Original quantitative research – Analysis of the geographical accessibility of vape shops in the vicinity of Quebec’s secondary and college educational institutions

Éric Robitaille, PhD Author reference 1,Author reference 2; Pascale Bergeron, MSc Author reference 1; Maxime Houde, MSc Author reference 1,Author reference 3

https://doi.org/10.24095/hpcdp.39.8/9.01

This article has been peer reviewed.

Author references:

Author reference 1

Institut national de santé publique du Québec, Montréal, Quebec, Canada

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Author reference 2

Department of Social and Preventive Medicine, École de santé publique de l’Université de Montréal, Montréal, Quebec, Canada

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Author reference 3

Centre urbanisation culture société, Institut national de la recherche scientifique, Montréal, Quebec, Canada

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Correspondence: Éric Robitaille, Institut national de santé publique du Québec, 190 Crémazie Blvd. East, Montréal, Quebec H2E 1P2; Email: eric.robitaille@inspq.qc.ca

Abstract

Introduction: A significant proportion of secondary school students and young adults in Quebec have experimented with electronic cigarettes (e-cigarettes). Both personal and environmental factors have been associated with the use of vaping products by youth. Geographical accessibility to the points of sale of these products may be one of these factors. The purpose of this study is to develop a profile of the spatial distribution of stores specializing in the sale of vaping products (vape shops) in the vicinity of secondary schools, colleges and CEGEPs in the province of Quebec.

Methods: We calculated the accessibility of businesses to account for geographical exposure. Analyses were conducted to provide a snapshot of the situation in Quebec and to identify associations between the characteristics of educational institutions and geographical accessibility to vape shops.

Results: A total of 299 vape shops were identified. Colleges are closer to a vape shop (median distance: 1.2 km) than are secondary schools (median distance: 2.3 km). Large private colleges located in urban areas are closer to specialized vape shops. Medium or large private secondary schools located in urban and more advantaged areas are also closer to a specialized vape shop.

Conclusion: This study is a step in developing an understanding of the location of vaping product shops and their geographical accessibility to young people. Important to consider is the geographical accessibility of young people to non-specialized shops that also sell e-cigarettes and then any potential connections between geographical accessibility to such non-specialized shops and the use of vaping products by young people.

Keywords: electronic cigarette, e-cigarette, vaping, Geographic Information System (GIS), school, adolescents, young adults

Highlights

  • In Quebec, we identified 299 points of sale specializing in vaping products (vape shops).
  • Colleges are closer to a vape shop (median distance: 1.2 km) than secondary schools (median distance: 2.3 km).
  • Area deprivation was not associated with the access to points of sale near college-level institutions.
  • Quebec students attending private educational institutions, both college and secondary schools, and institutions located in urban areas have greater geographical accessibility to shops specializing in vaping products.

Introduction

Experimentation with electronic cigarettes (e-cigarettes) is widespread among secondary school students and young adults in Quebec. In 2014–2015, 27% of secondary school students in Quebec reported having used e-cigarettes in their lifetime, a proportion higher than in Canada overall (15% of students), and 8% reported having used them within the last 30 days.Footnote 1 The same trends were observed in 2016–2017.Footnote 2 Of all the 18–24 year olds in Quebec in 2015, 32% had used e-cigarettes in their lifetime and 8% had used them recently.Footnote 1 Moreover, while the regular use of e-cigarettes among non-smoking adults over 35 years of age is a marginal phenomenon, a significant proportion of non-smokers among secondary school students use this product.Footnote 1 Recent longitudinal studies suggest that e-cigarette use among non-smoking youth may be an additional risk factor for smoking initiation.Footnote 3Footnote 4Footnote 5Footnote 6

Both personal and environmental factors have been associated with the use of vaping products by young people.Footnote 7 Some studies suggest that, like tobacco products, geographical accessibility to the point of sale of these products may be one of the factors associated with their use. Access to as well as visibility of tobacco products through points of sale have been associated with their use among youth.Footnote 8,Footnote 9 Some American studies suggest that the same could be true for vaping products.Footnote 10Footnote 11Footnote 12 Recent scientific investigations have focused on improving understanding of the spatial distribution of points of sale for vaping products in the USA,Footnote 13,Footnote 14 particularly in the vicinity of educational institutions.Footnote 10Footnote 11Footnote 12,Footnote 15,Footnote 16

Two US studies examined the impact of the geographical accessibility of the points of sale of vaping products on their use. One of these studies included shops specializing in the sale of vaping products alone (vape shops),Footnote 10,Footnote 11 while the other included both vape shops and tobacco outlets that also sell e-cigarettes.Footnote 12 The results of these analyses indicate a positive association between greater availability in shops selling vaping products that are near schools and the use of these products by students.

