Clarifying the role of tobacco retail outlets on maternal smoking during pregnancy and child secondhand smoke exposure

摘要 吸烟和二手烟(SHS)暴露都是慢性疾病和 癌症。虽然吸烟的流行率在整个人口中有所下降，但也有一些亚群 特别容易受到烟雾影响的人群，如孕妇和儿童，建议 几乎完全消除这些亚群中的暴露。许多州都在积极进行规划或 提出限制烟草零售点(Tro)密度的新法规，以此作为减少吸烟的一种手段。 据推测，降低tro密度应该会导致成人吸烟水平降低，这也应该会减少。 孕妇孕期吸烟与儿童SHS暴露。几乎没有证据表明反式密度 与吸烟行为有关，而且没有证据表明降低TO密度会延伸到 弱势群体和被动接触者，如孕妇和儿童。建议的目的是 这项研究是为了检查在何种程度上，tro密度与吸烟暴露的生物标记物(可替宁)有关。 在这些母亲所生的400名4至10岁的孩子中，有1000名妇女在怀孕期间出生。此外，这项研究还 将决定可替宁水平和反式浓度与医疗保健利用率和成本的关系程度 在怀孕期间和儿童早期。为了完成这项研究，该团队将整合关于生物标记物的数据 出生前纵向队列的吸烟暴露和卫生保健利用数据与公开数据 TRO和人口普查数据来源(美国社区调查)。通过更好地理解TRO 有了烟雾暴露以及与这种暴露相关的医疗费用，我们将会更好 定位于制定旨在改变tro格局的数据驱动型政策。成功完成这项工作 该项目将提供证据，支持继续努力扩大降低Tro密度和保留率的政策 它们正在被制定的地方。

Abstract Both smoking and second hand smoke (SHS) exposure are established risk factors for chronic disease and cancer. While the prevalence of smoking has decreased in the population as whole, there are subgroups that are particularly vulnerable to smoke exposure, such as pregnant women and children, and it is recommended to eliminate exposure almost entirely among these subgroups. Many states are active in either planning or proposing new regulations limiting tobacco retail outlet (TRO) density as a means of reducing smoking. Presumably, reducing TRO density should lead to lower levels of adult smoking, which should also reduce maternal smoking during pregnancy and SHS exposure in children. There is scant evidence that TRO density is related to smoking behaviors, and there is no evidence showing that reducing TRO density will extend to vulnerable subgroups and those passively exposed, like pregnant women and children. The purpose of proposed study is to examine the extent to which TRO density is related to biomarkers of smoke exposure (cotinine) in 1000 women during their pregnancy and in 400 children aged 4-10 born of these mothers. In addition, the study will determine the degree to which cotinine levels and TRO density relate to health care utilization and costs during pregnancy and early childhood. To accomplish this study, the team will integrate data on biomarkers of smoke exposure and health-care utilization data from a longitudinal pre-birth cohort with publically available data sources on TROs and census data (American Community Survey). By better understanding the link that TROs have with smoke exposure and the related health-care costs associated with such exposure, we will be better positioned to make data-driven policies that aim to modify the TRO landscape. Successful completion of this project will provide evidence supporting continued efforts to expand policies reducing TRO density and retain them where they are being enacted.