The Co-occurrence of Specialty Vape Shops, Social Disadvantage, and Poor Air Quality in the United States: An Assessment of Cumulative Risks to Youth.

Introduction: We conducted a cumulative environmental health risk assessment of whether specialty vape shops and poor air quality are more likely to co-occur in socially disadvantaged neighborhoods where racial/ethnic minority youth live. Methods: We examined the population-adjusted incidence of specialty vape shops in relation to youth race/ethnicity, neighborhood socioeconomic status (SES), and air quality (nitrogen dioxide [NO 2 ]) at the census tract level across the conterminous United States for 2018. Results: We did not find disparity in vape shop incidence related to minority youth race/ethnicity. Vape shop incidence was significantly negatively associated with all the youth race/ethnicities examined. The two lowest SES quintiles had nearly double the rate of specialty vape shop incidence compared with the highest SES quintile. Specialty vape shop incidence increased with NO 2 concentration, with more vape shops in poor air quality neighborhoods. Conclusions: Specialty vape shops are disproportionately present in neighborhoods with poor air quality and where socially disadvantaged youth live. The increased incidence of vape shops in poor air quality neighborhoods, particularly in an urban context with increased traffic emissions, further points to potentially disproportionate impacts on disadvantaged populations due to cumulative social and environmental risks. This raises environmental justice and health equity concerns. Retailer-focused strategies aimed at limiting youth exposure to electronic cigarettes' labeling and advertising, preventing sales to minors, and limiting the number of retailers in low-SES neighborhoods may reduce initiation and help prevent tobacco-related health disparities among youth.