In Quebec as well as the rest of Canada, e-cigarettes are sold both in some non-specialized shops (such as convenience stores and gas stations) and in specialized shops (vape shops). In Quebec, points of sale specializing in vaping products, which are not accessible to minors, are authorized to display their products only indoors. However, since these shops remain visible from the outside, frequent exposure to them could provide an incentive for young people to use vaping products, for instance by increasing the perception of the accessibility of these products, a factor associated with e-cigarette use among secondary school students in Canada.Footnote 17 Little data is currently available to capture this exposure in Quebec. Quebec organizations involved in tobacco control and public health have already mentioned the lack of valid information on the location of e-cigarette points of sale.Footnote 18,Footnote 19

An analysis of the spatial distribution of specialized vape shops that are in the vicinity of Quebec educational institutions (secondary schools and colleges / CEGEPsFootnote *) will provide a better understanding of the geographical exposure of young people and young adults to the places where these products are sold. It will represent a first step in the development of knowledge on the geographical accessibility of young people to shops selling vaping products and the potential impact of this accessibility on the use of these products. Our article presents part of this analysis, which will be published in its entirety and available on the Institut national de santé publique du Québec website.Footnote 20

Documenting the presence of specialized vape shops that are in the vicinity of secondary schools is important, as the school is the public place most frequented by adolescents. Colleges and CEGEPs are also attended by a significant proportion of minors, and the young adults who study there are also a priority for prevention of tobacco use in Quebec.Footnote 21 Since November 2017, these post-secondary institutions have been required to have adopted a policy aimed at creating smoke-free environments.

Methods

Two steps were necessary to draw a portrait of geographical accessibility to specialized vaping product stores near educational institutions in Quebec: the development of a georeferenced directory of specialized vaping product shops in Quebec and of a georeferenced directory of educational institutions.

Directory of points of sale

Two main data sources were used to create the Quebec directory of stores specializing in vaping products: a list of stores from the Ministère de la Santé et des Services sociaux (MSSS) and a list based on an online search of business directories (via Yelp and Google). Figure 1 illustrates this process.

Figure 1. Steps in building the Quebec directory of points of sale specializing in vaping products

Figure 1

Text Description - Figure 1:Robitaille

The final list of the Quebec directory of stores specializing in vaping products included 299 points of sale. The flowchart depicting the steps of the store selection process is shown in this figure, as follows:

  • The first data source was the MSSS list (n= 414), which initiated Step 1: Manual verification, as the list is not updated regularly. Step 1 yielded 281 stores officially opened in February 2018. Of those, 36 were excluded and 97 were potentially closed.
  • Step 2: Manual verification involved the verification of the potentially closed stores in Step 1, which resulted in 91 officially closed and 6 to validate.
  • The second data source involved the online search engines Google and Yelp. Google yielded 245 results and Yelp yielded 129 results, which initiated Step 3: Merging the two lists for a total of 278.
  • Step 4: Merging the two lists involved the addition of the results from both data sources (MSSS list and online search engines), which resulted in a total of 365 stores.
  • Step 5: Manual verification resulted in the following: 224 open, 37 open – confirmed via a telephone call, 57 to be defined, telephone confirmation, 31 potentially closed, and 16 excluded.
  • Step 6: Manual verification involved the verification of the 31 potentially closed stores from step 5, which resulted in 8 to verify and 23 excluded.
  • Step 7: Telephone validation in the field involved the verification of the 224 open stores, 37 open – confirmed via telephone call, 57 to be defined, telephone confirmation (from Step 5) and the 8 potentially closed stores to verify (from Step 6). The telephone validation was conducted as follows: 10% of the number of businesses open (n = 23) underwent validation by telephone. Of those, 17 underwent validation via a personal visit, to which n = 1 was added, for a total of 225 open stores. The potentially closed businesses (n = 102) underwent validation by telephone. Of those, 74 were open and 28 were excluded.

Adding the total number of open stores resulted in the final list of 299 stores.

The list of 414 specialized vape shops supplied by the MSSS includes those that, after the adoption in 2015 of the province’s Tobacco Control Act, applied to continue displaying their products inside their place of business, as permitted by the Act for establishments meeting certain criteria.Footnote 22 As this list is not updated regularly, we verified whether the 414 vaping specialty shops were still in business using various online tools (Google Street View, Google, Yelp, Yellow Pages, Facebook, the online search tool of the Registraire des entreprises). In doing so, we reduced the list to 281 stores currently selling vaping products alone (Figure 1).

In the meantime, we conducted an online search to identify specialized vape shops open in Quebec at the time of our study (details of online search available on request), via the Yelp and Google search engines. This methodology is based on the fact that government lists of the shops selling vaping products are rarely up-to-date.Footnote 10,Footnote 13,Footnote 16,Footnote 23 We obtained a list of 278 shops (Figure 1).

We merged these two lists (the MSSS and online search engine lists) and completed a final check of all 365 businesses found using the Google Street View online search engine and the Quebec Registraire des entreprises tool for some businesses, and telephone calls or a field visit for others (Figure 1). This data collection and verification process made it possible to identify 299 Quebec-based points of sale specialized exclusively in selling vaping products at the time of our study. These businesses were then geolocated using the Addresses Quebec website; (n = 273) via their respective address or using Google Earth ; (n = 26).

Directory of institutions

For this analysis, we used files developed by the Ministère de l’éducation et de l’enseignement supérieur (Quebec Department of Education and Higher Education, MEES) that give the location of educational institutions in the Quebec school system to draw up lists of the secondary and college-level educational institutions.

The MEES list of colleges obtained from the Quebec government’s open data website identified 170 colleges at the time of this study, while the list of secondary schools includes 729 schools that were geolocated using their geographic coordinates (provided in the MEES list).

Institutional characteristics

In addition to the level of education (college or secondary school), we used two institutional characteristics in our analyses: the educational system (private or public) and the size of the student population. We also took into account the characteristics of the location of the institutions, namely the level of deprivation of the area in which the institutions are located as well as the rural or urban nature of the region.

Institutions were broken down into four categories based on the size of their student population: very small, small, medium and large.

