Proximity and Density of Tobacco Retail Locations to Kentucky Schools and the Relationship to Youth Perceptions of Harm and Susceptibility to E-cigarette Use

Proximity and Density of Tobacco Retail Locations to Kentucky Schools and the Relationship to Youth Perceptions of Harm and Susceptibility to E-cigarette Use | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Proximity and Density of Tobacco Retail Locations to Kentucky Schools and the Relationship to Youth Perceptions of Harm and Susceptibility to E-cigarette Use Hannah Cardona, Melinda Ickes This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7133832/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 16 You are reading this latest preprint version Abstract Background With the continued concern of e-cigarette use among youth, it is crucial to understand risk factors that may increase susceptibility to e-cigarette use and c urrent use. Tobacco retailer placement and youth exposure to advertisements and products through brick-and-mortar locations may be a contributing risk factor to youth's e-cigarette use and susceptibility, yet youth exposure to tobacco retail locations as a potential influential factor for tobacco use is largely under-researched. The purpose of this study is to explore the potential relationship between tobacco retailer proximity/density around Kentucky elementary, middle, and high schools, and students’ perceptions of harm, perceived norms, susceptibility to, and use of e-cigarettes. Methods This study used a mixed-methods analysis of youth’s self-reported survey results and geographical data collection. Participants (N = 7,823) consisted of a convenience sample of students from 106 Kentucky elementary, middle, and high schools which participated in a tobacco education program between September 2023 and May 2024. Items assessing e-cigarette use, susceptibility, perceptions, and perceived norms were measured through an online survey. ANOVA tests were used to compare responses of elementary, middle, and high school students. Chi-squared tests were used to compare measures in proximity and density groups. Results High density of tobacco retailers around schools was positively associated with greater rates of susceptibility and lower perceived risks of e-cigarette use compared to lower density groups (p < .05). Students within one mile of a retailer were more likely to report positive perceptions of e-cigarettes compared to students further than one mile (p < .05). Conclusion Greater density and proximity of tobacco retailers around schools correlates with higher e-cigarette use, susceptibility, and positive perceptions of use. Identifying areas of influence for youth e-cigarette use, and implementation of appropriate restrictions may sufficiently decrease youth exposure to tobacco products and advertising, lowering future health inequalities among young people in Kentucky. E-cigarette youth tobacco density proximity tobacco retail perception Background E-cigarettes, or “vapes” are the most used tobacco product among youth in the United States, with over 1.6 million middle and high school students reporting current use in 2024. 1 Emerging research has shown a significant concern regarding health outcomes of youth who use e-cigarettes, as serious medical conditions such as popcorn lung, 2 EVALI, 3 and psychological distress 4 have been reported. The popularity of e-cigarettes has increased awareness of not only health concerns, but risk factors that may contribute to youth use. Exposure to brightly colored advertisements, novel flavors, and targeted marketing 5 towards vulnerable populations, such as youth, 6 those with poor mental health, 7 or those in a minority group 8 , can impact a person’s likelihood of engaging with e-cigarette use or increase acceptability of e-cigarette behavior. Research shows that more positive perceptions or attitudes towards a behavior increases the likelihood of engaging in that behavior. 9 Although research has continued to explore additional risk factors of youth curiosity, intention, and initiation of e-cigarette use, literature regarding exposure to tobacco retail locations as a risk factor for e-cigarette use is limited. In 2021, nearly 40% of youth e-cigarette users reported purchasing a vape product from a tobacco retail location, such as a vape shop, smoke shop, or convenience store. 10 Close proximity to a tobacco retailer may contribute to higher perceived acceptability of tobacco products and curiosity towards and initiation of cigarette smoking. 11 , 12 The number of tobacco retail locations around a young person’s home or school, or density, is also associated with an increased likelihood of cigarette use or susceptibility. 13 As much of the research is this space is focused on combustible tobacco products, similar studies have not yet investigated the influence of tobacco retail locations on youth e-cigarette perceptions and risk for youth e-cigarette use. Purpose The primary purpose of this study is to explore the association between Kentucky elementary, middle, and high school students' perceptions, use, and susceptibility of e-cigarettes in relation to the proximity and density of tobacco retail locations near their school. Methods Design and Sample This study utilized a cross-sectional design, exploring self-reported survey data from Ky students, as well as quantitative geographic locations of tobacco retail locations and school locations. The survey was administered online to Kentucky elementary, middle, and high schools who participated in the #iCANendthetrend (#iCETT) tobacco and e-cigarette prevention program between September 2023 and May 2024. Secondary data from that larger study is being utilized for the analysis here. Kentucky has approximately 715,000 students enrolled in ~ 1,500 public and private schools. 14 The student population statewide is composed of a variety of racial and ethnic groups: 72% white, 9% African American, 2% Asian, > 1% Hawaiian or Pacific Islander, > 1% Native American or Alaskan Native, and 5% multiracial. 15 Over 50% of students in Kentucky identified as male (51.5%) and 48.5% identified as female. 16 A total of 9,655 students between 4th and 12th grades from 160 Kentucky schools representing 45 counties completed the survey. An equal number of schools were located in rural counties (N = 53) as were in urban counties (N = 53). Approximately 10,700 students received an #iCETT presentation, with an effective survey response rate of 73%. Respondents who did not assent to participate in the survey (N = 1,114), did not answer questions related to the outcome measures (N = 599), reported their grade level as “college” (N = 12), could not be located through self-reporting or IP address (N = 4), or did not report their e-cigarette use (N = 103) were removed. A final count of 7,823 survey responses were used in the analysis for this study. Procedures Analysis for this study used secondary data from an online survey disseminated via Qualtrics, an online survey software, through the #iCANendthetrend program. For school participation in the #iCANendthetrend program, a letter of support is required from the school’s principal or administrator in which they agree to support the research efforts of the program and allow program educators to come to their school to provide the e-cigarette presentation. This letter of support also acknowledges that students are given the opportunity to voluntarily participate in the research portion of the study. Passive parental consent is employed before students are given the presentations, allowing parents to opt out their student if they so choose. An approved waiver of document of informed consent/assent is used to collect assent for students under the age of 18 and consent for students 18 and over at the time of completing the baseline survey. As the survey is voluntary, students may opt out at any time. Students who did not assent/consent to the survey were immediately skipped to the end of the survey and no data were collected. School administrators, teachers, or school staff were provided with a confidential link to distribute the survey to their students two weeks prior to receiving the #iCETT presentation. The administration of this survey took place between August 2023 and June 2024, or during the traditional school year. Tobacco retail locations were compiled from an available list provided by the Kentucky Synar program, which aims to reduce the purchase and sale of tobacco products to underage individuals. 17 The list is compiled through inspections of tobacco retail locations to ensure they are compliant with state law. Reports of sampling methodology and results are compiled in an annual report which is made available to the public the following year. A list of all tobacco retail locations that were assessed using the methodology of the Synar program were compiled and analyzed in this study Measures The survey used in this study was designed with the adoption of questions from previously validated questionnaires. Previous studies informed this study’s use of e-cigarette susceptibility 18 , e-cigarette use 19 , 20 , and perceived harm of e-cigarettes 21 . Theory of Planned Behavior. In this study, components related to TPB were used to guide exploration of participants’ attitudes towards e-cigarette use and identifying participants’ susceptibility to using e-cigarettes. This study explores three main predictors of health behaviors: subjective norms, perceptions of the behavior, and attitudes towards the behavior. Survey Items. Survey questions contained items to assess respondent demographics, e-cigarette user status, perception/attitude towards e-cigarettes, and perceived norms of e-cigarettes. E-cigarette Use. Respondents were categorized into four groups based on their responses to questions related to e-cigarette use and susceptibility: current users, ever users, susceptible never-users, and non-susceptible never users. Respondents were first about ever use: “ Have you ever used an e-cigarette or vape, even one or two puffs?” Those who selected “yes” or were asked an additional question to determine their frequency of use: “ How often do you use vapes/e-cigarettes?” Respondents who selected “I do not use nicotine containing e-cigarettes” were classified as ever-users, while respondents who selected any of the other options were classified as current users of e-cigarettes. Respondents who selected “don’t know” were asked “ How often do you use vapes/e-cigarettes? ” Those who selected “I do not use nicotine containing e-cigarettes” were categorized as never users. Respondents who selected any other option were categorized as current users. E-cigarette Susceptibility. Students who selected “no” to the question regarding ever e-cigarette use, or “don’t know” and were determined to not be current users, were asked two questions to assess susceptibility: "Have you ever been curious about using an e-cigarette/vape, even once or twice?” and “Do you think you will try an e-cigarette/vape in the next year?” . Respondents were classified as susceptible to e-cigarettes if they selected any response other than “Definitely Not” to one or both questions. These measures and procedures follow a standard approach for assessing susceptibility to e-cigarettes. 