BACKGROUND: Restricting tobacco retailers has the potential to substantially reduce smoking prevalence while promoting health equity, as retailer density is often higher in low socioeconomic areas. In South Korea, banning tobacco sales within 500m of schools has strong public support, but evidence on its potential impact remains limited. We aimed to estimate reductions in tobacco retailer density and smoking prevalence under a hypothetical 500m buffer around schools in urban, intermediate, and rural areas.
METHODS: Data sources included the list of tobacco retailers (2024 data, n=138.021) from the Ministry of the Interior and Safety, list of elementary, middle and high schools (n=11.992) from the Ministry of Education, and cigarette smoking prevalence from the 2023 Korea Community Health Survey. School and retailer locations were mapped, and reductions in retailer density were calculated after applying 500m buffer zones around schools. Smoking prevalence reductions were estimated using a previously published meta-analysis indicating a 2.06% relative decrease in smoking prevalence with reduced retailer density. Analyses were stratified by urban, intermediate and rural regions.
RESULTS: Removing retailers within 500m of schools reduced the total number from 138.021 to 63.225, a 49.7% reduction. Urban areas saw a 60.0% reduction (from 98.393 to 39.352), intermediate areas 41.4% (28.194 to 16.532), and rural areas 35.8% (11.434 to 7.341). The estimated smoking prevalence reductions averaged 0.5% nationwide (from 18.6% to 18.1%), with urban areas at 0.6% (from 18.3% to 17.7%), intermediate areas at 0.4% (from 19.6% to 19.2%), and rural areas at 0.3% (from 18.2% to 17.9%).
CONCLUSIONS: A 500m buffer around schools can substantially reduce tobacco retailer density, particularly in urban areas. However, the corresponding reduction in smoking prevalence is likely to be modest. A package of policies would be required to reduce smoking to minimal levels and promote health equity.