Each educational institution was assigned a dissemination area identifier based on its location. We linked this information to a material deprivation index used in public health surveillance.Footnote 24 This index is composed of indicators from Statistics Canada’s 2011 National Household Survey: the proportion of people aged 15 and over without a secondary school certificate or diploma; the proportion of people aged 15 and over who are employed; and the average income of people aged 15 and over. We assigned a quintile from the material deprivation indexFootnote 24 to the area in which each educational institution was located. We then divided the institutions into those in advantaged environments (quintiles 1, 2 and 3) and those in disadvantaged environments (quintiles 4 and 5).

We defined the rural or urban character of the area in which the institution was located based on whether it is located within or outside a population centre.Footnote

Dependent variable

The dependent variable is a measure of geographical accessibility, that is, proximity to points of sale,Footnote 26 and corresponds to the distance (in metres) from an establishment to the nearest vape shop. This distance was calculated on the basis of the road network, using ArcGIS software version 10.5.1 (Esri Canada, Toronto, ON).

Statistical analyses

First, we conducted descriptive analyses in order to obtain the distribution of the variable of interest (distance in metres to the nearest shop) according to the various variables related to the characteristics of the educational institutions and their location. Subsequently, univariate and multivariate generalized linear models were used to measure the associations between the distance to the nearest shop and the characteristics of the institutions. Schools with missing data were excluded from the analysis of generalized linear models in order to use the same samples for model construction.

These statistical analyses were intended to identify associations to extract the type of institution and the category of student population, as these students are more exposed to the presence of a specialized shop near their educational institution.Footnote 27 We used a bottom-up step selection starting from an empty model and adding independent variables. Using the Akaike Information Criterion (AIC), we were able to select the model that best explained the data.Footnote 28 We used a logarithmic function to correct the asymmetry in the distribution of the dependent variable and reduce the weight dedicated to extreme values in the estimate of the parameters of the regression models. Multivariate statistical analyses were performed with SPSS version 19 (IBM, Chicago, IL, USA).

Results

This study identified 299 points of sale specializing exclusively in vaping prod¬ucts distributed across Quebec (Figure 2).

Figure 2. Spatial distribution of the 299 businesses specializing in the sale of vaping products in Quebec

Figure 2

Sources: MSSS, 2017; Yelp, 2018; Google, 2018. Compilation: INSPQ, 2018.

