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Geographic Information Systems and Tobacco Control: An Overview of the City of Hamilton's Tobacco Vendor Surveillance

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I Introduction

Hamilton Public Health Services (HPHS) initiated GIS-supported surveillance of licensed tobacco product vendors in the city of Hamilton starting in 2006.  Following the launch of the Smoke-Free Ontario Strategy in 2005/06 staff from HPHS' Tobacco Control Program began working more formally with their colleagues in the Surveillance Unit and the City of Hamilton's Corporate Services Department/GIS Section to develop, execute and analyze a series of surveillance exercises looking at licensed tobacco product vendors in the city of Hamilton.
 
Geographic Information Systems (GIS) have been employed to routinely examine tobacco vendor 'sales-to-minors' compliance with the Smoke-Free Ontario Act. Utilizing GIS for the purpose of mapping locations of all known licensed tobacco product vendors operating in the city of Hamilton has allowed HPHS to initiate a number of additional surveillance exercises to both inform and document current tobacco control enforcement and health promotion initiatives ongoing across the community.
 
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II Background

The City of Hamilton has a population of 504,559 of which 68, 430 are youths between 10 - 19 years. The population density is 451.6/km² spread over a land mass of 1,117.21/km².

According to the 2005 Canadian Community Health Survey the smoking rates (12 years and over) are 20.2% in Ontario and 21.5% in Hamilton. Cigarette use in the past year (2007) according to the Centre for Addiction and Mental Health (CAMH) is 11.9% in Ontario, with about 5% reporting smoking on a daily basis. Current smoking (daily and occasional) reported by students in grades 9 -12 surveyed in Hamilton according to School Health Action, Planning and Evaluation System (SHAPES) 2006 is 18%.  

Tobacco sales to minors is enforced through the 2006 Smoke-Free Ontario Act through twice yearly compliance checks of the 530 licensed vendors in Hamilton, and follow-up regarding complaints. The Test Shopper Program runs on a six-month cycle using underage test shoppers, with a first offence resulting in a warning and a fine for a second offense within five years.

Overview of tobacco vendor surveillance
Data inputs include sales to minors (Test Shopper Program), vendor locations and school locations. The collation and analyses phase includes an overlay of layers for map production, density of vendors, offences over time and per inspection area, and vendors within one kilometre of schools (both with and without offences). The routine outputs include:

  • Description of offences
  • Keyed vendor location map
  • School location map showing vendors
  • Vendors by Planning Unit map
  • Vendors/offences by Inspection District Area map
  • Map of schools by vendors (within 1 km)
  • Map of schools by vendors in violation (within 1 km)

The results were disseminated to the Boards of Health and presented to the tobacco control team and the tobacco prevention team.

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III Results

In 2007 there were 561 licensed tobacco vendors eligible for the Test Shopper Program; 909 test shopper events took place, which resulted in 52 warnings and 20 charges. This translates to 14% of vendors with at least one ‘sale-to-minor' offence.

About the GIS Maps

Hamilton Public Health Services' GIS surveillance of licensed tobacco product vendors operating in the city of Hamilton includes a variety of investigative initiatives. Initial GIS maps were developed and produced to pinpoint licensed tobacco product vendors and where they are physically situated across the city. Address and postal code information was obtained from the City's Licensing Division and inputted using GIS. Data specific to the Tobacco Control Act and Smoke-Free Ontario Act compliance, related to 'sales-to-minors', was subsequently inputted for the purpose of creating maps that would identify geographic areas of non-compliance. Further, address and postal code information for all area elementary and high schools was overlaid to provide maps that would articulate proximity data concerning tobacco product point-of-sale locations within 1 km of every school location. And finally, socio-economic status (SES) data was used to investigate whether there was any correlation between the SES of a given community and the presence of legislative non-compliance as it pertains to tobacco product point-of-sale.

Neighbourhood types were categorized according to measurement of SES and the percentage of vendors with sales-to-minors offences were calculated:

  • Mature (many seniors) / low economic / urban / transition - 14 % vendors with sale-to-minors offence
  • High SES / low density - 11 % vendors with sale-to-minors offence
  • High economic / high minority / urban - 8 % vendors with sale-to-minors offence
  • Mature (many seniors) / owned dwelling / low education - 13 % vendors with sale-to-minors offence
  • Low SES / high minority - 16 % vendors with sale-to-minors offence

IV Conclusions

Challenges to implementation

  • Staffing pressures.
  • Data collection tools are not designed with surveillance/GIS in mind.
  • Geocoding large datasets can take considerable effort.
  • Developing the essential good working relationship between the data collectors. (tobacco enforcement officers) and the analysts (epidemiologist, GIS technician).
  • Absence of standardized information technology for public health unit field staff across Ontario.
  • Integrating results into practice.

Why use GIS technology for tobacco control surveillance?  

GIS technology provides numerous opportunities and applications for expanded tobacco control surveillance. In addition to informing tobacco control enforcement practices and strategies, GIS and its analysis point to further opportunities to develop, implement and evaluate community-level evidence-informed interventions for tobacco control practice, as well as inform policy development.