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

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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

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 / CEGEPs^{Footnote *}) 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.

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 index^{Footnote 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).

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

Location number	Postal code	X coordinate	Y coordinate
1	G0A 4V0	−7943084.124511710000000	5918642.913591200000000
2	J4B 6P5	−8174593.548616300000000	5715038.963427020000000
3	H2C 1P8	−8199740.049535550000000	5709783.925348480000000
4	J7V 4W7	−8232910.997549550000000	5683910.740677430000000
5	J7V 7X4	−8232744.056368360000000	5683807.561150480000000
6	J7C 2M5	−8224670.224461010000000	5728597.176530020000000
7	G3K 1L2	−7949366.970929380000000	5918402.187769440000000
8	J5W 4N7	−8173446.355898700000000	5755578.585306560000000
9	G6E 1M8	−7907713.226943570000000	5853440.262322360000000
10	H7G 2W2	−8204180.055037080000000	5712908.249710310000000
11	J8T 2R9	−8426565.632271090000000	5694676.245181050000000
12	H2Z 1S5	−8189230.430800800000000	5701027.602579600000000
13	J7E 2W3	−8218670.739114220000000	5723016.038024210000000
14	J2K 2Y7	−8098374.477321810000000	5652777.458429940000000
15	J7G 2T4	−8219655.812383850000000	5718885.233355940000000
16	G6S 1C1	−8006841.452898270000000	5789922.639107780000000
17	G8K 2X8	−8065826.031773620000000	6216628.419524580000000
18	J1G 1E4	−7999862.493382070000000	5685967.208638910000000
19	G7G 2H1	−7914083.111119190000000	6182325.918478710000000
20	J7V 2K7	−8238989.419231300000000	5682611.621291990000000
21	J7C 4K6	−8225774.667450220000000	5729473.596387220000000
22	J1E 2X4	−8000984.924671770000000	5688494.706203130000000
23	J2S 4P2	−8120073.924361320000000	5720620.002873380000000
24	G6V 6Y8	−7922871.163226140000000	5908894.087273490000000
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27	J3L 1X3	−8159775.886110910000000	5693482.197731570000000
28	H2J 1Y4	−8190665.585346240000000	5705293.611197190000000
29	J6E 4R4	−8175198.407101750000000	5784860.380094010000000
30	J6W 4P7	−8198530.524835300000000	5732452.357285710000000
31	J4K 3S6	−8181889.956072480000000	5703413.375835940000000
32	G1G 3Y4	−7935139.371404420000000	5921946.970945900000000
33	J3V 5J1	−8164866.892709470000000	5704928.149703250000000
34	G9P 1M2	−8098542.113953270000000	5864705.274499960000000
35	G9A 4S6	−8075390.838331470000000	5835432.471596150000000
36	J2S 6G1	−8121860.557399430000000	5720305.690826950000000
37	J2C 5S6	−8071531.855421920000000	5762663.326858940000000
38	G7A 2T2	−7935866.839395150000000	5899668.340418470000000
39	G7H 5N6	−7910004.062090190000000	6174285.361019300000000
40	J7M 1E7	−8205462.254386230000000	5741250.925917790000000
41	H2G 1A5	−8193710.064090690000000	5707696.934382130000000
42	H2K 4C7	−8187864.477891350000000	5704326.525488040000000
43	J1E 2T1	−8000883.429506130000000	5686072.487947280000000
44	G5L 1S8	−7628273.717226690000000	6182269.132110170000000
45	J0K 2T0	−8205473.003020780000000	5774760.864055810000000
46	J8P 1B9	−8421382.726833760000000	5698051.142431130000000
47	G3L 1H6	−7996587.763452360000000	5924002.042318580000000
48	J1E 3C9	−7998547.249239210000000	5686472.231417160000000
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51	G9N 0A2	−8098593.142752360000000	5869985.260155900000000
52	J8X 3J2	−8214427.566556010000000	5717651.603101800000000
53	H3H 2P3	−8190860.237811990000000	5699775.652967570000000
54	H7S 1M9	−8207306.609537130000000	5711321.377700520000000
55	H8N 1T8	−8196541.704484550000000	5689195.367489510000000
56	J4J 3X5	−8180164.036756680000000	5705347.627549310000000
57	H7M 2P6	−8206897.663669600000000	5716156.291256790000000
58	J2G 2V5	−8095831.288079290000000	5684705.035648830000000
59	H7T 1L1	−8210978.791992750000000	5708988.933266450000000
60	H7M 2P7	−8206987.268586060000000	5716418.399470340000000
61	G7A 1C8	−7935936.146381770000000	5895094.793429050000000
62	H3H 1M2	−8190898.466836090000000	5699548.401888580000000
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64	H2B 1H6	−8198998.979725860000000	5711490.819466770000000
65	H2G 1L9	−8192626.101135750000000	5707575.690846870000000
66	G7K 1E1	−7915365.646203810000000	6173091.079665640000000
67	G3K 0R6	−7948760.657032560000000	5919234.868841710000000
68	J5W 3E1	−8173582.430000940000000	5752614.261332330000000
69	J8V 1E5	−8432216.047464980000000	5698721.555920770000000
70	J3B 6S4	−8154829.177281030000000	5667943.435920500000000
71	J6K 1C5	−8206985.771522520000000	5678164.117736410000000
