BACKGROUND: Reducing tobacco retailer access and increasing retailer policy compliance are considered essential strategies for tobacco control. We examined retailer access and policy compliance and their associations with tobacco use susceptibility in a cohort of adolescents in two Indian cities.
METHODS: A population-based cohort of adolescents (12–14 years, n=1982) from neighborhoods in Kolkata (n=26) and Mumbai (n=23) was surveyed over three waves (2018–2023). During Wave 1, all neighborhood tobacco retailers were mapped, and a random sample (n=1229) was selected for compliance checks. Predictors were neighborhood tobacco retail density (number of retailers per square kilometer), adolescent retailer visit frequency (weekly or more visits to tobacco-selling retailers), neighborhood compliance rates for bans on retailer tobacco advertising, and tobacco sales within 100 yards of schools. Tobacco use susceptibility outcomes included intention to use and perceived peer use. Regression analyses (adjusted for age, sex, parent education, and religion) estimated associations between predictors and outcomes.
RESULTS: Neighborhood tobacco retailer access was high: overall mean density=93.1 (SD=75.1), Kolkata=82.0(31.3), Mumbai=106.0(104); 71.8% and 91.7% percent of adolescents reported weekly or more visits to tobacco-selling retailers in Kolkata and Mumbai, respectively. Neighborhood compliance rates with the ban on tobacco sales near schools (Kolkata=81.3%; Mumbai=75.1%) and retailer tobacco advertising (Kolkata=73.7%; Mumbai=46.5%) were moderate. In Mumbai, retailer density was positively associated with perceived peer use (p=0.025), and retailer visit frequency was positively associated with intention to use (p=0.043). Compliance with the ban on tobacco sales near schools was positively associated with reduced perceived peer use (p=0.028). In Kolkata, none of the predictors were associated with tobacco use susceptibility outcomes.
CONCLUSIONS: Reducing retailer access and increasing policy compliance may benefit tobacco use prevention in youth, but the influence of these neighborhood tobacco environmental factors may be context-dependent; we found effects in Mumbai but none in Kolkata.