A Neighborhood Analysis of Underage Tobacco Sales within the Serving Area of a Canadian Public Health Unit

Abstract

Despite the fact that the sale of tobacco to minors is illegal in Ontario, youth are still able to purchase tobacco. This study aims to determine the geographic variations of underage tobacco sales at the neighborhood level within the Windsor-Essex County Health Unit. Data were collected on all inspections of tobacco retail stores from 2007 to 2011 in the Windsor-Essex County Health Unit. Data were split into season 1 (September-February) and season 2 (March-August) to assess a possible seasonal effect. Relative risks were calculated for each dissemination area (DA) by modeling the risks in a hierarchical Bayesian fashion, incorporating appropriate random effects terms for both spatially correlated and uncorrelated random errors with adjustments for neighborhood income. The association between violation rate and proximity to a school was assessed through a buffer analysis. Elliptical analysis detected a significant cluster of high risk DAs in season 1 in Windsor (p-value = 0.022) but no significant cluster in season 2. Some DAs exhibited higher relative risks of tobacco sales to minors, however after adjusting the model for neighborhood income no excess risk was observed. The results of the buffer analysis showed that in season 1 there was a significantly higher probability (p-value = 0.045) of tobacco vendors located closer to schools to sell tobacco to minors. This analysis demonstrates the utility of a systematic approach to identifying neighborhoods with higher risks of tobacco sales to minors. The insights provided by this exploratory, ecologic study are valuable for program planning and directing tobacco enforcement efforts to high risk areas.