Tobacco outlet density and adolescents' cigarette smoking: a meta-analysis.

OBJECTIVE:We conducted meta-analyses of studies that investigated the associations between tobacco outlet density around homes and schools and adolescents' past-month cigarette smoking. DATA SOURCES:Systematic literature searches of eight databases were carried out in February 2017. Searches were not limited by date, language, country or peer-reviewed status. STUDY SELECTION:After screening for quality, studies that examined the relationship between tobacco outlet density and adolescents' past-month smoking were selected for inclusion. DATA EXTRACTION:Two investigators screened study abstracts and full texts and independently extracted data. Consensus was reached at each stage. DATA SYNTHESIS:Random-effects meta-analyses were conducted on 11 studies that provided 13 effect sizes. Results showed that there was a significant association between tobacco outlet density around homes and adolescents' past-month smoking behaviour, with an overall effect size of OR=1.08 (95% CI 1.04 to 1.13; P<0.001; I2=0%). For density around schools, the association was not statistically significant (OR=1.01, 95% CI 0.98 to 1.03; P=0.53; I2=39%). CONCLUSIONS:These findings suggest that exposure to tobacco outlets near home environments may be important for understanding adolescents' past-month smoking. Restricting access to tobacco outlets and controlling the number of outlets in residential areas may be an effective preventive strategy to help reduce adolescents' smoking.