22 E-cigarette Perceptions and Attitudes. Responses for the measures “perceptions/attitudes” were categorized into either positive perceptions or negative perceptions. Negative perceptions towards e-cigarettes are ideal as it indicates a lower risk to initiating use. Negative perceptions were identified if a respondent answered either “agree” or “strongly agree” to both of the following questions, “ E-cigarettes or vapes are bad for my health” and “ Using e-cigarettes or vapes would make my mental health worse” Positive perceptions were identified if a respondent answered “disagree” or “strongly agree” to either of the above questions. Geocoding Respondents were asked a single question to identify their school: “ What is your current school? ” Students were able to select one of the provided options, or if their school was not listed, type in the name of their school. All school locations (N = 160) were identified with their appropriate address and converted to projected coordinates of latitude and longitude through Excel. Tobacco retail locations provided through the state Synar list were verified and converted to projected coordinates of latitude and longitude through Excel. After removing duplicate retail locations (N = 8), 4,811 retail locations were used in this study. ArcGIS Pro, a geographic information system used in this study to create and analyze data visually through maps, was used to geocode tobacco retail locations and school locations based on the provided coordinates. ArcGIS was also used to calculate the number of tobacco retail locations within a 1-mile radius of any given school and schools were grouped according to the percentile of retail points: low density, medium density, and high density. Similarly, ArcGIS was used to calculate the distance from each school to the nearest tobacco retail location. The calculations were straight-line measurements in miles. Schools were grouped according to the distance calculated to the nearest retailer: close proximity, moderate proximity, and far proximity. Analysis Descriptive analysis (frequencies, distributions) was used to summarize the survey data. To identify any statistically significant differences between urban and rural students’ use, perceptions, and subjective norms towards e-cigarettes, an independent sample t -test was used. A one-way ANOVA test was used to compare Likert scale data of perceptions/attitudes and perceived norms of e-cigarette use between elementary, middle, and high school students. A chi-squared test was used to analyze e-cigarette use, susceptibility, and peer acceptance (perceived norms) between low, medium, and high-density groups, as well as close, moderate, and far proximity groups regarding positive and negative perceptions of e-cigarettes. Data analysis was performed with SPSS, version 30, and an alpha level of .05 was used throughout. Results A total of 7,823 respondents were analyzed in this study. Among these respondents, there were 2,414 (31%) elementary students, 3,595 (46%) middle school students, and 1,814 (23%) high school students. Most respondents were white (76%) and male (38.7%), with an average age 13 to 14 years old. Table 1 Characteristics of Study Sample Characteristic Level N (N = 7823) % Age 9–10 1553 19.9% 11–12 2268 29% 13–14 2748 35.1% 15–16 1024 13.1% 17–18 203 2.6% 19+ 16 .2% DNR 11 .1% Sex Female 2890 37% Male 3029 38.7% Prefer Not to Say 1904 24.3% Race White 5945 76% Black/African American 500 6.4% Asian 139 1.8% Native Hawaiian or Other Pacific Islander 31 .4% American Indian/ Alaskan Native 179 2.3% Multiracial 430 5.5% Other 534 6.8% DNR 65 .8% Ethnicity Not Hispanic or Latino 7014 89.7% Hispanic or Latino 746 9.5% DNR 63 .8% School Classification Elementary 2414 30.8% Middle 3595 46% High 1814 23.2% County Classification Rural 4354 55.7% Urban 3469 44.3% Vaping User - Status Non-Susceptible Never User 5604 71.6% Susceptible Never User 1171 15% Ever User 611 7.8% *DNR – Did not respond Among all students, 5.8% (N = 611) reported having used an e-cigarette, and 4.2% (N = 437) currently use it. The average age of ever and current e-cigarette users was 12.8 years old, with a majority of students in 8th or 9th grade. Among students who had never used an e-cigarette, 1,171 (15%) were considered susceptible to e-cigarette use. The average age of susceptible students was 12.7 years old, with a majority of students in 5th grade. A total of 5,604 (71.6%) students were not susceptible to e-cigarette use. The average age of non-susceptible students was 12.7 years old, with a majority of students in 5th or 7th grade. Table 2 Frequency Distributions of Perceptions, Attitudes, Proximity, Density, and Use of E-cigarettes in Elementary, Middle, and High School Respondents Elementary School N (%) Middle School N (%) High School N (%) Sample Size 2414 3595 1814 E-Cigarette Use Current User 40 (1.7%) 215 (6.0%) 182 (10.0%) Ever User 112 (4.6%) 251 (7.0%) 248 (13.7%) Never User 2262 (93.7%) 3129 (87.0%) 1384 (76.3%) E-Cigarette Susceptibility Susceptible 337 (14.9%) 518 (16.6%) 316 (22.8%) Not Susceptible 1925 (85.1%) 2611 (83.4%) 1068 (77.2%) Perception of Harm Positive (not ideal) 292 (12.5%) 476 (14.0%) 252 (14.5%) Negative (ideal) 2036 (87.5%) 2933 (86.0%) 1484 (85.5%) Peer Acceptance Yes 164 (7/1%) 511 (15.1%) 439 (25.3%) No 2143 (92.9%) 2881 (84.9%) 1295 (74.7%) Proximity Group Close 1406 (58.2%) 2650 (73.7%) 885 (48.8%) Moderate 144 (6.0%) 184 (5.1%) 479 (26.4%) Far 864 (35.8%) 761 (21.2%) 450 (24.8%) Density Group High 490 (20.3%) 1036 (28.8%) 809 (44.6%) Medium 628 (26.0%) 1509 (42.0%) 402 (22.2%) Low 1296 (53.7%) 1050 (29.2%) 603 (33.2%) School Classification High school students were an average of 3.7 times more likely than elementary or middle school students to be a current e-cigarette user. Although middle school students were 2.1 times more likely to be a current or ever user compared to elementary students, they were only 1.02 times more likely to be susceptible to using the products. Nearly 80% of high school students agreed that most students their age use e-cigarettes, compared to approximately 58% of middle school students and 12% of elementary students. Approximately 12.5% of middle and high school students disagree that vaping would make their mental health worse, while 7% disagreed that e-cigarettes are bad for their health. Roughly 7% of elementary students, 15% of middle school students, and 25.3% of high school students reported that it would be okay to their best friend if they were to use an e-cigarette. The mean distance between the nearest tobacco retail location and elementary schools was .71 miles, .51 miles for middle schools, and .68 miles for high schools (p < .001). Elementary schools had an average of 3.64 tobacco retailers within one-mile, middle schools had an average of 4.94 retailers, and high schools had an average of 4.7 retailers (p < .001). Density Groups Compared to students in low or medium density groups, students in the high-density group were more likely to report being current or ever users. Students in the high-density groups were 1.13 times more likely to be susceptible to e-cigarette use, while over 1.5 times more likely to be current e-cigarette users compared to those in the low or medium density groups. Respondents who were in the high density group were more likely to have used e-cigarettes, compared to respondents in the low and medium density groups (p < .05). The likelihood of student susceptibility significantly increased as the density of retail locations increased, with an average increase in susceptible students of 2.5%. It was observed that in all density groups, students who reported having positive perceptions of e-cigarettes were more likely to have used an e-cigarette (p < ,001) and be susceptible to e-cigarette use (p < .001). Students who were in the high-density group were more likely to report that their close friends would be okay with them using a vape, compared to students in the low or medium density group. Table 3 Summary of Measures Based on E-cigarette Perception for Each Density Group Tobacco Retailer Density Low Density (%) Positive Perception Negative Perception X 2 p-value Sample Size (N) 366 2482 Ever Use Yes 30.6 8.5 154 < .001 No 69.4 91.5 Susceptible to Use Yes 24.4 14.9 15.2 < .001 No 75.6 85.1 Peer Acceptance Yes 27.7 11.2 74.4 < .001 No 72.3 88.8 School Classification Elementary 37.2 45.9 9.5 .008 Middle 40.4 33.9 High 22.1 20.3 Medium Density (%) Sample Size (N) 312 2086 Ever Use Yes 25.6 8.7 79.8 < .001 No 74.4 91.3 Susceptible to Use Yes 27.2 15.3 21.1 < .001 No 72.8 84.7 Peer Acceptance Yes 25.0 12.9 31.5 < .001 No 75.0 87.1 School Classification Elementary 24.0 