Text Description - Figure 2
Figure 2: Spatial distribution of the 299 businesses specializing in the sale of vaping products in Quebec
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175 J3G 1P7 −8151005.103326460000000 5708408.448446360000000
176 G1M 3E5 −7931848.943485550000000 5913237.233894240000000
177 J5R 2L1 −8180629.950462950000000 5687216.205446500000000
178 H4A 1W5 −8194762.561929030000000 5696037.698357280000000
179 G8Y 1X7 −8081388.402465280000000 5838964.000837730000000
180 H3T 1Y8 −8196080.612932950000000 5700366.321276980000000
181 G8B 6S9 −7976177.661432140000000 6198741.767751050000000
182 J6S 3M1 −8252432.018775500000000 5663034.957595700000000
183 H2T 1N6 −8191512.651179980000000 5703874.328787200000000
184 J0J 1J0 −8166070.690171710000000 5632893.621599650000000
185 J9X 3C2 −8796282.598813850000000 6146533.597154170000000
186 J2S 4P4 −8120115.613316230000000 5720785.006475330000000
187 G6S 1C9 −8007691.802365310000000 5790245.068708710000000
188 H1G 2T6 −8194979.281873510000000 5717444.829325410000000
189 J1G 1B9 −8001152.690672520000000 5686020.111024940000000
190 G1R 1P7 −7928126.716989840000000 5911123.916841000000000
191 J9L 1S8 −8404106.817669900000000 5869418.871491590000000
192 G7H 1Z6 −8039940.750610230000000 6192337.740234340000000
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194 H1P 1H7 −8191112.408346360000000 5715237.749567850000000
195 J3B 2M6 −8157042.291598670000000 5669818.355951560000000
196 J8P 0B1 −8424302.362635130000000 5699130.404096790000000
197 H4E 3J2 −8192479.783200330000000 5693131.458383570000000
198 H3W 2T4 −8198022.432874280000000 5700119.052205820000000
199 J7Y 4B4 −8240031.886912010000000 5742426.809763730000000
200 H2S 2N1 −8194387.608708180000000 5706962.311685190000000
201 H8N 1X1 −8194854.569901900000000 5692243.003158370000000
202 H2P 1W2 −8196157.960045840000000 5707830.670461350000000
203 J2K 2Y2 −8098192.409382450000000 5653388.103478030000000
204 G1K 1J6 −7929570.024631840000000 5911356.374949250000000
205 G1R 1P9 −7927948.896038480000000 5911298.214407180000000
206 G6V 6S5 −7920236.007537550000000 5911899.625487360000000
207 J2C 6Y7 −8072565.813651960000000 5764263.266432650000000
208 J4Y 1A2 −8177997.170060100000000 5693846.417461990000000
209 J1G 1C6 −8000755.082243210000000 5686113.063943450000000
210 H7V 2V3 −8209478.726276350000000 5706801.460904830000000
211 G1G 4C7 −7933479.716581660000000 5919788.085672910000000
212 J5M 2V4 −8210572.988330320000000 5757127.029975440000000
213 J4K 2V1 −8183565.927529760000000 5705186.096798200000000
214 G1G 4C8 −7933682.799346310000000 5919802.199398290000000
215 J0K 1A0 −8147368.766860010000000 5794092.449573130000000
216 G7A 2V1 −7936518.584970550000000 5898136.239066010000000
217 H2Z 4G2 −8194547.948412070000000 5712515.660249340000000
218 J5M 2V4 −8210639.523433010000000 5757312.332639810000000
219 G5C 1C7 −7598654.693205900000000 6308375.750149870000000
220 G7H 1P9 −7911006.777737960000000 6178375.130200640000000
221 J7Y 3S7 −8239591.195035760000000 5747237.771098060000000
222 J8P 1H5 −8415167.508400330000000 5699006.084890830000000
223 J9P 1T4 −8659603.177646680000000 6124088.536617070000000
224 J7N 1N4 −8248268.351615300000000 5733601.145880170000000
225 J1E 3J7 −8000605.327076920000000 5688108.288704530000000
226 G0A 3C0 −7897958.223267660000000 5944382.365921620000000
227 G9A 4H7 −8075370.695343930000000 5835903.740882100000000
228 G5Y 5P4 −7869223.661065360000000 5801233.112717970000000
229 H2M 1S5 −8198742.492280170000000 5708569.937791150000000
230 G1X 4M5 −7944178.026575930000000 5903038.964724820000000
231 G2B 3Z6 −7943350.295781820000000 5915526.992822510000000
232 J3G 1V7 −8151917.556473330000000 5709616.888935700000000
233 J6W 2W5 −8197819.102732250000000 5732707.736572040000000
234 H4L 2A7 −8202229.564111250000000 5702794.911248230000000
235 J8B 2N4 −8252504.741422090000000 5772409.288043520000000
236 J8E 3J8 −8303910.435574370000000 5799288.750831560000000
237 G6P 4S2 −8009373.232046320000000 5789580.826661120000000
238 G7S 4S9 −7922574.087686500000000 6174095.139639150000000
239 G9T 2H2 −8091883.698299900000000 5879608.093074000000000
240 G6V 6C1 −7923925.086670850000000 5909351.646231730000000
241 J6E 6X6 −8173651.916341430000000 5785616.450966400000000
242 G5Y 7G4 −7867383.864152240000000 5799780.852791840000000
243 J4B 6G4 −8176165.781939890000000 5712878.920683190000000
244 J7P 2V2 −8223607.622415690000000 5712329.846532510000000
245 J1S 1J8 −8014976.143542690000000 5712075.689196260000000
246 J8Y 3X1 −8430616.926670160000000 5689881.277840790000000
247 H9R 5B1 −8213927.764316900000000 5695031.070699580000000
248 J3E 2T6 −8162733.535593580000000 5712568.540600130000000
249 H7M 2R2 −8207728.469268100000000 5717426.799920340000000
250 G8T 6Y1 −8074669.470200380000000 5839952.622912460000000
251 J0R 1R0 −8255136.364910780000000 5763522.881691710000000
252 J3P 3P8 −8137343.687576590000000 5786841.065266540000000
253 J8Y 3Y2 −8430586.452024560000000 5690841.715659160000000
254 J2C 4R8 −8070048.711916370000000 5760692.911521470000000
255 H7P 1T3 −8213937.489744700000000 5713297.304116300000000
256 J0N 1P0 −8230308.928040220000000 5705295.378364160000000
257 J0N 1P0 −8230870.369999920000000 5705194.498264970000000
258 J8T 8J3 −8426827.833264080000000 5697085.739936030000000
259 G1C 5R9 −7927931.661603130000000 5919338.363031220000000
260 J0J 1L0 −8171461.389405670000000 5651094.891673710000000
261 J6A 2S5 −8176749.072935060000000 5737473.237462650000000
262 J8C 2A6 −8269803.651157660000000 5787995.494776570000000
263 J8P 1L4 −8420364.366755720000000 5697667.386554900000000
264 J6Z 1J2 −8210669.805037890000000 5727069.392490720000000
265 H4G 1W8 −8189509.450904420000000 5694022.653676440000000
266 H7G 2V1 −8203276.441520250000000 5711595.210002390000000
267 J6T 1P3 −8252514.750061060000000 5661643.911377380000000
268 J8H 1Y5 −8274980.567932540000000 5725574.293096420000000
269 J3A 1M1 −8157583.041502010000000 5673523.771997930000000
270 H8R 3G6 −8198812.011419540000000 5688330.723246450000000
271 J6A 2W5 −8174285.908219230000000 5740996.502729300000000
272 J7C 2J5 −8222577.426664180000000 5726530.005223580000000
273 J7Z 5M2 −8237997.299853290000000 5746129.111150800000000
274 H1M 2S5 −8186655.229639730000000 5715271.269714140000000
275 H1E 3Y1 −8193034.351531600000000 5720409.033843620000000
276 G6Z 2C6 −7926915.850634040000000 5898611.112435320000000
277 G8T 2T9 −8073705.279216970000000 5839052.473052680000000
278 J5L2L1 −8240815.337211860000000 5747873.336045890000000
279 J3A 1L2 −8156236.111663260000000 5674242.439855960000000
280 J6E 1E5 −8174892.103203060000000 5787083.331173970000000
281 H3L 2N5 −8199783.742079770000000 5708101.617524060000000
282 J7Z 5N6 −8238476.470264970000000 5747207.865046960000000
283 H9R 5M3 −8218849.424122390000000 5695844.788447580000000
284 G2L 2X2 −7941267.161742780000000 5919031.692326080000000
285 J9L 1T3 −8403966.006778460000000 5869992.005439260000000
286 G9P 1NZ −8098168.273358800000000 5864302.629788050000000
287 G9A 4N3 −8077954.286520300000000 5832408.060523520000000
288 J7K 2L5 −8195222.702033520000000 5737225.622384490000000
289 H1P 1Z4 −8192096.258267460000000 5717070.814778460000000
290 H1R 2B7 −8194374.906394880000000 5716132.970042150000000
291 J3E 1W9 −8164973.277938920000000 5715882.282533280000000
292 J7R 2J5 −8227238.900030400000000 5710625.925381070000000
293 H1W 1R4 −8187089.664169030000000 5707536.967134930000000
294 H2S 3E2 −8195117.963995920000000 5706035.944587470000000
295 H4C 1P4 −8190914.107113200000000 5697374.230493480000000
296 J5A 1G7 −8189538.406007090000000 5681106.802552830000000
297 J0L 1B0 −8205149.172347060000000 5681052.614888510000000
298 J5R 0E5 −8182827.364553630000000 5680048.184759270000000
299 H9H 5J1 −8221442.549804540000000 5693249.066685380000000

