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依然强劲。重要的是， 目前烟草市场上提供的各种产品对使用者造成了不同程度的伤害。 可燃产品，如香烟和雪茄，在烟草风险连续体上比非 可燃产品，如无烟烟草和电子烟(电子烟)。可以想象，吸烟者 改用非易燃产品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，这种情况在白人中更常见，黑人的发病率最高 使用任何种族或民族的可燃烟草。事实上，吸烟率下降的速度更快。 白人多于黑人，这可能是由于电子烟的普及所致。不同的改换戒烟率 电子烟或其他非燃烧产品可能会加剧白人和 黑人。尽管烟草的使用受到几个个人、人际和社会因素的影响，但零售 众所周知，环境在塑造吸烟行为方面发挥着关键作用，特别是在少数族裔中， 他们是烟草业历来剥削的对象。尽管电子烟和其他非电子烟越来越受欢迎 关于香烟烟草产品，人们对这些产品在销售点的促销情况知之甚少。这 该项目将研究美国各地不同烟草产品的零售情况，以及它在多大程度上 与社区居民的使用行为有关。具体地说，这项研究将1)调查 区域烟草产品销售、控烟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)记录当地烟草与 使用来自国家健康访谈调查的地理编码数据的零售环境和烟草产品使用 (NHIS)和商店审计，以及3)建立烟草使用变化导致的与吸烟相关的差异模型 使用重复横断面NHIS数据和来自人口评估的纵向数据的行为 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.