Project 2: Big City Tobacco Control Study

项目2：大城市控烟研究 据估计，3650万美国成年人仍然吸烟，近70%的人想戒烟，但只有7%的人想戒烟 成功。吸烟集中在低收入和某些种族/民族群体，他们面临着额外的 戒烟障碍：生活在烟草零售商不成比例饱和的地区，那里有 更多的营销线索，并提供明显更便宜的烟草产品。两种类型的基于人口的 在地方一级，对零售环境的干预正在迅速增加。基于地点的策略限制了 烟草零售商的位置、类型和密度(例如，限制距离学校、无烟药店、上限 按人口计算的零售商数量)。以消费者为中心的策略通过非税收机制提高价格(例如， 确定最低价格和包装尺寸)并限制销售的烟草产品(例如，调味产品 烟草专卖店)。然而，这些干预措施对烟草控制的总体好处，以及具体的 对弱势群体和种族/族裔多元化社区的福利并没有得到牢固的确立。的目标是 项目2是为了解决烟草控制研究中的这一关键差距，通过评估正在进行的自然 在全美30个大城市进行零售干预试验。大城市健康的参与 联盟，项目2建议评估地方干预措施是否以及如何影响烟草零售 环境和成人烟草使用的潜在后果。将集成多级别的空间数据集 每个城市的唯一数据来源：1)法律研究，以表征以下城市的存在、类型和实力 干预措施；2)在烟草零售商纵向队列中进行营销观察(n=1800，每个城市60个)， 3)关于烟草产品销售量的具体城市数据；4)对成年吸烟者进行纵向队列调查 评估戒烟尝试(n=2400，每个城市80个)；5)人口普查地区烟草零售商密度的空间分析 以及以商店和个人为中心的缓冲区。根据无烟空气进行调整的广义线性混合模型 法律和烟草税水平将根据三个主要目标进行估计。目标1考察了基于地点的 干预措施与烟草零售商在基线上密度较低、烟草零售商减少有关 随着时间的推移，人口密度越来越大，低收入社区的不平等程度也更小。AIM 2考察了 以消费者为中心的干预措施与更高的基线烟草价格、更大的增长 随着时间的推移，价格会有所下降，低收入社区的不平等程度也会缩小。AIM 3考察了 更强的零售干预措施与城市一级的烟草使用减少(销售量)和 个人级别(退出尝试)。项目2的公共卫生意义在于告知证据库 指导州和地方项目的最佳实践，旨在对抗烟草行业在 销售。在该方案项目的背景下，由烟草公司组成的ASPIRE社区咨询委员会 来自大城市的控制程序领导人将增加拟议研究的相关性和影响力。

Project 2: Big City Tobacco Control Study An estimated 36.5 million US adults still smoke cigarettes and nearly 7 in 10 want to quit but only 7 in 100 succeed. Smoking is concentrated in lower income and certain racial/ethnic groups who face additional obstacles to quitting: living in areas that are disproportionately saturated with tobacco retailers, that contain a larger volume of marketing cues, and offer markedly cheaper tobacco products. Two types of population-based interventions in the retail environment are increasing rapidly at the local level. Place-based strategies limit the location, type and density of tobacco retailers (e.g., limit proximity to schools, tobacco-free pharmacies, a cap on retailers per population). Consumer-focused strategies increase price through non-tax mechanisms (e.g., establish minimum price and pack size) and restrict which tobacco products are sold (e.g., flavored products in tobacco-only shops). However, the overall benefits of these interventions for tobacco control, and specific benefits to disadvantaged and racial/ethnically diverse communities, are not firmly established. The goal of Project 2 is to address this critical gap in tobacco control research by evaluating an on-going natural experiment in retail interventions in 30 large cities across the US. With engagement of Big Cities Health Coalition, Project 2 proposes to evaluate whether and how local interventions affect the tobacco retail environment and the potential consequences for adult tobacco use. A multilevel, spatial dataset will integrate unique data sources for each city: 1) legal research to characterize the presence, type and strength of interventions; 2) marketing observations in a longitudinal cohort of tobacco retailers (n=1800, 60 per city), 3) city-specific data on sales volume of tobacco products; 4) a longitudinal cohort survey of adult smokers to assess quit attempts (n=2400, 80 per city); 5) spatial analyses of tobacco retailer density in census tracts as well as store- and person-centered buffers. Generalized linear mixed models that adjust for smoke-free air laws and tobacco tax levels will be estimated for three primary aims. Aim 1 examines whether place-based interventions are associated with lower density of tobacco retailers at baseline, decreases in tobacco retailer density over time, and with narrower inequities in lower-income neighborhoods. Aim 2 examines whether consumer-focused interventions are associated with higher tobacco prices at baseline, greater increases in price over time, and with narrower inequities in lower-income neighborhoods. Aim 3 examines whether stronger retail interventions are associated with tobacco use reduction at the city level (sales volume) and individual level (quit attempts). The public health significance of Project 2 is to inform the evidence base that guides best practices for state and local programs aiming to counter tobacco industry influence at the point of sale. In the context of this Program Project, an ASPiRE Community Advisory Board comprised of tobacco control program leaders from the big cities will increase the relevance and impact of the proposed research.