For the entire province of Quebec, the median distance of secondary schools to the nearest specialized vape shop is 2278 m (Table 1). More precisely, the median distance is 1993 m for private institutions and 2454 m for public institutions. The shortest median distance to the nearest shop is for educational institutions in advantaged areas (1979 m).

Table 1. Number, median distance, mean and standard deviation at the nearest point of sale, according to the characteristics of the secondary institution and its location
Secondary schools Number Median distance
(m)
Mean distance
(m)
Standard deviation
Characteristics
Private institution 169 1 993 5 452 19 051
Public institution 543 2 454 47 591 145 594
Very small (1–115 students) 164 3 380 89 307 218 183
Small (118–429 students) 172 3 036 42 601 103 782
Medium (431–863 students) 177 2 054 19 609 84 505
Large (868–2540 students) 176 1 970 6 506 35 341
Environment
Advantaged area 442 1 979 20 081 87 599
Disadvantaged area 270 3 711 66 249 172 858
Urban 578 1 914 15 219 60 705
Rural 134 33 492 134 076 247 027
Combined 712 2 278 37 589 128 712

For the entire province of Quebec, the median distance of secondary schools to the nearest specialized point of sale is 1231 m (Table 2), specifically 1001 m for private educational institutions and 1381 m for public educational institutions. The median distance to the nearest shop is lower for educational institutions located in more advantaged areas (1231 m).

Table 2. Number, median distance, mean and standard deviation at the nearest point of sale, according to the characteristics of the college and its location
College Number Median distance
(m)
Mean distance
(m)
Standard deviation
Characteristics
Private institution 78 1 001 2 033 2 695
Public institution 92 1 381 30 624 98 290
Very small (5–106 students) 37 942 1 406 1 261
Small (107–497 students) 36 927 47 375 138 623
Medium (502–1930 students) 37 1 750 27 180 70 820
Large (1944–11 062 students) 36 1 122 1 236 685
Environment
Advantaged area 102 1 231 12 326 44 607
Disadvantaged area 47 1 750 36 101 122 346
Urban 152 1 077 12 100 48 727
Rural 18 7 104 63 154 173 837
Combined 170 1 231 17 506 73 549

Distance to points of sale is treated as a continuous variable in a generalized linear regression model. Medium-sized (versus very small) and large (versus very small) educational institutions as well as urban (versus rural) institutions tend to have a specialized vape shop located closer. Private (versus public) educational institutions, as well as those located in disadvantaged (versus advantaged) areas, are geographically more distant from a vaping product shop (Table 3).

Table 3. Generalized linear regression model: distance from the 689 secondary schools in Quebec to the nearest specialized shop selling vaping products
Log (distance to the nearest point of saleFootnote a, in meters) Univariate model Final multivariate model
BFootnote a 95% CI BFootnote a 95% CI
Intercepted 4.49Footnote *** 4.35 to 4.64
Characteristics
Private institution Ref. Ref.
Public institution 0.34Footnote *** 0.21 to 0.47 0.23Footnote *** 0.11 to 0.34
Very small Ref. Ref.
Small −0.10 −0.25 to −0.07 −0.00 −0.13 to 0.13
Medium −0.43Footnote *** −0.59 to −0.27 −0.25Footnote *** −0.38 to −0.11
Large −0.59Footnote *** −0.75 to −0.43 −0.36Footnote *** −0.50 to −0.28
Environment
Urban Ref. Ref.
Rural −1.1Footnote *** −1.21 to −0.97 −0.92Footnote *** −1.04 to −0.79
Advantaged area Ref. Ref.
Disadvantaged area 0.46Footnote *** 0.35 to 0.57 0.21Footnote *** 0.11 to 0.31

Abbreviations: CI, confidence interval; ref.; reference.

Table 3 Footnote a

Distance (in metres) from the educational institution to the nearest point of sale. Β is the regression coefficient in the multivariate analysis. A high positive coefficient is related to an increase in the log (distance) of the point of sale closest to the educational institution. A negative coefficient is related to a decrease in the log (distance) of the point of sale closest to the educational institution.

Table 3 Return to footnote a referrer

Table 3 Footnote b

p < 0.05.

