Stores saturated with ads and promotions for cigarettes constitute a significant public health concern, especially for adolescents. Our previous research combined data from school-based surveys of middle school students at baseline, 12 months, and 30 months, with data from observations in all stores that sold cigarettes in the study community. Two measures of exposure to retail tobacco advertising were developed by: (a) assessing the frequency of visits to types of stores that contain the most tobacco advertising (convenience, small grocery, and liquor stores) and (b) eliciting information about where and how often adolescents shopped in tobacco outlets near school and assessing the quantity of cigarette marketing materials in those stores. Both exposure measures predicted significant increases in the odds of initiating smoking at each follow-up, and the more exposure adolescents reported, the greater their chances of experimenting. A second longitudinal study observed similar findings in an urban community with a higher concentration of tobacco outlets and a more racially diverse population. This proposal seeks continued funding to better understand the impact of the retail tobacco environment on smoking initiation at the national level. Adolescents (ages 13-16) will be surveyed at baseline, 8 months, and 16 months (n=1,350), using an existing Internet panel that is representative of U.S. households with telephones. An innovative feature of this research is the ability to link all respondents'data to their residential and school addresses, allowing simultaneous study of environmental and individual risk factors for smoking initiation.
This research aims to: (a) determine whether our previous results about the impact of exposure to retail tobacco advertising on smoking initiation generalize from two California communities to a population-based survey of U.S. adolescents, and (b) test the hypothesis that the odds of smoking initiation are increased for adolescents in neighborhoods with higher tobacco outlet density, adjusting for both individual and neighborhood characteristics. Secondary analyses will compare different process explanations for the impact of retail tobacco advertising and tobacco outlet density on smoking initiation. This investigation will advance our understanding of the health risks associated with the availability of cigarettes and visibility of cigarette advertising in the environment and provide a scientific rationale for new policies to reduce them.

Public Health Relevance

Adolescent tobacco use predicts a range of early adult social and health problems. This research examines how the concentration of tobacco outlets in neighborhoods, and the widespread cigarette advertising that these stores contain, promote adolescent smoking. Evidence of such effects could inform U.S. and international regulatory efforts to limit the availability of cigarettes and visibility of cigarette advertising in the environment.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
Project #
Application #
Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Hunt, Yvonne M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Stanford University
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Henriksen, Lisa; Schleicher, Nina C; Ababseh, Kimberly et al. (2018) Marijuana as a 'concept' flavour for cigar products: availability and price near California schools. Tob Control 27:585-588
Epperson, Anna E; Prochaska, Judith J; Henriksen, Lisa (2018) The flip side of Natural American Spirit: corporate social responsibility advertising. Tob Control 27:355-356
Mills, Sarah D; Henriksen, Lisa; Golden, Shelley D et al. (2018) Disparities in retail marketing for menthol cigarettes in the United States, 2015. Health Place 53:62-70
Epperson, Anna E; Henriksen, Lisa; Prochaska, Judith J (2017) Natural American Spirit Brand Marketing Casts Health Halo Around Smoking. Am J Public Health 107:668-670
Schleicher, Nina C; Johnson, Trent O; Fortmann, Stephen P et al. (2016) Tobacco outlet density near home and school: Associations with smoking and norms among US teens. Prev Med 91:287-293
Henriksen, Lisa; Schleicher, Nina C; Barker, Dianne C et al. (2016) Prices for Tobacco and Nontobacco Products in Pharmacies Versus Other Stores: Results From Retail Marketing Surveillance in California and in the United States. Am J Public Health 106:1858-64
Sanders-Jackson, Ashley; Schleicher, Nina C; Fortmann, Stephen P et al. (2015) Effect of warning statements in e-cigarette advertisements: an experiment with young adults in the United States. Addiction 110:2015-24
Sanders-Jackson, Ashley; Parikh, Nina M; Schleicher, Nina C et al. (2015) Convenience store visits by US adolescents: Rationale for healthier retail environments. Health Place 34:63-6
Sanders-Jackson, Ashley N; Tan, Andy S L; Bigman, Cabral A et al. (2015) Knowledge About E-Cigarette Constituents and Regulation: Results From a National Survey of U.S. Young Adults. Nicotine Tob Res 17:1247-54
Dauphinee, Amanda L; Doxey, Juliana R; Schleicher, Nina C et al. (2013) Racial differences in cigarette brand recognition and impact on youth smoking. BMC Public Health 13:170

Showing the most recent 10 out of 17 publications