Associations between real-world tobacco retail exposure and smoking outcomes: a geolocation study

Importance: The tobacco industry spends over $8 billion annually in the United States on marketing at the point-of-sale. Exposure to tobacco retail has been associated with smoking outcomes, but substantially less is known about how objectively logged day-to-day, real-world tobacco retail exposure is linked to smoking outcomes. Objective: To assess pre-registered hypotheses that individuals report greater craving and cigarettes smoked on days when their objectively logged retail exposure is higher than usual. Design: A 14-day within-person observational study combining objectively logged geolocation tracking, public tobacco-retail location records, and ecological momentary assessment. Data collection occurred from 2022 to 2024. Setting: A multimodal study including participants statewide in Pennsylvania, New Jersey, and Delaware. Participants: Main eligibility criteria were: aged 21-65 years, smoked at least five cigarettes per day for the previous six months, owned an iPhone or Android smartphone, and a resident of Pennsylvania, New Jersey, or Delaware. Participants were selected via convenience sampling. A total of 310 participants enrolled.Exposure: To assess tobacco retail exposure, mobility data collected objectively via geolocation tracking was matched with locations of tobacco retailers across three states. Main Outcomes and Measures: Daily average craving and daily number of cigarettes smoked, reported via ecological momentary assessment. Results: A total of 273 participants were included in the final analyses (151 [55.3%] women; 175 [64.1%] white; mean [SD] age, 42.46 [10.69] years). Multilevel models revealed support for both pre-registered hypotheses. On days when individuals had more tobacco retail exposure than their usual baseline, they reported significantly higher levels of craving (b = 0.04, t(3,456.79) = 2.56, p = 0.01) and smoking significantly more cigarettes (b = 0.01, t(3,469) = 2.47, p = 0.01).Conclusions and Relevance: People’s environments shape their feelings and behaviors. Exposure to tobacco retail in the real-world is associated with increases in craving and smoking. Findings highlight the significance of retail exposure in relation to smoking, information that is critical for developing effective tobacco control interventions, and lays foundations for broader health research on environmental factors shaping health behaviors.