Table 3 Return to footnote * referrer

Table 3 Footnote c

p < 0.01.

Table 3 Return to footnote ** referrer

Table 3 Footnote d

p < 0.001.

Table 3 Return to footnote *** referrer

Public (versus private), small (versus very small) and medium-sized (versus very small) college institutions are significantly more geographically distant from a vaping product shop. Institutions located in rural areas are significantly further from a vape shop than urban institutions (Table 4).

Table 4. Generalized linear regression model: distance from the 126 colleges in Quebec to the nearest specialized shop selling vaping products
Log (distance to the nearest point of saleFootnote a, in meters) Univariate model Final multivariate model
BFootnote a 95% CI BFootnote a 95% CI
Intercepted 3.50Footnote *** 3.07 to 3.93
Characteristics
Private institution Ref. Ref.
Public institution 0.48Footnote *** 0.22 to 0.74 0.51Footnote *** 0.26 to 0.75
Very small Ref. Ref.
Small −0.42Footnote * 0.06 to 0.77 0.27 −0.01 to 0.56
Medium 0.52Footnote ** 0.17 to 0.88 0.20 −0.10 to 0.51
Large −0.22 −0.38 to 0.34 −0.31 −0.64 to 0.02
Location
Urban Ref. Ref.
Rural −0.86Footnote *** −1.30 to −0.42 −0.66Footnote *** −1.04 to −0.27
Advantaged area Ref. N/A N/A
Disadvantaged area 0.19 −0.09 to 0.47 N/A N/A

Abbreviations: CI, confidence interval; ref., reference.

Table 4 Footnote a

Distance (in metres) from the educational institution to the nearest point of sale. Β is the regression coefficient in the multivariate analysis. A high positive coefficient is related to an increase in the log (distance) of the point of sale closest to the educational institution. A negative coefficient is related to a decrease in the log (distance) of the point of sale closest to the educational institution.

Table 4 Return to footnote a referrer

Table 4 Footnote b

p < 0.05.

Table 4 Return to footnote * referrer

Table 4 Footnote c

p < 0.01.

Table 4 Return to footnote ** referrer

Table 4 Footnote d

p < 0.001.

Table 4 Return to footnote *** referrer

Discussion

First, our study sought to build a georeferenced directory of specialized vape stores in Quebec, so that we could link them to educational institutions. We found that 299 businesses exclusively selling vaping products were open in Quebec in early 2018. Although a detailed analysis of the evolution of the presence of specialized shops in Quebec was beyond the scope of our study, the development and validation of our database leads us to believe that the number of this type of shop could be decreasing. The MSSS list compiled in 2015, which was used to build our directory, contained 414 businesses, while our final directory contains 299. A decrease in this type of business has been observed elsewhere, particularly in France.Footnote 29 The tightening of the legal framework and the decline of vaping as a fashion trend could be two factors that might explain this decline.

The main objective of our study was to examine, according to various characteristics, the geographical accessibility of specialized vape shops in Quebec that are in the vicinity of educational institutions. This analysis revealed that, in Quebec, colleges had greater accessibility to such specialized shops than did secondary schools. The same situation was observed in the USA: no specialized shop was found within 800 m of secondary schools in New Jersey,Footnote 13 while 30% of all colleges across the USA were located within 1.6 km of a vape shop.Footnote 16 However, the situation appears to vary across the USA: a study in California found that 28% of secondary schools had such a vape shop within an 800 m radius.Footnote 10

A variety of reasons may explain why colleges and CEGEPs in Quebec tend to have greater geographical accessibility to this type of business. One explanation is that college campuses are generally located in more densely populated areas or urban agglomerations, which makes them more likely to be located near any business.

Our analysis also showed that more educational institutions in urban areas than in rural areas are located near specialized vape shops in Quebec. The same situation has been observed in the United States. According to a study conducted across the USA, there is a greater availability of specialized vape shops in urban census areas (0.47 average availability) than in rural areas (0.23 average availability).Footnote 14 According to another US study, greater proximity to speciality shops is associated with urban areas: median distance from the nearest shop is 1.1 miles in the city; 1.9 miles in the suburbs; 6.3 miles in a smaller town or village; and 7.9 miles in rural areas).Footnote 16

Our study revealed that private educational institutions are located closer to specialized vape shops in Quebec. This situation was also observed in the USA: vape shops were more likely to be closer to private colleges (2.6 km for median proximity) than public ones (3.2 km for median proximity). The authors suggested that one of the reasons is that this type of trade potentially targets populations that are more socioeconomically advantaged and therefore more likely to attend private schools.Footnote 16

One of the objectives of our analysis was to examine the proximity of specialized vape shops to educational institutions according to the level of material deprivation of the area. Our analysis revealed that vape stores are closer to secondary schools in advantaged areas, but area deprivation was not associated with accessibility to points of sale in conjunction with colleges.

A similar situation exists in the USA. A study conducted in New Jersey, USA, showed that neighbourhoods with an average median household income—as opposed to the lowest—were more likely to be associated with a higher number of specialized vape shops.Footnote 13 In another study conducted in New Jersey, USA,Footnote 30 more shops (specialized and non-specialized) selling e-cigarettes were identified near schools with fewer students eligible for free school meals than near less advantaged schools.

Some researchers have hypothesized that this type of business potentially targets populations that are more socioeconomically advantaged and yet still have high proportions of smokers.Footnote 16 In fact, the e-cigarette, especially the starting device, is more expensive than tobacco and therefore requires, to a certain extent, more resources. As we have seen, more private educational institutions are located near such shops in Quebec, probably also because a more affluent clientele attends these schools.