24.6 1.0 .6 Middle 312 2086 High High Density (%) Sample Size (N) 342 1885 Ever Use Yes 32.7 14 72.5 < .001 No 67.3 86 Susceptible to Use Yes 26.1 18.8 6.8 .009 No 73.9 81.2 Peer Acceptance Yes 30.4 15.4 43.7 < .001 No 69.6 84.6 School Classification Elementary 23.4 20.4 1.5 .45 Middle 40.4 33.9 High 22.1 20.3 Proximity Groups Students in the moderate proximity group were more likely to be both current and ever users of e-cigarettes compared to those in the far or close proximity groups. Students in the close proximity group were 1.1x more likely to be susceptible to e-cigarette use compared to students in the far or moderate proximity groups. Respondents in the moderate proximity group were more likely to have positive perceptions of e-cigarettes compared to the close proximity group and the far proximity group (16.7% vs 13.5% vs 12.8%), as seen in Tables 11 and 13. Students in the close proximity groups were more likely to be susceptible to e-cigarette use compared to respondents in the moderate or far proximity groups regardless of perception. However, those in the moderate proximity group were more likely to report having ever used an e-cigarette regardless of positive or negative perception towards the products. Ever use of e-cigarettes was greater in all proximity groups when the respondent reported positive perceptions of e-cigarettes as students with positive perceptions were nearly 3x more likely to have ever used e-cigarettes. Similar findings were identified in each group regarding peer acceptance of e-cigarette use. Table 4 Summary of Measures Based on E-cigarette Perception in Each Proximity Group Tobacco Retailer Density Close Proximity (%) Positive Perception Negative Perception X 2 p-value Sample Size (N) 637 4070 Ever Use Yes 28.3 10.4 158 < .001 No 71.7 89.6 Susceptible to Use Yes 27.1 16.7 30.3 < .001 No 72.9 83.3 Peer Acceptance Yes 28.4 12.9 101.4 < .001 No 71.6 87.1 School Classification Elementary 26.8 28.6 1.9 .38 Middle 53.2 53.6 High 19.9 17.8 Moderate Proximity (%) Sample Size (N) 128 640 Ever Use Yes 39.8 14.8 43.3 < .001 No 60.1 85.2 Susceptible to Use Yes 20.8 16.9 .715 .398 No 79.2 83.1 Peer Acceptance Yes 33.6 17.1 18 < .001 No 66.4 82.9 School Classification Elementary 25.0 16.3 8.7 .013 Middle 15.6 25.2 High 59.4 58.6 Moderate Proximity (%) Sample Size (N) 255 1743 Ever Use Yes 28.6 8 99.1 < .001 No 71.4 92 Susceptible to Use Yes 24.7 14.7 12.4 < .001 No 75.3 85.3 Peer Acceptance Yes 23.4 11.6 27 < .001 No 76.5 88.4 School Classification Elementary 34.9 44.2 14.5 < .001 Middle 45.9 33.8 High 19.2 22.0 Discussion While previous research has sought to explore the relationship between tobacco retail location and tobacco use, this is one of the first studies to analyze the relationship between tobacco retail location and youth use, perceptions, and acceptance of e-cigarettes. Among schools within one mile of a tobacco retail location, students reported greater positive perceptions of e-cigarettes and indicated a greater likelihood of viewing e-cigarettes as not harmful. Among schools with a greater density of tobacco retailers within one mile, students were significantly more likely to report ever or current e-cigarette use, as well as positive perceptions of the products. The differences in perceptions, susceptibility, and use were seen across school level as well. Several reasons may contribute to the differences between density and proximity groups and positive perceptions of e-cigarettes. Tobacco marketing and advertisements are most often seen within tobacco retail locations. Areas that have lower densities of retail locations provide fewer chances for youth exposure to marketing or messaging that might contribute to positive views of tobacco products. Similar conclusions can be seen in areas that are further away from a retail location 18 . Neutral or negative views of tobacco products lower instances of engaging in risky behaviors, such as ever or continued e-cigarette use. 23 Areas of high retail density correlate with increased access to tobacco products and related marketing, which can disproportionately expose young people, individuals who are already at a heightened risk of tobacco use. The results of this study also indicate an increased likelihood of e-cigarette use and positive perceptions of the products among middle school and early high school aged youth. Age is a pre-existing risk factor for tobacco use, with nearly 90% of adults who currently use cigarettes having first tried smoking by age 18. 24 Inequities in tobacco retail exposure can exacerbate risky health behaviors that could lead to tobacco related diseases and nicotine dependence. Ensuring youth have access to age-appropriate prevention education and cessation resources can decrease youth initiation of e-cigarette products and increase awareness of targeted marketing by the Tobacco industry. Implementing preventative education in elementary, middle, and high schools can provide students with critical information to make healthy and informed decisions about their health, regardless of retail exposure. Reducing the density and number of tobacco retail locations, especially in areas with a high count of schools, is critical to lowering the risk of tobacco exposure. Licensing laws play a significant role in restricting where tobacco products can be sold, often prohibiting sale in zones near schools or playgrounds. 25 However, Kentucky does not have any statewide restrictions. 26 Certain cities have enacted zoning laws that require tobacco retailers to be at least 1000 feet away from any school, park, playground, and other community center facilities. 27 While these zoning restrictions can create a better environment for young people, the laws do not apply to retail locations that currently exist, only to new businesses. 28 Therefore, retailers that were constructed prior to any zoning laws may continue to sell tobacco products within any distance of a school. While zoning laws may be effective to reduce new construction of retail locations around youth populated areas, especially in cities that do not currently have zoning laws, additional measures must be taken to reduce access and exposure to tobacco products. Tobacco retail licensure would aid government programs with monitoring retail locations through inspections and compliance checks, requiring retail locations to obtain a license to sell tobacco products at their locations. 29 As of September 30, 2024, thirty-six states require tobacco retailers to have a license to sell conventional or non-traditional tobacco products. 26 While Kentucky is not one of these states with an active tobacco retail license requirement, legislation (specifically senate bill 100 is in the process of approval to require such a license in the state). 30 Current studies indicate that youth living in areas with restrictive ordinances (tobacco retail license) have a lower odd of ever e-cigarette use compared to youth in areas with less restrictive ordinances. 31 Retail licensing ensures increased monitoring of marketing and advertisements of tobacco products, where more strict regulations on marketing materials can decrease youth exposure to tobacco products. 32 Conclusion The results of this study indicate a relationship between tobacco retail location and an increase in youth’s positive perceptions of e-cigarettes. Students with a higher density of tobacco retailers around their school reported significantly higher rates of e-cigarette use, susceptibility, peer acceptability, and positive perceptions of e-cigarettes. Similar results were seen among students within one mile of a retail location. Increased exposure to tobacco retail location is associated with greater likelihood of initiation, continued use, and positive perceptions, which can exacerbate health disparities among youth. Restrictive policies, retail licensure, and compliance monitoring may sufficiently decrease youth exposure to tobacco products and advertising, lowering future health inequalities among young people in Kentucky. Abbreviations #iCETT: #iCANendthetrend Declarations Ethics approval and consent to participate All procedures performed in this study involving human participants were conducted ethically according to the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent and assent were obtained from all individual participants included in the study. The authors confirm that the research presented in this article received approval from the Institutional Review Board of University of Kentucky. Consent for publication Not applicable. Availability of data and materials The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data is not available. Competing interests The authors declare that they have no competing interests. Funding Research reported in this publication was supported in part by grant U54DA058256 from the National Institute on Drug Abuse (NIDA) and the Food and Drug Administration (FDA) Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration. It was also supported in part by funding received from the Kentucky Cabinet for Health and Family Services. Authors contributions HC conceived the presented idea, performed the analysis, interpreted the results, and wrote the manuscript with support from MI. Both HC and MI contributed to the final version of the manuscript. MI supervised the project. Acknowledgements The authors would like to express gratitude to Dr. Jennifer McMullen, Dr. Shemeka Thorpe, and Dr. Jay Christian for their support in the analysis and review of this paper. References Park-Lee E, Jamal A, Cowan H, Sawdey MD, Cooper MR, Birdsey J, et al. 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Available from: https://dbhdid.ky.gov/sud/synar Margolis KA, Donaldson EA, Portnoy DB, Robinson J, Neff LJ, Jamal A. E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Preventive Medicine [Internet]. 2018 Apr 17;112:119–25. