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

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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.