Study finds dense tobacco retail environments near Indian schools linked to higher youth susceptibility

Dr. Ritesh Mistry, an associate professor of global public health at the University of Michigan, told a National Cancer Institute Center for Global Health seminar that neighborhood retail environments in Indian cities are highly concentrated with tobacco outlets and that stronger local compliance with youth‑oriented rules is associated with lower adolescent susceptibility to tobacco use.

Mistry presented findings from a Mumbai pilot (26 schools; 1,533 students) and a later longitudinal, community‑based study covering neighborhoods in Mumbai and Kolkata (longitudinal fieldwork 2018–2023). He described field mapping of tobacco retailers and advertisements, compliance checks at sampled retailers, and household surveys that used audio‑assisted self‑interviews to limit social desirability bias.

The presentation highlighted several measurable points. In the Mumbai pilot, field teams found about 62 retailers on average within a 500‑meter walking radius of a school. Across the two cities the investigators mapped roughly 5,000 retailers in the first wave and about 8,000 in a second wave of neighborhood data collection. Compliance checks showed very low rates of full compliance with all retailer rules (about 3% met every measured requirement in the pilot), variable compliance with the 100‑yard school‑proximity rule, and near‑absence of required signage notifying that sales to minors are illegal. Dr. Mistry said observational checks suggested roughly three‑quarters of retailers appeared to refrain from on‑site sales to minors during short observations in Mumbai, but he emphasized that purchase‑attempt studies were not performed and self‑report/observation measures likely overestimate true compliance.

Analyses presented linked higher advertisement density and greater retailer access to increased risk of experimental tobacco use and of past‑30‑day smokeless or any tobacco use in their samples. Neighborhoods with higher overall retailer compliance had lower rates of current tobacco use among adolescents after adjustment for sociodemographic and psychosocial covariates. Because household surveys recorded few self‑reported users, the team relied on validated susceptibility measures (intent to use, perceived ease of access, perceived peer use) as proximate outcomes; Dr. Mistry said these measures predict later use in the literature.

Mistry illustrated how product mix shapes cancer patterns: "We see a lot more esophageal and oral cancers in India relative to lung cancer," he said, reflecting the predominance of smokeless and locally used products. He also noted policy shifts over the study period: India tightened rules on retailer advertising such that retailer ads at point of sale are now broadly prohibited compared with earlier rules that permitted limited ads.

The presenter recommended policy and implementation steps: strengthen enforcement of the Cigarettes and Other Tobacco Products Act (COTPA) provisions—particularly the 100‑yard school‑proximity restriction and signage requirements—consider limits on retailer density and product placement at point of sale, and invest in systematic retailer tracking and licensing to reduce the need for repeated field enumeration. He said city context and family factors matter: associations between compliance and youth outcomes were stronger in Mumbai than Kolkata, where adult tobacco use was higher and family influences may play a bigger role.

During Q&A, Mistry clarified timing: the pilot was conducted in 2011 and the longitudinal study ran from 2018 to 2023. He acknowledged persistent fieldwork challenges (no national retailer licensing list), noted e‑cigarettes are banned yet still observed in some higher‑income neighborhoods, and said monitoring new products will require continued surveillance and funding.

The NCI seminar recording and event information are available on the NCI events site; the seminar moderator was Mark Pariscondola of the NCI Center for Global Health.