A 10-year-old growing up in a neighbourhood packed with vape shops and off-licences is more likely to start smoking or drinking by age 17 than a child in an area with fewer such outlets—but no one has yet tracked this link over time, or accounted for where teenagers actually spend their days. Most studies on the availability of tobacco, alcohol, and vapes have looked at adults, or have taken a single snapshot of a child’s home neighbourhood. This project follows 10- to 17-year-olds in Scotland over several years, using GPS data from their phones to measure their real-world exposure to unhealthy commodity retailers—near home, school, and along their daily routes. It also asks whether family income or local deprivation makes the effect worse. If the research confirms that growing up surrounded by these outlets directly drives higher rates of smoking, vaping, and drinking, it would give the Scottish Government and public health agencies the evidence they need to tighten licensing laws, restrict new outlets near schools, or target interventions at the most exposed communities. Scotland has pledged to end smoking by 2034 and to curb youth vaping, but currently lacks the specific policy levers to do so. This study aims to supply them.
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Context: The local availability of unhealthy commodities, including tobacco, vape and alcohol products, normalises, reinforces and promotes their use, and is a vector for ill health, particularly in more socially disadvantaged neighbourhoods. The consumption of unhealthy commodities is strongly shaped by local environments with adolescence a key period for initiating health behaviours and inequalities. Therefore, identifying environmental risks factors related to initiation is a policy priority. Challenge the project addresses: Most research into the availability of unhealthy products focuses on adults. Yet (pre)adolescence is a formative period when knowledge and attitudes to health-related behaviours become ‘hard-wired’. Research on adults finds consumption is higher in neighbourhoods with more outlets. Similarly, research on children shows greater knowledge of tobacco products and increased initiation in areas of high availability. To date this work has been cross-sectional and there is no longitudinal evidence on how growing up in neighbourhoods with differing levels of availability shapes health behaviours in later years. Further, earlier work relies on static exposure measures overlooking people’s movements between different social and physical environments (work, school, recreation) over the course of their daily lives. Another criticism is the under theorisation of availability and consequently how it is operationalised. Most studies measure availability using count of outlets or rates per area or at best density surfaces representing accumulative exposures. However, the precise mechanisms linking availability, consumption and harm for different socio-demographic groups are unknown, undermining the development of robust exposure metrics and subsequent policy options. Aims and objectives: The aim is to use longitudinal data to examine how neighbourhood availability of unhealthy commodities (tobacco, alcohol, vapes) in childhood and adolescence (age 10-17) affects adolescent health behaviours and inequalities. The specific objectives are to: develop theoretically-grounded spatial measures of exposure to unhealthy commodities using individual-level GPS data to account for when (e.g. time of day, duration) and where (e.g. near home or school) children and adolescents interact with unhealthy commodity retailing; assess whether the local availability of unhealthy commodity retailing during childhood and adolescence (age 10-17) is associated with adolescent health-related behaviours (smoking, drinking, vaping), how local availability is associated with inequalities in these behaviours, and how exposure in different spaces (e.g. around home, school) relates to behaviours; examine how individual, family/household and neighbourhood-level pathways mediate or moderate the impact of the local availability of unhealthy commodities on adolescent health-related behaviours. Potential applications and benefits: Our focus is Scotland where population health outcomes are poorer and health inequalities higher than the rest of the UK and other western European countries. The consumption of unhealthy commodities are important contributors to these public health challenges. There is a commitment to substantively diminish the health and societal impact of unhealthy commodities, for example Scotland’s National Performance Framework targets reducing the prevalence of smoking and harmful/hazardous drinking, and the Scottish Government’s tobacco strategy pledges achieving the tobacco ‘end game’ by 2034 and addressing children’s use of vape products. However, the specific policy levers for achieving these ambitions are not in place. This project responds to this challenge and has been co-produced with key partners concerned with addressing the impact of unhealthy commodities in shaping health inequalities including Scottish Government, Public Health Scotland, Alcohol Focus Scotland and ASH Scotland.
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