Density of tobacco retail outlets around school in Lao People's Democratic Republic 2024: a geospatial analysis.

Abstract

Introduction: Exposure to tobacco advertising at tobacco retail outlets (TROs) is associated with smoking initiation among youth. There is limited geospatial evidence on the density of TROs in Lao People's Democratic Republic (PDR), a country with high prevalence of tobacco smoking. This study examined the density and proximity of TROs around schools in two urban districts and one rural district of Vientiane Capital, Lao PDR, using geographic information systems.

Methods: We audited 233 TROs around 27 schools between January 19 and February 18, 2024. TROs were mapped within 250 m and 500 m buffers in two urban districts (Chanthabuly and Sissatanak), and 500 m and 1,000 m buffers in one rural district (Naxaithong). Buffer analysis and network analysis estimated TRO density and median walking distances between TROs and schools. We used the Kruskal-Wallis test to determine if TRO density varied significantly in urban districts within two buffers and the chi-square test to examine differences in TRO characteristics based on proximity to schools.

Results: TRO density was defined as the number of TROs mapped within a 250 m radius of urban schools and those mapped within 1,000 m radius of rural schools. TRO density was higher within the buffer of 250-500 m in Chanthabuly (median = 12), followed by Sissatanak (median = 3) (p = 0.01). Comparing the two urban districts, the median distance between TROs and schools within the buffer of 250-500 m was significantly less in Sissatanak compared to Chanthabuly (p = 0.04). The shortest distance between an urban school and any TRO (i) without age verification signage was 21.58 m, (ii) with outside cigarette advertisements was 9.95 m, and (iii) selling "single" cigarettes was 311.36 m. In the rural district, the TRO density was higher within 500-1,000 m (median = 2) compared to within 500 m (median = 0.5).

Conclusion: Within the context of the Lao PDR, our study provides the first geospatial evidence of tobacco retail outlet density in both urban and rural districts of Vientiane Capital, revealing a substantially higher concentration of outlets in urban districts.We also quantified walking distances between schools and outlets violating tobacco control measures, including lack of age verification signage and outdoor cigarette advertising. These findings suggest that stricter regulation of tobacco retail outlets could strengthen tobacco control policy implementation in Lao PDR.