Project 2: Big City Tobacco Control Study An estimated 36.5 million US adults still smoke cigarettes and nearly 7 in 10 want to quit but only 7 in 100 succeed. Smoking is concentrated in lower income and certain racial/ethnic groups who face additional obstacles to quitting: living in areas that are disproportionately saturated with tobacco retailers, that contain a larger volume of marketing cues, and offer markedly cheaper tobacco products. Two types of population-based interventions in the retail environment are increasing rapidly at the local level. Place-based strategies limit the location, type and density of tobacco retailers (e.g., limit proximity to schools, tobacco-free pharmacies, a cap on retailers per population). Consumer-focused strategies increase price through non-tax mechanisms (e.g., establish minimum price and pack size) and restrict which tobacco products are sold (e.g., flavored products in tobacco-only shops). However, the overall benefits of these interventions for tobacco control, and specific benefits to disadvantaged and racial/ethnically diverse communities, are not firmly established. The goal of Project 2 is to address this critical gap in tobacco control research by evaluating an on-going natural experiment in retail interventions in 30 large cities across the US. With engagement of Big Cities Health Coalition, Project 2 proposes to evaluate whether and how local interventions affect the tobacco retail environment and the potential consequences for adult tobacco use. A multilevel, spatial dataset will integrate unique data sources for each city: 1) legal research to characterize the presence, type and strength of interventions; 2) marketing observations in a longitudinal cohort of tobacco retailers (n=1800, 60 per city), 3) city-specific data on sales volume of tobacco products; 4) a longitudinal cohort survey of adult smokers to assess quit attempts (n=2400, 80 per city); 5) spatial analyses of tobacco retailer density in census tracts as well as store- and person-centered buffers. Generalized linear mixed models that adjust for smoke-free air laws and tobacco tax levels will be estimated for three primary aims.
Aim 1 examines whether place-based interventions are associated with lower density of tobacco retailers at baseline, decreases in tobacco retailer density over time, and with narrower inequities in lower-income neighborhoods.
Aim 2 examines whether consumer-focused interventions are associated with higher tobacco prices at baseline, greater increases in price over time, and with narrower inequities in lower-income neighborhoods.
Aim 3 examines whether stronger retail interventions are associated with tobacco use reduction at the city level (sales volume) and individual level (quit attempts). The public health significance of Project 2 is to inform the evidence base that guides best practices for state and local programs aiming to counter tobacco industry influence at the point of sale. In the context of this Program Project, an ASPiRE Community Advisory Board comprised of tobacco control program leaders from the big cities will increase the relevance and impact of the proposed research.
/Public Health Relevance Smoking remains the leading cause of death and disease in the US, with disparities in use evident in lower socioeconomic and particular racial/ethnic communities where tobacco retailers are disproportionately concentrated and tobacco products cost less. Local interventions in the retail environment are increasing, but too little is known about their overall benefit for tobacco control and specific advantages for priority populations. Project 2 will help public health strategy development by evaluating the potential impact of retail interventions on reductions in tobacco consumption and increased quitting in 30 large cities across the US.