Project 2: Big City Tobacco Control Study

项目2：大城市烟草控制研究 据估计，3650万美国成年人仍在吸烟，近十分之七的人想戒烟，但只有百分之七的人想戒烟。 成功吸烟集中在低收入和某些种族/族裔群体，他们面临额外的健康风险。 戒烟的障碍：生活在烟草零售商不成比例饱和的地区， 大量的营销线索，并提供明显更便宜的烟草产品。两种基于人口的 地方一级对零售环境的干预正在迅速增加。基于位置的策略限制了 烟草零售商的位置、类型和密度（例如，限制靠近学校，无烟药店， 零售商的数量）。以消费者为中心的战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）并限制销售哪些烟草产品（例如，调味产品在 烟草专卖店）。然而，这些干预措施对烟草控制的总体效益， 为弱势群体和种族/族裔多样性社区提供的福利没有得到牢固确立。的目标 项目2是通过评估一项正在进行的自然研究， 在美国30个大城市进行零售干预实验。与大城市卫生组织的合作 联盟，项目2建议评估当地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。一个多层次的空间数据集将整合 每个城市独特的数据来源：1）法律的研究，以表征的存在，类型和强度， 干预措施; 2）烟草零售商纵向队列的营销观察（n=1800，每个城市60）， 3)特定城市的烟草产品销售量数据; 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）; 5）人口普查区烟草零售商密度的空间分析， 以及以存储和人员为中心的缓冲区。适用于无烟空气的广义线性混合模型 将为三个主要目标估计法律和烟草税水平。目标1审查基于地点的 干预措施与基线时烟草零售商密度较低、 随着时间的推移，人口密度也在下降，低收入社区的不平等现象也在缩小。目标2审查是否 以消费者为中心的干预措施与基线时烟草价格较高、 随着时间的推移，价格，并在低收入社区缩小不平等。目标3审查是否 更强有力的零售干预与城市一级的烟草使用减少（销售量）有关， 个人水平（退出尝试）。项目2的公共卫生意义是告知证据基础， 指导州和地方计划的最佳实践，旨在打击烟草业的影响， 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 来自大城市的控制项目负责人将增加拟议研究的相关性和影响。

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.