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5971002/ About historical NYTS data and documentation [Internet]. Smoking and Tobacco Use. 2025. Available from: https://www.cdc.gov/tobacco/about-data/surveys/historical-nyts-data-and-documentation.html Graham AL, Amato MS, Cha S, Jacobs MA, Bottcher MM, Papandonatos GD. Effectiveness of a vaping cessation text message program among young adult e-Cigarette users. JAMA Internal Medicine [Internet]. 2021 May 17;181(7):923. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2779740?guestAccessKey=47c4d83e-5f45-4024-857a-2e296e550101&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=051721 Hair EC, Truth Initiative Schroeder Institute, Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA, School of Global Public Health, New York University, New York, NY, USA. Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults [Internet]. Tob Control. 2021. Available from: https://tobaccocontrol.bmj.com/content/tobaccocontrol/early/2021/07/20/tobaccocontrol-2020-056047.full.pdf Margolis KA, Donaldson EA, Portnoy DB, Robinson J, Neff LJ, Jamal A. E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Preventive Medicine [Internet]. 2018 Apr 17;112:119–25. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5971002/ Barrington-Trimis JL, Liu F, Unger JB, Alonzo T, Cruz TB, Urman R, et al. Evaluating the predictive value of measures of susceptibility to tobacco and alternative tobacco products. Addictive Behaviors [Internet]. 2019 Apr 1;96:50–5. Available from: https://www.sciencedirect.com/science/article/pii/S0306460318315156 Youth and Tobacco Use [Internet]. Smoking and Tobacco Use. 2024. Available from: https://www.cdc.gov/tobacco/php/data-statistics/youth-data-tobacco/index.html Tobacco retailer location restrictions [Internet]. County Health Rankings & Roadmaps. 2021. Available from: https://www.countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/tobacco-retailer-location-restrictions STATE System Licensure Fact Sheet [Internet]. Available from: https://www.cdc.gov/statesystem/factsheets/licensure/Licensure.html Smoke-Free Ordinance and Licensing Program [Internet]. LouisvilleKY.gov. Available from: https://louisvilleky.gov/government/health-wellness/smoke-free-ordinance-and-licensing-program Building/Zoning Permits - Kentucky Business One Stop [Internet]. Available from: https://onestop.ky.gov/start/Pages/buildingzoning.aspx Tobacco Retailer Licensing Policies Enhance Tobacco Control [Internet]. Available from: https://www.astho.org/communications/blog/enhancing-tobacco-control-through-retailer-licensing-policies/ Kentucky Legislative Research Commission. 25RS SB 100 [Internet]. Available from: https://apps.legislature.ky.gov/record/25rs/sb100.html Astor RL, Urman R, Barrington-Trimis JL, Berhane K, Steinberg J, Cousineau M, et al. Tobacco Retail Licensing and Youth Product Use. PEDIATRICS [Internet]. 2019 Jan 7;143(2). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6361350/ MacMonegle A, Zarndt AN, Wang Y, Bennett M, Malo V, Pitzer L, et al. The Impact of “The Real Cost” on E-cigarette Initiation among U.S. Youth. American Journal of Preventive Medicine [Internet]. 2025 Mar 1; Available from: https://www.ajpmonline.org/article/S0749-3797(25)00071-6/fulltext Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 28 Aug, 2025 Reviews received at journal 31 Jul, 2025 Reviews received at journal 28 Jul, 2025 Reviews received at journal 26 Jul, 2025 Reviewers agreed at journal 25 Jul, 2025 Reviewers agreed at journal 24 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers agreed at journal 21 Jul, 2025 Reviewers invited by journal 21 Jul, 2025 Editor assigned by journal 21 Jul, 2025 Editor invited by journal 18 Jul, 2025 Submission checks completed at journal 17 Jul, 2025 First submitted to journal 17 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7133832","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489412430,"identity":"a22ed3fe-d0a7-4757-9c65-3ce02fff9706","order_by":0,"name":"Hannah Cardona","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBACgwNAgrHhAJhz4EOFhByY8YBILYwPZ5yxMQZrSSBSC7Mxb1taYgOIiVfL8bPHHvzccSefXyL3mAQP2+H0+WGHHwJtsZPTbcCuxf5MXrph75lnljNn5KVJSPAczt14O80AqCXZ2OwALoflmEnwth02MLgNZBhIALXMTgBpOZC4DZeW82/MJP/CtCQYHE43nJ3+Ab+WGzlm0lBbjIGmpyXIS+cQsOXGGzNp2bZnBpLz3xg+bDhgY7hBOqfgQIIBHr+czzGTfNt2x4Cf54zB4b//JOTlZ6dv/vChwk4OlxZsAQImiVUOAvINpKgeBaNgFIyCkQAAPUVtfPDp2H4AAAAASUVORK5CYII=","orcid":"","institution":"University of Kentucky HealthCare","correspondingAuthor":true,"prefix":"","firstName":"Hannah","middleName":"","lastName":"Cardona","suffix":""},{"id":489412432,"identity":"4fee23b7-74ff-4c4d-8e68-7d18b45e0941","order_by":1,"name":"Melinda Ickes","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Melinda","middleName":"","lastName":"Ickes","suffix":""}],"badges":[],"createdAt":"2025-07-15 20:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7133832/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7133832/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87395886,"identity":"e68963d2-c77c-49dc-b5eb-fd6bd9a29e48","added_by":"auto","created_at":"2025-07-23 10:44:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1358834,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7133832/v1/86fb3d38-a436-471d-a4e2-fca59405fd2c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Proximity and Density of Tobacco Retail Locations to Kentucky Schools and the Relationship to Youth Perceptions of Harm and Susceptibility to E-cigarette Use","fulltext":[{"header":"Background","content":"\u003cp\u003eE-cigarettes, or “vapes” are the most used tobacco product among youth in the United States, with over 1.6\u0026nbsp;million middle and high school students reporting current use in 2024.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Emerging research has shown a significant concern regarding health outcomes of youth who use e-cigarettes, as serious medical conditions such as popcorn lung,\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e EVALI,\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e and psychological distress \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e have been reported. The popularity of e-cigarettes has increased awareness of not only health concerns, but risk factors that may contribute to youth use. Exposure to brightly colored advertisements, novel flavors, and targeted marketing \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e towards vulnerable populations, such as youth,\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e those with poor mental health,\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e or those in a minority group\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, can impact a person’s likelihood of engaging with e-cigarette use or increase acceptability of e-cigarette behavior. Research shows that more positive perceptions or attitudes towards a behavior increases the likelihood of engaging in that behavior.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAlthough research has continued to explore additional risk factors of youth curiosity, intention, and initiation of e-cigarette use, literature regarding exposure to tobacco retail locations as a risk factor for e-cigarette use is limited. In 2021, nearly 40% of youth e-cigarette users reported purchasing a vape product from a tobacco retail location, such as a vape shop, smoke shop, or convenience store.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Close proximity to a tobacco retailer may contribute to higher perceived acceptability of tobacco products and curiosity towards and initiation of cigarette smoking.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e The number of tobacco retail locations around a young person’s home or school, or density, is also associated with an increased likelihood of cigarette use or susceptibility.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e As much of the research is this space is focused on combustible tobacco products, similar studies have not yet investigated the influence of tobacco retail locations on youth e-cigarette perceptions and risk for youth e-cigarette use.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary purpose of this study is to explore the association between Kentucky elementary, middle, and high school students' perceptions, use, and susceptibility of e-cigarettes in relation to the proximity and density of tobacco retail locations near their school.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eDesign and Sample\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study utilized a cross-sectional design, exploring self-reported survey data from Ky students, as well as quantitative geographic locations of tobacco retail locations and school locations. The survey was administered online to Kentucky elementary, middle, and high schools who participated in the #iCANendthetrend (#iCETT) tobacco and e-cigarette prevention program between September 2023 and May 2024. Secondary data from that larger study is being utilized for the analysis here.\u003c/p\u003e\u003cp\u003eKentucky has approximately 715,000 students enrolled in ~ 1,500 public and private schools.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e The student population statewide is composed of a variety of racial and ethnic groups: 72% white, 9% African American, 2% Asian, \u0026gt; 1% Hawaiian or Pacific Islander, \u0026gt; 1% Native American or Alaskan Native, and 5% multiracial.\u003csup\u003e15\u003c/sup\u003e Over 50% of students in Kentucky identified as male (51.5%) and 48.5% identified as female.