Assessing the impact, equity, and mechanisms of a novel policy intervention to reduce tobacco retailer density in communities

项目摘要/摘要 烟草零售商的密度在低收入社区和某些种族/民族中高得不成比例 飞地，助长了吸烟及其健康方面的严重社会经济和社会差距 伤害。旨在减少烟草零售商数量的地方、环境层面的干预措施是一种新的 烟草控制的政策前沿可能在促进健康公平方面特别有效，但 在现实世界的背景下，这些举措被严重地忽视了。美国三大城市-旧金山， 费城和纽约市(NYC)-最近颁布了新的措施，对人数设定上限 城市地区允许的烟草零售许可证的数量。这种干预下的密度降低不是通过 吊销执照，但逐渐通过零售商的自然减员。这些“封顶”政策对零售商的影响 密度降低和由此产生的烟草产品市场在很大程度上取决于时间、空间和 执照没收中的商店级模式，这还不是很好的理解。此外，要全面评估 公共健康影响，关键是在实施后进行利益相关者分析，描述政策的 对行为改变的影响和机制，并确定潜在的意想不到的影响。建议数 混合方法，比较案例研究将使用烟草零售许可证档案数据，年度审计 烟草零售商、与关键社区利益相关者的半结构化访谈和地理编码健康调查 评估这种干预措施并检查不同社区和人口的不同政策影响的数据 子组。具体地说，该项目将：1)衡量烟草零售商密度的减少及其与 研究地点的社区人口统计；2)纵向描述烟草的变化 政策执行过程中的市场；3)定性评估关键利益相关者对政策的看法，其 作用机制及其行为影响；以及4)确定烟草零售商密度之间的联系 使用地理编码的独特的年度人口调查减少纽约市社区的吸烟趋势 被调查者数据。鉴于缺乏对这种新生的、环境层面的烟草控制的经验支持 干预，研究结果将为制定公平的政策提供及时的、必要的和经验的证据。 形成和改进执行情况，以最大限度地产生影响并减少持续的健康差距。

PROJECT SUMMARY/ABSTRACT Tobacco retailer density is disproportionately high in low-income communities and certain racial/ethnic enclaves, contributing to severe socioeconomic and social disparities in smoking and its resultant health harms. Local, environmental-level interventions that aim to reduce the number of tobacco retailers are a new policy frontier in tobacco control that may be particularly effective in promoting health equity, but the impact of these initiatives is critically understudied in real-world settings. Three major US cities – San Francisco, Philadelphia, and New York City (NYC) – recently enacted novel measures that establish caps on the number of tobacco retail licenses permitted in city districts. Density reduction under this intervention occurs not through license revocation, but gradually through retailer attrition. The effects of these “capping” policies on retailer density reduction and the resultant tobacco product marketplace largely depend on temporal, spatial, and store-level patterns in license forfeiture, which are not well-understood. Moreover, to comprehensively assess public health impact, it is critical to conduct stakeholder analyses after implementation, describe the policy’s impact on and mechanisms of behavior change, and identify potential unintended effects. The proposed mixed-methods, comparative case study will use archival tobacco retail licensing data, annual audits of tobacco retailers, semi-structured interviews with key community stakeholders, and geocoded health survey data to evaluate this intervention and examine differential policy impact across neighborhoods and population subgroups. Specifically, the project will: 1) Measure tobacco retailer density reduction and its association with community demographics across study sites; 2) Longitudinally characterize changes in the tobacco marketplace during policy implementation; 3) Qualitatively assess key stakeholder perceptions of the policy, its mechanisms of action, and its behavioral impact; and 4) Identify associations between tobacco retailer density reduction and smoking trends in NYC neighborhoods using a unique, annual population survey with geocoded respondent data. Given the lack of empirical support for this nascent, environmental-level tobacco control intervention, study results will provide timely, essential, and experiential evidence to inform equitable policy formation and improve implementation in order to maximize impact and reduce persistent health disparities.