Modeling the equity impact of age restricted in-person location policies for youth tobacco use

项目总结/摘要 该提案涉及年龄限制的面对面位置政策（ARLP），这是一种新的烟草控制策略， 可能会对减少青少年吸烟产生重大影响。在ARLP下，只有在烟草销售许可证有效的情况下， 在烟草商店或其他成人专用零售商。由于大多数烟草零售商都是便利店， 折扣店，ARLP可以大大降低烟草零售商的密度，从而减少青少年和 年轻人（“青年”）烟草接触和营销接触。此外，作为便利店和折扣店， 在历史上被边缘化的社区中，ARLP通常不成比例地普遍存在， 烟草零售商的密度。美国迫切需要证据来支持ARLP的引入。 需要从烟草零售商密度的潜在减少、 年轻人的“焦点零售商”（即，年轻人经常遇到或购买烟草最多的零售商）， 对青少年行为的潜在影响，以及青少年的潜在补偿行为（例如，获得 烟草替代品）。交织在这些问题中的是对股权影响的关键关注： ARLP减少了零售商密度和青少年烟草使用的当前差距？这个项目的目标是 ARLP对青少年烟草使用的潜在影响，包括总体影响和对不同优先人群的影响（定义如下 按居住在低收入、种族/少数民族或农村社区分列）。目标1将使用空间统计 模拟ARLP对烟草零售商密度的潜在影响的方法。横跨四个州（加州， 康涅狄格州、北卡罗来纳州和俄亥俄州），调查人员将对目前所有烟草零售商的位置进行地理编码 模拟ARLP对零售商格局的影响。将这些环境数据与来自 一个生活在这些州的多样化的年轻人群体，目标2将利用地理生态瞬间 评估（EMA），以（a）确定年轻人最关注的零售商和（B）模型的程度， 来自这些重点零售商的访问和使用将受到ARLP的影响。研究者将招募 480名青年（每个州120名;年龄16-25岁; 80%烟草使用者; 50%优先人群）收集这一真实世界， 接近实时的地理EMA数据。分析将模拟ARLP是否会阻止购买 和营销接触的显着程度，特别是在优先人口的青年。第三，目标 将使用调查和定性方法来确定年轻人潜在的补偿行为。亚组 烟草使用者将参加焦点小组，所有烟草使用者将被要求完成一份 在线调查。分析将评估从替代来源获得烟草是否会更难获得优先权 (vs.非优先青年。一个由主要合作伙伴组成的外部咨询委员会将为项目的所有阶段提供信息， 传播。该项目的成功完成将为支持公平提供急需的信息， 加强州和地方的ARLP。从长远来看，这些努力将有助于减少并最终 通过促进所有人口的健康公平，消除与烟草有关的健康差距。

PROJECT SUMMARY/ABSTRACT This proposal concerns age restricted in-person location policies (ARLPs), a novel tobacco control strategy that could have a critical impact on reducing youth tobacco use. Under an ARLP, tobacco sales would only be allowed in tobacco shops or other adult-only retailers. As the majority of tobacco retailers are convenience stores and discount stores, ARLPs could drastically reduce tobacco retailer density, and thereby reduce adolescent and young adult (“youth”) tobacco access and marketing exposure. Moreover, as convenience and discount stores are often disproportionately prevalent in historically marginalized neighborhoods, ARLPs may reduce disparities in tobacco retailer density. Evidence is badly needed to support the introduction of ARLPs to the United States. Data are needed from models of the potential reduction in tobacco retailer density, the potential reduction in youths’ “focal retailers” (i.e., the retailers that youth frequently encounter or use the most for tobacco purchases), the potential impact on youth behavior, and the potential compensatory behaviors by youth (e.g., obtaining tobacco through alternative sources). Woven into these questions is the critical concern of equity impact: Will an ARLP reduce current disparities in retailer density and youth tobacco use? The goal of this project is to model the potential impact of ARLPs on youth tobacco use, both overall and for different priority populations (defined by residence in low-income, racial/ethnic minority, or rural neighborhoods). Aim 1 will use spatial statistical methods to model the potential impact of an ARLP on tobacco retailer density. Across four states (California, Connecticut, North Carolina, and Ohio), investigators will geocode the locations of all current tobacco retailers to model an ARLP’s impact on the retailer landscape. Pairing this environmental data with behavioral data from a diverse cohort of young people living in those states, Aim 2 will use geographic ecological momentary assessment (EMA) to (a) identify young people’s most focal retailers and (b) model the extent to which exposure, access, and use stemming from these focal retailers would be impacted by an ARLP. Investigators will enroll 480 youth (120 per state; ages 16-25; 80% tobacco users; 50% priority population) to collect this real-world, close-to-real-time geographic EMA data. Analyses will model whether an ARLP would have prevented purchases and marketing exposures to a significant extent—particularly among the priority population youth. Finally, Aim 3 will use survey and qualitative methods to determine potential compensatory behaviors by youth. Subgroups of tobacco users will participate in focus groups and all tobacco users from the cohort will be asked to complete an online survey. Analyses will assess whether obtaining tobacco from alternative sources will be harder for priority (vs. non-priority) youth. An external advisory board of key partners will inform all stages of the project, particularly dissemination. Successful completion of this project will provide much-needed information to support equity- enhancing state and local ARLPs. In the long-term, such efforts will contribute to reducing and eventually eliminating tobacco-related health disparities by promoting health equity among all populations.