Distribution of tobacco retail outlets around secondary schools and association with students' smoking behaviour in China, 2024

To protect youth from tobacco exposure, China's Minors' Protection Act prohibits tobacco retail outlets (TROs) around schools. However, the legislation lacks a specified restriction distance. This study examined the distribution of TROs and its association with secondary student smoking behaviours to inform recommendations for specific distance requirements.

We analysed data from the 2023 National Youth Tobacco Survey conducted by the Chinese Center for Disease Control and Prevention, encompassing 34 028 secondary students from 244 schools across seven provinces. Between July and August 2024, we conducted surveys of TRO distribution within 50 m, 100 m, 200 m and 500 m distances around schools. TRO distribution was characterised using straight-line and walking distance measurements. Two-level logistic regression examined associations between TRO density and student smoking behaviour.

Using straight-line distance, the proportion of schools with TROs within 50 m, 100 m, 200 m and 500 m around schools was 21.7%, 47.1%, 75.8% and 97.5%, respectively. For walking distance, these proportions were 14.8%, 35.2%, 65.6% and 89.8%, respectively. TRO density within 200 m (straight-line and walking distance) demonstrated positive associations with increased odds of ever smoked (adjusted OR (aOR) 1.024, 95% CI 1.004 to 1.044; aOR 1.038, 95% CI 1.005 to 1.072, p<0.05). TRO density within 200 m walking distance was positively associated with current smoking (aOR 1.083, 95% CI 1.005 to 1.168, p<0.05).

The findings indicate an association between TRO density within 200 m of schools and adolescent smoking, suggesting that a 200 m restriction and stronger enforcement of existing legislation may help reduce students' tobacco exposure.