Tobacco retailer density and smoking prevalence following a hypothetical 500-meter buffer around schools in South...

To inform tobacco endgame policies, we aimed to assess the spatial distribution of tobacco retailers across districts and around schools in South Korea, and to estimate the potential impact of a simulated 500-meter school buffer zone policy on retailer density and adult smoking prevalence.

A cross-sectional simulation study compared tobacco retailer exposure between status quo and simulated policy scenarios. District-level measures included retailer density and smoking prevalence; school-level measures included retailer counts within buffer zones and distance to the nearest retailer. The simulated policy removed all retailers within 500-meter circular buffers around schools. Changes in adult smoking prevalence were estimated using meta-analytic effect sizes. Results were stratified by urbanicity, income quartile, educational level, and institutional type.

Simulated implementation of 500-meter school buffers was projected to reduce national retailer density by 66.6% (from 130,718 to 43,618 retailers), and lower adult smoking prevalence by 0.55 percentage points. At the district level, urban areas had higher baseline density and greater proportional reductions than rural areas. At the school level, approximately 70% of schools had at least one retailer within 200 m at baseline, and policy implementation increased mean distance to the nearest retailer from 221 m to 857 m.

This simulation indicates that a 500-meter school buffer policy could substantially reduce tobacco retailer density and smoking prevalence in South Korea's dense retail environment. Comprehensive implementation is recommended, and integration with other tobacco control measures will be essential to achieve tobacco endgame goals.