It is important to note, however, that across the USA there appears to be a greater availability of specialized vape shops in both urban and rural census areas where fewer people own their own homes, an indicator of lesser socioeconomic advantage. Similarly, the availability of specialized vape stores would be expected to be more prevalent in areas where fewer people have a level of education equal to or higher than college level; however, the associations between the proportion of people living below the poverty line in an area and the availability of vape shops were not significant.Footnote 14

Strengths and limitations

To our knowledge, this is one of the only profiles of the spatial distribution of businesses specializing in the sale of vaping products in Quebec and Canada. The presence of specialized vape shops in the study area was carefully validated (by phone, in person and through the use of various databases). We included several types of schools (private and public, secondary schools and colleges), with variable enrolment. We also took into account the characteristics of the location of these institutions, namely the types of environment (urban or rural, disadvantaged or advantaged). From this point of view, there seems to be an interaction between the urban or rural character and the type of education (private or public), and between the type of education and level of deprivation. Such analysis is beyond the scope of this article, and further research is recommended.

Some limitations should also be mentioned. Specialist vape shops are only a part of e-cigarette business in Quebec: vaping products are also available in other stores, in particular, in convenience stores, tobacconists and gas stations. Unlike specialized vape shops, minors can enter these places, although they cannot legally buy e-cigarettes; and like tobacco products, vaping products must not be visible to customers. Since not all of these businesses sell vaping products, a field visit would have been necessary to identify them, which was beyond the scope of our analysis. Thus, our profile underestimates the true geographical accessibility of points of sale for vaping products to young people near schools.

It would be relevant to continue this analysis to include these points of sale, not least because research in the USA has shown that they are present near schools.Footnote 12,Footnote 15 Moreover, the geographical accessibility of young people to the points of sale of various products (including tobacco and vaping products) can be defined differently from schools: near places of residence or near other places that youth frequent (e.g. sports, cultural and recreational centres). In fact, it is increasingly recognized that research must also include several of these places simultaneously.Footnote 31 Considering only accessibility near schools means that only a portion of the geographical accessibility of young people to the points of sale of these products is taken into account, even if the school is the public place most frequented by young people over the longest period. It would therefore be appropriate to expand on this research given that studies have shown that young people’s accessibility to tobacco sales outlets in the vicinity of their homes is associated with the consumption of these products.Footnote 32 Our analysis was not intended to examine the use of vaping products by young Quebecers based on the geographical accessibility of specialized vape shops that are near educational institutions.

Conclusion

Experimentation with e-cigarettes is widespread among young adults in Quebec and among many secondary school students. The factors associated with the use of vaping devices by youth are currently the subject of scientific research. It is possible that geographical accessibility to shops selling these products may be one of these factors, as is the case for tobacco products. As these factors are still largely unknown in Quebec, we have undertaken to provide a snapshot of the geographical accessibility of points of sale specializing in vaping products that are in the vicinity of educational institutions.

Our analysis suggests that specialized vape shops are more easily accessible to students attending college than secondary school. They also appear to be more accessible to students attending private institutions than public ones. For secondary schools, those located in more advantaged areas are closer to a specialized vaping product point of sale. Speciality stores are closer to schools in urban areas than in rural areas.

Future investigations should examine geographical accessibility to all businesses that sell e-cigarettes (such as some convenience stores, tobacco stores and gas stations) and studying the impact of this accessibility on the use of vaping products by young people.

Public health experts agree on the need to limit the use of vaping products among young people in order not to induce nicotine dependence or to provide an incentive for the subsequent use of tobacco products. It is important to continue to improve scientific knowledge about vaping products, their use and marketing and the places where they are sold. In Quebec and Canada overall, legislation has been passed in an attempt to restrict young people’s access to vaping products while allowing adults who want to quit smoking access to them. It is relevant and worthwhile to continue research in this changing regulatory environment.

Acknowledgements

This study was made possible with the financial support of the MSSS.

Conflict of interest

The authors declare that there are no conflicts of interest.

Authors’ contributions and statement

ER and PB designed the project. ER, PB and MH designed the study. MH undertook the data collection. ER and MH conducted the data analysis. ER wrote the manuscript. ER and PB contributed to the synthesis of the data. All the authors contributed to the discussion of the findings and their interpretation, as well as to the writing of the manuscript and approval of its final version. The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

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Footnote 12

Giovenco DP, Casseus M, Duncan DT, Coups EJ, Lewis MJ, Delnevo CD. Association between electronic cigarette marketing near schools and e-cigarette use among youth. J Adolesc Health. 2016;59(6):627-34. doi: 10.1016/j.jadohealth.2016.08.007.

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Footnote 13

Giovenco DP, Duncan DT, Coups EJ, Lewis MJ, Delnevo CD. Census tract correlates of vape shop locations in New Jersey. Health Place. 2016;40:123-8. doi: 10.1016/j.healthplace.2016.05.008.

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Footnote 14

Dai H, Hao J, Catley D. Vape shop density and socio-demographic disparities: a US Census tract analysis. Nicotine Tob Res. 2017;19(11):1338-44. doi: 10.1093/ntr/ntx063.

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Footnote 15

Hahn EJ, Begley K, Gokun Y, Johnson AO, Mundy ME, Rayens MK. Electronic cigarette retail outlets and proximity to schools. Am J Health Promot. 2015;29(6):380-3. doi: 10.4278/ajhp.130627-ARB-335.

