Adding or modifying tobacco licensing laws is becoming an increasingly popular tobacco control approach, but the implications for health disparities is unknown. Currently, it is well-documented that the density of tobacco retailers is greater in low-income, African American, and Hispanic neighborhoods. Marketing at these retailers' points of sale impacts the social environment and can have powerful effects on promoting initiation and inhibiting cessation. With licensing-law strategies, communities can not only require stores to obtain a license to sell tobacco, but can set stipulations to granting these licenses (e.g., capping the number of retailers in an area, or banning retailers from within 1000 feet of a school). Research suggests this public policy approach is an effective means for reducing the number of tobacco retailers and their corresponding point-of-sale marketing. However, some of these strategies could be more beneficial for affluent, low-minority areas than for low-income, high-racial/ethnic minority areas?what the proposal is referring to as ?high risk? areas. This potential outcome is particularly troubling given that low-income, African American, and Hispanic populations also exhibit some of the highest rates of tobacco-related morbidity and mortality. Therefore, the purpose of this R21 proposal is to evaluate in Ohio the equality-impact of the four major licensing-law strategies that have been proposed to restrict tobacco retailers.
Aim 1 will test whether reducing the number and/or density of tobacco retailers will reduce inequalities in the distribution of tobacco retailers.
Aim 2 will test whether restricting tobacco retailers from being close to schools will reduce current inequalities in the distribution of tobacco retailers.
Aim 3 will test whether banning tobacco sales in pharmacies will exacerbate inequalities in the distribution of tobacco retailers. Analyses will be conducted using spatial modeling techniques, which have rarely been used in tobacco control research. With a list that has already been acquired of all 10,722 tobacco retailers in Ohio, analyses will begin by establishing the current, pre-policy state of tobacco retailer density, at the census-tract level.
Each aim will then model the effects of a licensing-law restriction and estimate the post- policy retailer density. Finally, each policy will be evaluated in terms of its equality-impact (whether it will provide less, equal, or greater benefit to vulnerable groups). Three benchmarks will be used: the % reduction in retailer density is not greater for low-risk census tracts; the strength of the relation between tobacco retailer density and sociodemographics has diminished; and the post-policy density of tobacco retailers is not greater in low-risk census tracts. This novel project will provide much-need information on the relative equality-impact of the major licensing-law strategies. Findings will guide state and community efforts away from licensing-law strategies that will inadvertently widen the nation's cancer disparities and toward licensing-law strategies that will have a positive equality-impact. As the first project to integrate licensing-law research with disparities research, this project could significantly change the direction of tobacco control research and policy.
RELEVANCE TO PUBLIC HEALTH An increasingly popular tobacco control approach is licensing-law strategies, whereby communities set stipulations to granting tobacco-retail licenses (e.g., capping the number of retailers in an area, or banning retailers from within 1000 feet of a school). Our research is relevant to public health because it will provide the first information on which licensing-law strategies are effective for low-income, high-racial/ethnic minority areas, compared to affluent, low-minority areas. The project is relevant to NCI's mission because it will help guide tobacco control efforts toward licensing-law strategies that will reduce income- and race/ethnicity-based cancer disparities.