Distance From Home to the Nearest Tobacco Outlet May Not Reflect the True Accessibility.

Distance FromHome to theNearest TobaccoOutlet MayNot Reflect the True Accessibility To the Editor In their Original Investigation in a recent issue of JAMA InternalMedicine, Pulakka et al1 examined the association between walking distance from home to the nearest tobacco outlet and smoking cessation and relapse. We noticed several limitations that should be considered. First, Pulakka et al1 simply used the distance but did not consider thewalkability2 of the neighborhoods, including the street connectivity, land use mix, and residential density. A neighborhoodwithhigher street connectivity, forexample,has higheraccessibility to tobaccooutlets thananeighborhoodwith lower street connectivity, providing that thewalking distance from home to the tobacco outlet is the same between the 2 neighborhoods. Landusemixand residential density also contribute totheaccessibility to thetobaccooutlet.Therefore,measuring thedistance fromhome to the tobaccooutlet alonemay not reflect the true accessibility. Second, assessment of smoking behavior in this study has also raised concerns that some nonregular smokersmayhavebeenmisclassifiedas if theyhave quit smoking. Third,walking distance fromhome to the nearest tobaccooutletwas the focusof this study, but the individuals’ functional capacity (eg, walking ability) and transportation preference (eg,whether the individualswalk or use other meansof transportationwithin theneighborhood)werenotaddressed. For example, riding a bicycle for 1 kmandwalking for 1 kmrequiredifferent energyexpenditure andmayaffect their motivation to go to the tobacco outlet. Fourth, the perceived distance to the nearest tobacco outlet should have been addressed, as the perceived environmentmayhave stronger impact on behaviors than the actual environment.3