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA total of 9,655 students between 4th and 12th grades from 160 Kentucky schools representing 45 counties completed the survey. An equal number of schools were located in rural counties (N = 53) as were in urban counties (N = 53). Approximately 10,700 students received an #iCETT presentation, with an effective survey response rate of 73%. Respondents who did not assent to participate in the survey (N = 1,114), did not answer questions related to the outcome measures (N = 599), reported their grade level as “college” (N = 12), could not be located through self-reporting or IP address (N = 4), or did not report their e-cigarette use (N = 103) were removed. A final count of 7,823 survey responses were used in the analysis for this study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnalysis for this study used secondary data from an online survey disseminated via Qualtrics, an online survey software, through the #iCANendthetrend program. For school participation in the #iCANendthetrend program, a letter of support is required from the school’s principal or administrator in which they agree to support the research efforts of the program and allow program educators to come to their school to provide the e-cigarette presentation. This letter of support also acknowledges that students are given the opportunity to voluntarily participate in the research portion of the study. Passive parental consent is employed before students are given the presentations, allowing parents to opt out their student if they so choose.\u003c/p\u003e\u003cp\u003eAn approved waiver of document of informed consent/assent is used to collect assent for students under the age of 18 and consent for students 18 and over at the time of completing the baseline survey. As the survey is voluntary, students may opt out at any time. Students who did not assent/consent to the survey were immediately skipped to the end of the survey and no data were collected.\u003c/p\u003e\u003cp\u003eSchool administrators, teachers, or school staff were provided with a confidential link to distribute the survey to their students two weeks prior to receiving the #iCETT presentation. The administration of this survey took place between August 2023 and June 2024, or during the traditional school year.\u003c/p\u003e\u003cp\u003eTobacco retail locations were compiled from an available list provided by the Kentucky Synar program, which aims to reduce the purchase and sale of tobacco products to underage individuals. \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The list is compiled through inspections of tobacco retail locations to ensure they are compliant with state law. Reports of sampling methodology and results are compiled in an annual report which is made available to the public the following year. A list of all tobacco retail locations that were assessed using the methodology of the Synar program were compiled and analyzed in this study\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe survey used in this study was designed with the adoption of questions from previously validated questionnaires. Previous studies informed this study’s use of e-cigarette susceptibility \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, e-cigarette use \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, and perceived harm of e-cigarettes \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheory of Planned Behavior.\u003c/b\u003e In this study, components related to TPB were used to guide exploration of participants’ attitudes towards e-cigarette use and identifying participants’ susceptibility to using e-cigarettes. This study explores three main predictors of health behaviors: subjective norms, perceptions of the behavior, and attitudes towards the behavior.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurvey Items.\u003c/b\u003e Survey questions contained items to assess respondent demographics, e-cigarette user status, perception/attitude towards e-cigarettes, and perceived norms of e-cigarettes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eE-cigarette Use.\u003c/b\u003e Respondents were categorized into four groups based on their responses to questions related to e-cigarette use and susceptibility: current users, ever users, susceptible never-users, and non-susceptible never users. Respondents were first about ever use: “\u003cem\u003eHave you ever used an e-cigarette or vape, even one or two puffs?”\u003c/em\u003e Those who selected “yes” or were asked an additional question to determine their frequency of use: “\u003cem\u003eHow often do you use vapes/e-cigarettes?”\u003c/em\u003e Respondents who selected “I do not use nicotine containing e-cigarettes” were classified as ever-users, while respondents who selected any of the other options were classified as current users of e-cigarettes. Respondents who selected “don’t know” were asked “\u003cem\u003eHow often do you use vapes/e-cigarettes?\u003c/em\u003e” Those who selected “I do not use nicotine containing e-cigarettes” were categorized as never users. Respondents who selected any other option were categorized as current users.\u003c/p\u003e\u003cp\u003e\u003cb\u003eE-cigarette Susceptibility.\u003c/b\u003e Students who selected “no” to the question regarding ever e-cigarette use, or “don’t know” and were determined to not be current users, were asked two questions to assess susceptibility: \u003cem\u003e\"Have you ever been curious about using an e-cigarette/vape, even once or twice?”\u003c/em\u003e and \u003cem\u003e“Do you think you will try an e-cigarette/vape in the next year?”\u003c/em\u003e. Respondents were classified as susceptible to e-cigarettes if they selected any response other than “Definitely Not” to one or both questions. These measures and procedures follow a standard approach for assessing susceptibility to e-cigarettes.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eE-cigarette Perceptions and Attitudes.\u003c/b\u003e Responses for the measures “perceptions/attitudes” were categorized into either positive perceptions or negative perceptions. Negative perceptions towards e-cigarettes are ideal as it indicates a lower risk to initiating use. Negative perceptions were identified if a respondent answered either “agree” or “strongly agree” to both of the following questions, “\u003cem\u003eE-cigarettes or vapes are bad for my health”\u003c/em\u003e and “\u003cem\u003eUsing e-cigarettes or vapes would make my mental health worse”\u003c/em\u003e Positive perceptions were identified if a respondent answered “disagree” or “strongly agree” to either of the above questions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGeocoding\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRespondents were asked a single question to identify their school: “\u003cem\u003eWhat is your current school?\u003c/em\u003e” Students were able to select one of the provided options, or if their school was not listed, type in the name of their school. All school locations (N = 160) were identified with their appropriate address and converted to projected coordinates of latitude and longitude through Excel. Tobacco retail locations provided through the state Synar list were verified and converted to projected coordinates of latitude and longitude through Excel. After removing duplicate retail locations (N = 8), 4,811 retail locations were used in this study.\u003c/p\u003e\u003cp\u003eArcGIS Pro, a geographic information system used in this study to create and analyze data visually through maps, was used to geocode tobacco retail locations and school locations based on the provided coordinates.\u003c/p\u003e\u003cp\u003eArcGIS was also used to calculate the number of tobacco retail locations within a 1-mile radius of any given school and schools were grouped according to the percentile of retail points: low density, medium density, and high density. Similarly, ArcGIS was used to calculate the distance from each school to the nearest tobacco retail location. The calculations were straight-line measurements in miles. Schools were grouped according to the distance calculated to the nearest retailer: close proximity, moderate proximity, and far proximity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDescriptive analysis (frequencies, distributions) was used to summarize the survey data. To identify any statistically significant differences between urban and rural students’ use, perceptions, and subjective norms towards e-cigarettes, an independent sample \u003cem\u003et\u003c/em\u003e-test was used. A one-way ANOVA test was used to compare Likert scale data of perceptions/attitudes and perceived norms of e-cigarette use between elementary, middle, and high school students. A chi-squared test was used to analyze e-cigarette use, susceptibility, and peer acceptance (perceived norms) between low, medium, and high-density groups, as well as close, moderate, and far proximity groups regarding positive and negative perceptions of e-cigarettes. Data analysis was performed with SPSS, version 30, and an alpha level of .05 was used throughout.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 7,823 respondents were analyzed in this study. Among these respondents, there were 2,414 (31%) elementary students, 3,595 (46%) middle school students, and 1,814 (23%) high school students. Most respondents were white (76%) and male (38.7%), with an average age 13 to 14 years old.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Study Sample\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;7823)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDNR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrefer Not to Say\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1904\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBlack/African American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNative Hawaiian or Other Pacific Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmerican Indian/ Alaskan Native\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiracial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e430\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e534\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDNR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Hispanic or Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e89.