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Footnote 16

Dai H, Hao J. Geographic density and proximity of vape shops to colleges in the USA. Tob Control. 26(4):379-85. doi: 10.1136/tobaccocontrol-2016-052957.

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Footnote 17

Montreuil A, MacDonald M, Asbridge M, Wild TC, Hammond D, Manske S, et al. Prevalence and correlates of electronic cigarette use among Canadian students: cross-sectional findings from the 2014/15 Canadian Student Tobacco, Alcohol and Drugs Survey. CMAJ Open. 2017;5(2):E460-7. doi: 10.9778/cmajo.20160167.

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Footnote 18

Gervais A, Massé R, Jacques M, Tessier S. Montréal sans tabac: mise en œuvre de la Loi sur le tabac 2005–2010: observations et recommandations pour la mise à jour de la Loi: mémoire du directeur de santé publique de Montréal. Montréal (QC): Agence de la santé et des services sociaux de Montréal, Direction de santé publique; 2013. 26 pp.

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Footnote 19

Coalition Québécoise pour le contrôle du tabac. La promotion de la cigarette électronique au Québec. Montréal (QC): Coalition Québécoise pour le contrôle du tabac; 2015. Available from: http://www.cqct.qc.ca/Documents_docs/DOCU_2015/DOCU_15_08_16_Promotion_CigaretteElectronique.pdf

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Footnote 20

Bergeron P, Robitaille É, Houde M. Accessibilité géographique aux commerces spécialisés en produits de vapotage autour des établissements d’enseignement secondaire et collégial du Québec. Montréal (QC): Institut national de santé publique du Québec; 2019. Available from: https://www.inspq.qc.ca/sites/default/files/publications/2510_accessibilite_commerces_vapotage_etablissements_scolaires-collegial.pdf

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Footnote 21

Ministère de la Santé et des Services sociaux (MSSS). Le tabagisme chez les jeunes adultes : agir ensemble pour diminuer la prévalence : Rapport du directeur national de santé publique 2017. Québec (QC): MSSS; 2017. Available from: http://publications.msss.gouv.qc.ca/msss/fichiers/2017/17-228-01W.pdf

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Footnote 22

Ministère de la Santé et des Services sociaux (MSSS). Loi concernant la lutte contre le tabagisme [Internet]. Québec (QC): MSSS; 2017 [cited 2018 Oct 8]. Available from: http://www.msss.gouv.qc.ca/ministere/lois-et-reglements/loi-concernant-la-lutte-contre-le-tabagisme/

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Footnote 23

Kim AE, Loomis B, Rhodes B, Eggers ME, Liedtke C, Porter L. Identifying e-cigarette vape stores: description of an online search methodology. Tob Control. 2016;25(e1):e19-23. doi: 10.1136/tobaccocontrol-2015-052270.

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Footnote 24

Gamache P, Hamel D. The challenges of updating the deprivation index with data from the 2011 Census and the National Household Survey (NHS). Montréal (QC): Institut national de santé publique du Québec; 2017. 7 pp.

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Footnote 25

Statistics Canada. From urban areas to population centres [Internet]. Ottawa (ON): Statistics Canada; 2011 [modified 2017 May 8; cited 2018 Oct 8]. Available from: https://www.statcan.gc.ca/eng/subjects/standard/sgc/notice/sgc-06

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Footnote 26

Apparicio P, Gelb J, Dubé AS, Kingham S, Gauvin L, Robitaille É. The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues. Int J Health Geogr. 2017;16:32. doi: 10.1186/s12942-017-0105-9.

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Footnote 27

McCullagh P, Nelder JA. Generalized linear models. Boca Raton (FL): Chapman & Hall/CRC; 1989. (Monographs on Statistics & Applied Probability).

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Footnote 28

Burnham KP, Anderson DR. Multimodel inference: understanding AIC and BIC in model selection. Sociol Methods Res. 2004;33(2):261-304. doi: 10.1177/0049124104268644.

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Footnote 29

Buhagiar R. Le commerce du vapotage s’essouffle [Internet]. La Dépêche du Midi; 2017 [cited 2018 Oct 17]. Available from: https://www.ladepeche.fr/article/2017/02/16/2518145-le-commerce-du-vapotage-s-essouffle.html

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Footnote 30

Giovenco DP, Ackerman C, Hrywna M, Delnevo CD. Changes in the availability and promotion of non-cigarette tobacco products near secondary schools in New Jersey, USA. Tob Control. 27(5):578-9. doi: 10.1136/tobaccocontrol-2017-053800.

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Footnote 31

Shareck M, Kestens Y, Vallée J, Datta G, Frohlich KL. The added value of accounting for activity space when examining the association between tobacco retailer availability and smoking among young adults. Tob Control. 2016;25(4):406-12. doi: 10.1136/tobaccocontrol-2014-052194.

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Footnote 32

Finan LJ, Lipperman-Kreda S, Abadi M, et al. Tobacco outlet density and adolescents’ cigarette smoking: a meta-analysis. Tob Control. 2019;28(1):27-33. doi: 10.1136/tobaccocontrol-2017-054065.

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Footnotes

Footnote 1

General and vocational college.

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Footnote 2

“A population centre [is] an area with a population of at least 1,000 and a density of 400 or more persons per square kilometre. All areas outside population centres [are] defined as rural areas.”Footnote 25

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