Associations of Tobacco Retailer Density with Neighborhood Sociodemographics, Individual Smoking Behaviors, & COPD Hospital Admission Rates: A Spatial Health Approach

抽象的。烟草使用仍然是美国可预防死亡的主要原因，导致更多 每年有超过48万人死亡。由于吸烟率较高，与烟草有关的健康问题 不成比例地困扰着低收入和一些种族和少数民族群体。烟草的存在 零售商可能会通过增加烟草产品的可获得性、降低吸烟成本 获得产品，更便宜的价格，以及更多地接触烟草产品营销。烟草零售商 密度(TRD)是衡量烟草零售商在一个地区的集中度，零售商密度是 与吸烟意图、开始、使用和戒烟有关。的整体培训目标 这个项目是为了让申请者从理论上理解建筑环境如何 影响健康，同时发展多层次和地理空间建模和分析技能。这些技能将被用到 实现研究TRD与地区人口统计、吸烟之间关系的总体项目目标 行为，以及全国与COPD相关的住院率。虽然有越来越多的证据表明 对烟草零售商的风险敞口在社区人口统计中并不公平，TRD可能 对吸烟行为的影响，文献中仍然存在显著的空白，包括：1)没有考虑到 社区TRD部分取决于周围地区的人口结构；2)有限数量的全国 研究了TRD与吸烟和戒烟行为的多层次关联，但很少关注 关系是否会因社区人口结构不同而不同；以及3)很少有研究考察关联性 患有与吸烟有关的疾病的TRD。使用二手数据，申请人将填补这些差距， 有三个具体目的的文献：1)使用空间计量经济学，识别邻居 焦点区域周围人口普查区域的社会人口构成与TRD有关；2) 检查县级TRD与个人吸烟和戒烟行为的关系；2a)测试a 确定这些关联是否随县级社会人口的不同而变化的适度模型 3)审查县级TRD与县级COPD相关医院的关联性 录取率。为了调查拟议的目标，申请者将整合几个公开可用的数据 资料来源，包括2010-2014年美国社区调查(社区社会人口统计)，2014- 2015年烟草使用补充资料(个人层面的吸烟和戒烟行为)，以及2014年医疗保健 成本与利用项目国家住院病人数据库(县级COPD相关住院率)。 这项拟议中的研究符合美国国家癌症研究所的愿景，即消除吸烟、癌症和其他危害 事业，以改善公共卫生。我的研究将扩大TRD是否与吸烟有关的知识 和疾病在不同的社区。其结果将使司法管辖区更好地设计和瞄准烟草 控制政策，如减少零售商或量身定做的戒烟计划，以减少地区吸烟的风险。

Abstract. Tobacco use remains the leading cause of preventable death in the United States, causing more than 480,000 deaths annually. Due to higher smoking prevalence, tobacco-related health problems disproportionately afflict lower income and some racial and ethnic minority groups. The presence of tobacco retailers may influence smoking behaviors through greater availability of tobacco products, lower costs of obtaining products, cheaper prices, and greater exposure to tobacco product marketing. Tobacco retailer density (TRD) is a measure of the concentration of tobacco retailers in an area, and retailer density is associated with cigarette smoking intentions, initiation, use, and cessation. The overall training objectives of this project are for the applicant to develop a theoretical understanding of how the built environment may impact health while developing multilevel and geospatial modeling and analysis skills. These skills will be used to achieve the overall project objective of examining associations of TRD with area demographics, smoking behaviors, and COPD-related hospital admission rates across the nation. While there is increasing evidence that exposure to tobacco retailers is not equitable across neighborhood demographics and that TRD may impact smoking behaviors, significant gaps in the literature remain, including: 1) a failure to consider whether neighborhood TRD depends, in part, on the demographics of surrounding area; 2) a limited number of national studies examining multilevel associations of TRD with smoking and cessation behaviors, and little attention to whether relationships may differ by neighborhood demographics; and 3) few studies that examine associations of TRD with smoking-related disease. Using secondary data, the applicant will address these gaps in the literature with three Specific Aims: 1) Using spatial econometrics, identify whether neighborhood sociodemographic compositions of census tracts surrounding a focal tract are associated with TRD; 2) Examine associations of county-level TRD with individual-level smoking and cessation behaviors; 2a) Test a moderation model to determine whether these associations vary by county-level sociodemographic compositions; and 3) Examine associations of county-level TRD with county-level COPD-related hospital admission rates. To investigate the proposed Aims, the applicant will integrate several publicly available data sources, including the 2010-2014 American Community Survey (neighborhood sociodemographics), the 2014- 2015 Tobacco Use Supplement (individual-level smoking and cessation behaviors), and the 2014 Healthcare Cost and Utilization Project State Inpatient Database (county-level COPD-related hospital admission rates). The proposed research fits within NCI’s vision, “To eliminate smoking, and the cancers and other harms it causes, to improve public health.” My study will extend knowledge of whether TRD is associated with smoking and disease in diverse neighborhoods. The results will better equip jurisdictions to design and target tobacco control policies, such as retailer reduction or tailored cessation programs, to ameliorate area smoking risks.