalogued retailers by type. We found an average density of 60 retailers within a square kilometer of schools (range: 40-90). Eighty-six percent of schools had at least one retailer within 50 meters of campus (average 1.7). In focus groups, youth described school-proximate retailing as “normal” and purchasing tobacco as “easy.” Among 994 retailers, over 50% lacked a license to sell tobacco, 77% displayed tobacco with food and 6% with school supplies or toys. The finding that students in Kunming experience high exposure to tobacco retailing measured by density and proximity to schools demonstrates the importance of regulating retail environments under broader tobacco control initiatives, including implementation of WHO Framework Convention Article 13. Enforcing sales licenses under Kunming's “Tobacco Retail Licensing Program” could also decrease youth exposure by restricting unregistered retailers.