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）暴露都是慢性病的既定危险因素， 癌虽然吸烟率在整个人口中有所下降，但也有一些亚群体， 特别容易受到烟雾的影响，如孕妇和儿童，建议 几乎完全消除了这些亚组的接触。许多国家积极参与规划或 提出新的法规，限制烟草零售点（TRO）密度，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 母亲在怀孕期间吸烟和儿童接触SHS。很少有证据表明TRO密度是 与吸烟行为有关，没有证据表明降低TRO密度会延伸到 弱势亚群和被动接触者，如孕妇和儿童。建议的目的 这项研究的目的是检查TRO密度与吸烟暴露生物标志物（可替宁）的相关程度， 1 000名怀孕妇女和这些母亲所生的400名4-10岁儿童。此外，研究 将决定可替宁水平和TRO密度与卫生保健利用和成本的相关程度 在怀孕和幼儿期。为了完成这项研究，该团队将整合生物标志物的数据， 吸烟暴露和卫生保健利用数据来自一个纵向出生前队列，具有可获得的数据 来源于TRO和人口普查数据（美国社区调查）。通过更好地理解TROs 如果我们能减少吸烟以及与吸烟相关的医疗费用， 定位于制定旨在改变TRO格局的数据驱动政策。成功完成本 该项目将提供证据，支持继续努力扩大降低TRO密度的政策， 他们在哪里被执行。

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.