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHispanic or Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e746\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDNR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchool Classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3595\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1814\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCounty Classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3469\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaping User - Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-Susceptible Never User\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5604\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSusceptible Never User\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEver User\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e611\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*DNR \u0026ndash; Did not respond\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong all students, 5.8% (N\u0026thinsp;=\u0026thinsp;611) reported having used an e-cigarette, and 4.2% (N\u0026thinsp;=\u0026thinsp;437) currently use it. The average age of ever and current e-cigarette users was 12.8 years old, with a majority of students in 8th or 9th grade. Among students who had never used an e-cigarette, 1,171 (15%) were considered susceptible to e-cigarette use. The average age of susceptible students was 12.7 years old, with a majority of students in 5th grade. A total of 5,604 (71.6%) students were not susceptible to e-cigarette use. The average age of non-susceptible students was 12.7 years old, with a majority of students in 5th or 7th grade.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency Distributions of Perceptions, Attitudes, Proximity, Density, and Use of E-cigarettes in Elementary, Middle, and High School Respondents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary School\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMiddle School\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh School\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSample Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3595\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1814\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE-Cigarette Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent User\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (1.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e215 (6.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182 (10.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEver User\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e112 (4.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e251 (7.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e248 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever User\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2262 (93.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3129 (87.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1384 (76.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE-Cigarette Susceptibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSusceptible\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e337 (14.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e518 (16.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e316 (22.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Susceptible\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1925 (85.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2611 (83.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1068 (77.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerception of Harm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive (not ideal)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e292 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e476 (14.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e252 (14.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative (ideal)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2036 (87.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2933 (86.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1484 (85.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeer Acceptance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164 (7/1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e511 (15.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e439 (25.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2143 (92.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2881 (84.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1295 (74.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProximity Group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1406 (58.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2650 (73.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e885 (48.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144 (6.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e184 (5.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e479 (26.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e864 (35.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e761 (21.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e450 (24.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDensity Group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e490 (20.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1036 (28.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e809 (44.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e628 (26.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1509 (42.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e402 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1296 (53.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1050 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e603 (33.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSchool Classification\u003c/b\u003e\u003c/p\u003e\u003cp\u003eHigh school students were an average of 3.7 times more likely than elementary or middle school students to be a current e-cigarette user. Although middle school students were 2.1 times more likely to be a current or ever user compared to elementary students, they were only 1.02 times more likely to be susceptible to using the products.\u003c/p\u003e\u003cp\u003eNearly 80% of high school students agreed that most students their age use e-cigarettes, compared to approximately 58% of middle school students and 12% of elementary students. Approximately 12.5% of middle and high school students disagree that vaping would make their mental health worse, while 7% disagreed that e-cigarettes are bad for their health. Roughly 7% of elementary students, 15% of middle school students, and 25.3% of high school students reported that it would be okay to their best friend if they were to use an e-cigarette.\u003c/p\u003e\u003cp\u003eThe mean distance between the nearest tobacco retail location and elementary schools was .71 miles, .51 miles for middle schools, and .68 miles for high schools (p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Elementary schools had an average of 3.64 tobacco retailers within one-mile, middle schools had an average of 4.94 retailers, and high schools had an average of 4.7 retailers (p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eDensity Groups\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCompared to students in low or medium density groups, students in the high-density group were more likely to report being current or ever users. Students in the high-density groups were 1.13 times more likely to be susceptible to e-cigarette use, while over 1.5 times more likely to be current e-cigarette users compared to those in the low or medium density groups.\u003c/p\u003e\u003cp\u003eRespondents who were in the high density group were more likely to have used e-cigarettes, compared to respondents in the low and medium density groups (p\u0026thinsp;\u0026lt;\u0026thinsp;.05). The likelihood of student susceptibility significantly increased as the density of retail locations increased, with an average increase in susceptible students of 2.5%. It was observed that in all density groups, students who reported having positive perceptions of e-cigarettes were more likely to have used an e-cigarette (p \u0026lt; ,001) and be susceptible to e-cigarette use (p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\u003cp\u003eStudents who were in the high-density group were more likely to report that their close friends would be okay with them using a vape, compared to students in the low or medium density group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Measures Based on E-cigarette Perception for Each Density Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eTobacco Retailer Density\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eLow Density (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive Perception\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative Perception\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample Size (N)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSusceptible to Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeer Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e74.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSchool Classification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedium Density (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample Size (N)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e79.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSusceptible to Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e21.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeer Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e31.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSchool Classification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eHigh Density (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample Size (N)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1885\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e72.