Spatial and economic proximity of cigarette sales to school children in Mongolia

Background The Western Pacific Region has the highest rate of cigarette smoking in the world. In this region, Mongolia has ratified the WHO FCTC treaty and, as part of treaty implementation, monitored school children using the 2014 Global Youth Tobacco Survey (GYTS). Our objective is to examine spatial and economic factors associated with cigarette use in school children of Mongolia. Methods The 2014 GYTS is a cross-sectional, stratified, multi-stage cluster survey of 7,298 school children (ages 13-15) from 63 schools sampled from all urban and rural regions of Mongolia. We conducted logistic regression modelling to examine whether spatial (proximity of cigarette sales to schools), economic (pocket money available to school children), and other environmental/contextual factors were predictors of cigarette use in school children. Results We found that only 11% of rural students and 23% of urban students had adequate amounts of pocket money to purchase a cigarette pack (average price of the pack: 1.8 USD) and have money remaining for the week. Our model indicated that those students given > 2 USD of weekly pocket money were two times more likely (OR=2.2 95% CI [1.20, 4.21]) to be current cigarette users than those with no weekly pocket money. Current pricing of the cigarette pack may not be preventive in students since we found that, among those who smoked cigarettes, 37.5% smoked single cigarettes, and that this increased to 47.5% when cigarette vendors were near the schools. Our models indicated that the presence of cigarette vendors near schools increased the likelihood of cigarette smoking (OR= 1.37; 95% CI [1.03-1.81]) and nearly doubled the likelihood of single cigarette smoking (OR= 1.76; 95% CI [1.09-2.83]). Conclusions Our findings from Mongolia indicate that despite the higher pricing of cigarette packs (relative to the region), illicit sales of single cigarettes are targeting school children near their schools