Geographic variation in the diverse tobacco retail environment and its impact on tobacco use disparities

摘要 在卷烟消费下降的情况下，非卷烟烟草产品的销售仍然强劲。重要的是 在当前烟草市场上可获得的不同产品对使用者造成不同程度的伤害。 香烟和雪茄等可燃产品在烟草风险连续统中的比例高于非烟草产品。 可燃产品，如无烟烟草和电子烟（e-cigs）。可以想象，吸烟者 换用不可燃产品的人可能会降低他们患吸烟相关疾病的风险。这种行为， 然而，与黑人相比，白人中更常见，黑人的发病率最高。 任何种族或族裔群体使用可燃烟草。事实上，吸烟率下降得更快， 白人比黑人多，这可能是由电子烟的吸收推动的。按转换方式分列的戒烟率差异 电子烟或其他不可燃产品可能会加剧白人之间现有的健康差距， 黑人虽然烟草使用受到几个个人、人际和社会因素的影响，但零售业仍在继续发展。 众所周知，环境在形成吸烟行为方面起着关键作用，特别是在少数民族中， 他们一直被烟草业剥削尽管电子烟和其他非电子烟越来越流行， 香烟烟草产品，关于这些产品在销售点的促销知之甚少。这 该项目将研究美国各地不同烟草产品的零售情况，以及 与社区居民的使用行为有关。具体而言，本研究将1）调查 区域烟草产品销售、烟草控制政策和社区人口统计之间的关系 使用尼尔森市场扫描数据和人口普查数据，2）记录当地烟草之间的关联 零售环境和烟草制品使用的地理编码数据从全国健康访谈调查 （NHIS）和商店审计，以及3）归因于烟草使用变化的吸烟相关差异模型 行为使用重复的横截面NHIS数据和纵向数据从人口评估 烟草与健康（PATH）研究。

ABSTRACT Amid declining cigarette consumption, sales of non-cigarette tobacco products remain strong. Importantly, the diverse products available in the current tobacco marketplace pose different levels of harm to the user. Combustible products such as cigarettes and cigars are higher on the tobacco risk continuum than non- combustible products such as smokeless tobacco and electronic cigarettes (e-cigs). Conceivably, smokers who switch to a non-combustible product may reduce their risk of smoking-related disease. This behavior, however, is significantly more common among whites compared to blacks, who have the highest rates of combustible tobacco use of any racial or ethnic group. Indeed, cigarette smoking rates are declining faster among whites than blacks, potentially driven by e-cig uptake. Differential rates of quitting smoking by switching to e-cigs or other non-combustible products may exacerbate existing health disparities between whites and blacks. Although tobacco use is influenced by several individual, interpersonal, and societal factors, the retail environment is known to play a critical role in shaping smoking behaviors, particularly among racial minorities, whom the tobacco industry has historically exploited. Despite the growing popularity of e-cigs and other non- cigarette tobacco products, little is known about the promotion of these products at the point-of-sale. This project will examine how the retail of diverse tobacco products varies across the U.S. and the extent to which it is associated with use behaviors of community residents. Specifically, this study will 1) investigate the relationship between regional tobacco product sales, tobacco control policies, and community demographics using Nielsen market scanner data and census data, 2) document the association between the local tobacco retail environment and tobacco product use using geocoded data from the National Health Interview Survey (NHIS) and store audits, and 3) model smoking-related disparities attributed to changes in tobacco use behaviors using repeated cross-sectional NHIS data and longitudinal data from the Population Assessment of Tobacco and Health (PATH) study.