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSusceptible to Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeer Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e43.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSchool Classification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eProximity Groups\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStudents in the moderate proximity group were more likely to be both current and ever users of e-cigarettes compared to those in the far or close proximity groups. Students in the close proximity group were 1.1x more likely to be susceptible to e-cigarette use compared to students in the far or moderate proximity groups.\u003c/p\u003e\u003cp\u003eRespondents in the moderate proximity group were more likely to have positive perceptions of e-cigarettes compared to the close proximity group and the far proximity group (16.7% vs 13.5% vs 12.8%), as seen in Tables\u0026nbsp;11 and 13. Students in the close proximity groups were more likely to be susceptible to e-cigarette use compared to respondents in the moderate or far proximity groups regardless of perception. However, those in the moderate proximity group were more likely to report having ever used an e-cigarette regardless of positive or negative perception towards the products. Ever use of e-cigarettes was greater in all proximity groups when the respondent reported positive perceptions of e-cigarettes as students with positive perceptions were nearly 3x more likely to have ever used e-cigarettes. Similar findings were identified in each group regarding peer acceptance of e-cigarette use.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Measures Based on E-cigarette Perception in Each Proximity Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eTobacco Retailer Density\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eClose Proximity (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive Perception\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative Perception\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample Size (N)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e637\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSusceptible to Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e30.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeer Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e101.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSchool Classification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eModerate Proximity (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample Size (N)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSusceptible to Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.715\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.398\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeer Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSchool Classification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eModerate Proximity (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample Size (N)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1743\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e99.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSusceptible to Use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e12.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeer Acceptance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSchool Classification\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e14.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhile previous research has sought to explore the relationship between tobacco retail location and tobacco use, this is one of the first studies to analyze the relationship between tobacco retail location and youth use, perceptions, and acceptance of e-cigarettes. Among schools within one mile of a tobacco retail location, students reported greater positive perceptions of e-cigarettes and indicated a greater likelihood of viewing e-cigarettes as not harmful. Among schools with a greater density of tobacco retailers within one mile, students were significantly more likely to report ever or current e-cigarette use, as well as positive perceptions of the products. The differences in perceptions, susceptibility, and use were seen across school level as well.\u003c/p\u003e\u003cp\u003eSeveral reasons may contribute to the differences between density and proximity groups and positive perceptions of e-cigarettes. Tobacco marketing and advertisements are most often seen within tobacco retail locations. Areas that have lower densities of retail locations provide fewer chances for youth exposure to marketing or messaging that might contribute to positive views of tobacco products. Similar conclusions can be seen in areas that are further away from a retail location\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Neutral or negative views of tobacco products lower instances of engaging in risky behaviors, such as ever or continued e-cigarette use.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Areas of high retail density correlate with increased access to tobacco products and related marketing, which can disproportionately expose young people, individuals who are already at a heightened risk of tobacco use.\u003c/p\u003e\u003cp\u003eThe results of this study also indicate an increased likelihood of e-cigarette use and positive perceptions of the products among middle school and early high school aged youth. Age is a pre-existing risk factor for tobacco use, with nearly 90% of adults who currently use cigarettes having first tried smoking by age 18.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Inequities in tobacco retail exposure can exacerbate risky health behaviors that could lead to tobacco related diseases and nicotine dependence. Ensuring youth have access to age-appropriate prevention education and cessation resources can decrease youth initiation of e-cigarette products and increase awareness of targeted marketing by the Tobacco industry. Implementing preventative education in elementary, middle, and high schools can provide students with critical information to make healthy and informed decisions about their health, regardless of retail exposure.\u003c/p\u003e\u003cp\u003eReducing the density and number of tobacco retail locations, especially in areas with a high count of schools, is critical to lowering the risk of tobacco exposure. Licensing laws play a significant role in restricting where tobacco products can be sold, often prohibiting sale in zones near schools or playgrounds.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e However, Kentucky does not have any statewide restrictions.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Certain cities have enacted zoning laws that require tobacco retailers to be at least 1000 feet away from any school, park, playground, and other community center facilities.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e While these zoning restrictions can create a better environment for young people, the laws do not apply to retail locations that currently exist, only to new businesses.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Therefore, retailers that were constructed prior to any zoning laws may continue to sell tobacco products within any distance of a school.\u003c/p\u003e\u003cp\u003eWhile zoning laws may be effective to reduce new construction of retail locations around youth populated areas, especially in cities that do not currently have zoning laws, additional measures must be taken to reduce access and exposure to tobacco products. Tobacco retail licensure would aid government programs with monitoring retail locations through inspections and compliance checks, requiring retail locations to obtain a license to sell tobacco products at their locations.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e As of September 30, 2024, thirty-six states require tobacco retailers to have a license to sell conventional or non-traditional tobacco products.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e While Kentucky is not one of these states with an active tobacco retail license requirement, legislation (specifically senate bill 100 is in the process of approval to require such a license in the state). \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Current studies indicate that youth living in areas with restrictive ordinances (tobacco retail license) have a lower odd of ever e-cigarette use compared to youth in areas with less restrictive ordinances.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Retail licensing ensures increased monitoring of marketing and advertisements of tobacco products, where more strict regulations on marketing materials can decrease youth exposure to tobacco products.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study indicate a relationship between tobacco retail location and an increase in youth\u0026rsquo;s positive perceptions of e-cigarettes. Students with a higher density of tobacco retailers around their school reported significantly higher rates of e-cigarette use, susceptibility, peer acceptability, and positive perceptions of e-cigarettes. Similar results were seen among students within one mile of a retail location. Increased exposure to tobacco retail location is associated with greater likelihood of initiation, continued use, and positive perceptions, which can exacerbate health disparities among youth. Restrictive policies, retail licensure, and compliance monitoring may sufficiently decrease youth exposure to tobacco products and advertising, lowering future health inequalities among young people in Kentucky.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e#iCETT: #iCANendthetrend \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in this study involving human participants were conducted ethically according to the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent and assent were obtained from all individual participants included in the study. The authors confirm that the research presented in this article received approval from the Institutional Review Board of University of Kentucky.