Heated tobacco retailers near schools in urban Portugal: a geospatial point-pattern analysis

Background

In Portugal, the mean age of smoking experimentation is around 16 years, and use of heated tobacco products is increasing among youth. International evidence links tobacco outlet proximity to schools with higher smoking initiation risk, but this spatial exposure has not been quantified for heated tobacco in Portugal.

Methods

We conducted a cross-sectional geospatial point-pattern analysis in urban mainland Portugal using data collected in March 2026. A total of 1161 public and private secondary/vocational (n = 883) and higher education (n = 278) establishments and 5292 retailers of a major heated tobacco brand (IQOS®) were geocoded. An urban mask was derived from CORINE 2018, and retailer locations were modelled as an inhomogeneous Poisson process based on kernel-smoothed intensity. We computed the proportion of schools with at least one retailer within 400 m and 800 m. Observed proportions were compared with Monte Carlo envelopes from 199 simulations, and analyses were stratified by education level.

Results

Overall, 66.6% of schools had at least one retailer within 400 m (simulated median 34.5%; 95% envelope 32.3–36.5%) and 87.3% within 800 m (median 49.8%; 48.3–51.9%), with empirical p-values <0.005. Among secondary schools, 64.1% and 85.6% had a retailer within 400 m and 800 m, respectively, above simulated medians (30.8% and 45.5%; both p < 0.005). For higher education institutions, 74.5% and 92.1% of schools had a retailer within 400 m and 800 m, respectively, exceeding the corresponding simulated medians (45.7% and 63.7%; both p < 0.005).

Conclusions

In urban mainland Portugal, schools are more often located near heated tobacco retailers than expected from the underlying retailer intensity alone. These findings suggest non-random clustering of outlets around educational settings and support policies restricting the proximity of heated tobacco points of sale to schools, aligned with national tobacco control and health promotion strategies.

Key messages

• Many portuguese schools are surrounded by heated tobacco retailers, meaning students are routinely exposed to these products in their daily school environment.

• Limiting heated tobacco sales near schools could help protect young people and support Portugal’s tobacco control and health promotion goals.