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73	J1H 4S8	−8003032.490716250000000	5684238.129958290000000
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77	J7R 2L8	−8225964.574536580000000	5709860.386696260000000
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80	G9N 2J4	−8097447.493124020000000	5869760.245870360000000
81	J3G 5P3	−8149419.163928080000000	5710872.820312440000000
82	G6G 6K2	−7939001.789338840000000	5796635.528774830000000
83	G7X 6L8	−7931943.112520730000000	6176084.035135970000000
84	J0N 1H0	−8216554.314027160000000	5742577.810306400000000
85	G1M 3H6	−7931888.148271090000000	5912453.874695760000000
86	G1J 1Y4	−7927727.708194090000000	5916794.550997230000000
87	J5T 2H7	−8158060.011374000000000	5762446.723078540000000
88	J3X 1R4	−8174154.149884640000000	5730834.880600140000000
89	J1J 2H1	−8007881.806514290000000	5684402.136714570000000
90	G1V 1V3	−7936778.883409780000000	5906458.485057660000000
91	H7X 2Y9	−8214677.603535990000000	5703975.129551510000000
92	G5R 3A9	−7740799.002852990000000	6079148.140488870000000
93	J0L 1C0	−8152798.313465590000000	5757638.732013230000000
94	J3T 1C4	−8083607.465668540000000	5816948.822766070000000
95	G6G 2S4	−7936607.870165750000000	5795514.494340520000000
96	H7E 2B5	−8200823.087899080000000	5715200.084634180000000
97	J0N 1P0	−8230030.036232040000000	5705910.332567790000000
98	G5R 4C2	−7742101.611737160000000	6077688.598783530000000
99	G8Y 4R9	−8080458.374262910000000	5834883.435425960000000
100	J7K 1Y4	−8193055.878216380000000	5739106.974728190000000
101	J6A 2R9	−8177184.043188930000000	5737167.836363170000000
102	G1X 1R4	−7938866.433646970000000	5905179.362641050000000
103	G1L 3P8	−7931059.956336440000000	5915892.835188770000000
104	G3M 2A2	−7985008.592747890000000	5890127.808516180000000
105	H7T 1A1	−8209544.856228840000000	5709533.932269610000000
106	G1X 1S1	−7939277.491892260000000	5904758.328336060000000
107	G1X 1S6	−7939546.533357010000000	5904419.209822820000000
108	J6A 2S2	−8177008.449473490000000	5737279.550246160000000
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110	H1W 1P9	−8187079.630838730000000	5707425.789198540000000
111	H4C 1P3	−8190816.948350020000000	5697550.683844200000000
112	J3G 1V1	−8150495.702237150000000	5708068.270668600000000
113	J8X 3G8	−8428740.942233350000000	5688939.620501390000000
114	H2R 1T3	−8194763.343372580000000	5706548.468367760000000
115	G1W 2L2	−7939355.724188350000000	5903171.171572110000000
116	J4T 2G2	−8179085.818519460000000	5699232.250174590000000
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118	G7X 7X2	−7929916.037592340000000	6175617.925520500000000
119	J4T 2G3	−8178995.809116340000000	5698992.424674400000000
120	H1W 1S1	−8186957.282064200000000	5707862.086911730000000
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123	G6B2C4	−7890821.934867610000000	5713005.468212960000000
124	J9V 1J5	−8842853.747223610000000	5997097.063034410000000
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135	G5L 7Y5	−7627037.865925880000000	6185050.115537450000000
136	J3P 4M7	−8139330.276936240000000	5787472.576619010000000
137	J9H 6W7	−8442000.648452110000000	5684470.234330190000000
138	H1V 1X4	−8185885.519051640000000	5708496.282215470000000
139	H4G 1W2	−8189421.557906050000000	5694454.024617650000000
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141	J5Z 1N9	−8178647.200952620000000	5740994.914334240000000
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143	G0A 4N0	−7961151.974094490000000	5923577.290184840000000
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156	J1N 1E8	−8013902.211307660000000	5680430.307337440000000
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160	J0S 1H0	−8256900.862037390000000	5635475.437968370000000
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164	H2T 1R8	−8192393.130221900000000	5704257.992397710000000
165	G1P 4B2	−7940705.700829850000000	5912884.145750160000000
166	H3W 1X5	−8196202.453491180000000	5698165.544720140000000
167	G6V 4Z4	−7923982.207437270000000	5908201.337252420000000
168	G1H 6Y8	−7931513.106419480000000	5917808.072706410000000
169	G6V 4Z2	−7923644.765428420000000	5908299.358229310000000
170	G8Z 4A7	−8080602.662223740000000	5834435.233217170000000
171	G1L 2W3	−7928934.803349920000000	5913337.954227790000000
172	G8Y 5L5	−8081396.154718520000000	5838791.376020280000000
173	J6W 1T5	−8196936.232849320000000	5733060.667759110000000
174	J8H 1Y6	−8274744.021272480000000	5725629.795494300000000
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
193	G1M 2T4	−7931682.367605750000000	5911833.888649590000000
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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