Project 1: Tobacco Retailer Density, Smoking and Tobacco-Related Disease

摘要 烟草零售店集中在特定区域（即，烟草零售商密度）可以产生或 通过增加接触烟草营销、获得更便宜的烟草 产品，并将烟草使用作为一种规范。烟草零售商密度的差异 记录显示，非洲裔美国人、拉丁裔和低收入社区的烟草零售商密度较高 比他们的对手。一些社区正在探索降低零售商密度的方法，但收效甚微。 关于这些干预措施的潜在影响的经验证据。我们建议提供证据 关于零售商密度对a）吸烟行为和B）随后的健康结果的影响。 在本研究的目标1中，我们建立了一个约275，000个烟草的地理编码纵向数据库， 2000年至2018年期间，美国各地的零售商。使用自适应核密度估计，我们将开发 每年测量普查区和县一级的烟草零售商密度， 地区人口特征。在目标2中，我们将密度数据与来自 行为危险因素监测系统。然后，我们分析交叉滞后模型，以确定是否更大 零售商密度驱动县吸烟率，或者零售商是否位于对吸烟需求高的地区， 烟草aim3整合了癌症，心血管和肺部疾病以及出生结局发病率数据 来自北美中央癌症登记协会（NACCR），医疗保健成本和效用 项目（HCUP）和国家生命统计系统（NVSS），以估计潜在的人口健康水平 限制烟草零售商密度的影响。 关于零售密度对吸烟的影响的证据正在出现，但关于暂时性的问题仍然存在 和对健康的最终影响。拟议的工作是第一次纵向检查这些协会， 大大加强了因果推理，也是第一个研究烟草之间的联系， 零售商密度和随后的烟草相关的健康影响，包括癌症。

Abstract The concentration of tobacco retail stores in a specific area (i.e., tobacco retailer density) may produce or sustain higher smoking levels through increased exposure to tobacco marketing, access to cheaper tobacco products, and establishing tobacco use as a norm. Disparities in tobacco retailer density have been documented with African American, Latino, and low-income communities having higher tobacco retailer density than their counterparts. Some communities are exploring ways to reduce retailer density, but there is little empirical evidence about the potential impacts of such interventions. We propose to provide evidence regarding the impacts of retailer density on a) smoking behaviors; and b) subsequent health outcomes. In Aim 1 of this study we build a geocoded, longitudinal database of the approximately 275,000 tobacco retailers throughout the U.S. between 2000-2018. Using adaptive kernel density estimation, we will develop annual measures of census tract- and county- level tobacco retailer density and examine associations with area demographic characteristics. In Aim 2, we link the density data with county smoking data derived from the Behavioral Risk Factor Surveillance System. We then analyze cross-lag models to determine whether greater retailer density drives county smoking prevalence or whether retailers locate in areas with high demand for tobacco. Aim 3 integrates cancer, cardiovascular and pulmonary disease, and birth outcomes incidence data from the North American Association of Central Cancer Registries (NACCR), the Healthcare Cost and Utility Project (HCUP), and the National Vital Statistics System (NVSS) to estimate potential population level health effects of capping tobacco retailer density. Evidence regarding the effect of retail density on smoking is emerging, but questions remain about temporality and ultimate impact on health. The proposed work is the first to longitudinally examine these associations, substantially strengthening causal inference, and is also the first to examine associations between tobacco retailer density and subsequent tobacco-related health effects, including cancer.