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research, supporting data is not available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch reported in this publication was supported in part by grant U54DA058256 from the National Institute on Drug Abuse (NIDA) and the Food and Drug Administration (FDA) Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration. It was also supported in part by funding received from the Kentucky Cabinet for Health and Family Services. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHC conceived the presented idea, performed the analysis, interpreted the results, and wrote the manuscript with support from MI. Both HC and MI contributed to the final version of the manuscript. MI supervised the project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003eThe authors would like to express gratitude to Dr. Jennifer McMullen, Dr. Shemeka Thorpe, and Dr. Jay Christian for their support in the analysis and review of this paper. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePark-Lee E, Jamal A, Cowan H, Sawdey MD, Cooper MR, Birdsey J, et al. Notes from the Field: E-Cigarette and Nicotine Pouch Use Among Middle and High School Students — United States, 2024. MMWR Morbidity and Mortality Weekly Report [Internet]. 2024 Sep 5;73(35):774–8. Available from: https://www.cdc.gov/mmwr/volumes/73/wr/mm7335a3.htm\u003c/li\u003e\n \u003cli\u003eAmerican Lung Association. Popcorn Lung: A Dangerous Risk of Flavored E-Cigarettes [Internet]. 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Available from: https://pubmed.ncbi.nlm.nih.gov/27864341/\u003c/li\u003e\n \u003cli\u003eMarsh L, Vaneckova P, Robertson L, Johnson TO, Doscher C, Raskind IG, et al. Association between density and proximity of tobacco retail outlets with smoking: A systematic review of youth studies. Health \u0026amp; Place [Internet]. 2020 Mar 9;67:102275. Available from: https://pubmed.ncbi.nlm.nih.gov/33526204/\u003c/li\u003e\n \u003cli\u003ePublic education in Kentucky - Ballotpedia [Internet]. Ballotpedia. Available from: https://ballotpedia.org/Public_education_in_Kentucky\u003c/li\u003e\n \u003cli\u003eKentucky Education Facts - Kentucky Department of Education [Internet]. Available from: https://www.education.ky.gov/comm/edfacts/Pages/default.aspx\u003c/li\u003e\n \u003cli\u003eSafe Schools Annual Statistical Report [Internet]. Kentucky Department of Education; 2022 Dec. 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Effectiveness of a vaping cessation text message program among young adult e-Cigarette users. JAMA Internal Medicine [Internet]. 2021 May 17;181(7):923. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2779740?guestAccessKey=47c4d83e-5f45-4024-857a-2e296e550101\u0026amp;utm_source=For_The_Media\u0026amp;utm_medium=referral\u0026amp;utm_campaign=ftm_links\u0026amp;utm_content=tfl\u0026amp;utm_term=051721\u003c/li\u003e\n \u003cli\u003eHair EC, Truth Initiative Schroeder Institute, Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA, School of Global Public Health, New York University, New York, NY, USA. Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults [Internet]. Tob Control. 2021. 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Available from: https://www.cdc.gov/tobacco/php/data-statistics/youth-data-tobacco/index.html\u003c/li\u003e\n \u003cli\u003eTobacco retailer location restrictions [Internet]. County Health Rankings \u0026amp; Roadmaps. 2021. Available from: https://www.countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/tobacco-retailer-location-restrictions\u003c/li\u003e\n \u003cli\u003eSTATE System Licensure Fact Sheet [Internet]. Available from: https://www.cdc.gov/statesystem/factsheets/licensure/Licensure.html\u003c/li\u003e\n \u003cli\u003eSmoke-Free Ordinance and Licensing Program [Internet]. LouisvilleKY.gov. Available from: https://louisvilleky.gov/government/health-wellness/smoke-free-ordinance-and-licensing-program\u003c/li\u003e\n \u003cli\u003eBuilding/Zoning Permits - Kentucky Business One Stop [Internet]. Available from: https://onestop.ky.gov/start/Pages/buildingzoning.aspx\u003c/li\u003e\n \u003cli\u003eTobacco Retailer Licensing Policies Enhance Tobacco Control [Internet]. Available from: https://www.astho.org/communications/blog/enhancing-tobacco-control-through-retailer-licensing-policies/\u003c/li\u003e\n \u003cli\u003eKentucky Legislative Research Commission. 25RS SB 100 [Internet]. Available from: https://apps.legislature.ky.gov/record/25rs/sb100.html\u003c/li\u003e\n \u003cli\u003eAstor RL, Urman R, Barrington-Trimis JL, Berhane K, Steinberg J, Cousineau M, et al. Tobacco Retail Licensing and Youth Product Use. PEDIATRICS [Internet]. 2019 Jan 7;143(2). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6361350/\u003c/li\u003e\n \u003cli\u003eMacMonegle A, Zarndt AN, Wang Y, Bennett M, Malo V, Pitzer L, et al. The Impact of “The Real Cost” on E-cigarette Initiation among U.S. Youth. American Journal of Preventive Medicine [Internet]. 2025 Mar 1; Available from: https://www.ajpmonline.org/article/S0749-3797(25)00071-6/fulltext\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"E-cigarette, youth, tobacco, density, proximity, tobacco retail, perception","lastPublishedDoi":"10.21203/rs.3.rs-7133832/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7133832/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWith the continued concern of e-cigarette use among youth, it is crucial to understand risk factors that may increase susceptibility to e-cigarette use and \u003cb\u003ec\u003c/b\u003eurrent use. Tobacco retailer placement and youth exposure to advertisements and products through brick-and-mortar locations may be a contributing risk factor to youth's e-cigarette use and susceptibility, yet youth exposure to tobacco retail locations as a potential influential factor for tobacco use is largely under-researched. The purpose of this study is to explore the potential relationship between tobacco retailer proximity/density around Kentucky elementary, middle, and high schools, and students\u0026rsquo; perceptions of harm, perceived norms, susceptibility to, and use of e-cigarettes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study used a mixed-methods analysis of youth\u0026rsquo;s self-reported survey results and geographical data collection. Participants (N\u0026thinsp;=\u0026thinsp;7,823) consisted of a convenience sample of students from 106 Kentucky elementary, middle, and high schools which participated in a tobacco education program between September 2023 and May 2024. Items assessing e-cigarette use, susceptibility, perceptions, and perceived norms were measured through an online survey. ANOVA tests were used to compare responses of elementary, middle, and high school students. Chi-squared tests were used to compare measures in proximity and density groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eHigh density of tobacco retailers around schools was positively associated with greater rates of susceptibility and lower perceived risks of e-cigarette use compared to lower density groups (p\u0026thinsp;\u0026lt;\u0026thinsp;.05). Students within one mile of a retailer were more likely to report positive perceptions of e-cigarettes compared to students further than one mile (p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eGreater density and proximity of tobacco retailers around schools correlates with higher e-cigarette use, susceptibility, and positive perceptions of use. Identifying areas of influence for youth e-cigarette use, and implementation of appropriate restrictions may sufficiently decrease youth exposure to tobacco products and advertising, lowering future health inequalities among young people in Kentucky.\u003c/p\u003e","manuscriptTitle":"Proximity and Density of Tobacco Retail Locations to Kentucky Schools and the Relationship to Youth Perceptions of Harm and Susceptibility to E-cigarette Use","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 10:20:43","doi":"10.21203/rs.3.rs-7133832/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-28T07:07:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T21:01:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-28T22:30:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-26T20:31:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217065494123674250474113360513172608464","date":"2025-07-25T18:22:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272785250616000296155246914524178007978","date":"2025-07-24T20:41:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49413480859304828902541449855031284529","date":"2025-07-22T22:52:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244487611124353239017207785513065426948","date":"2025-07-22T15:44:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92510281276084181541643095801804097350","date":"2025-07-22T14:03:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64370193433118655606097615199168699491","date":"2025-07-22T11:12:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303639878155227337725248067156687294641","date":"2025-07-22T02:08:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-22T02:03:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-22T01:58:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-18T08:55:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-17T21:06:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-07-17T15:00:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ac43ea9-854c-4f38-984e-d327ef898935","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T10:55:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 10:20:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7133832","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7133832","identity":"rs-7133832","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}