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Ji T, Stankov I, Egan NS, Lich KH, Thornton RLJ, Wang Q, Igusa T, Wei HH, Matson PA. Investigating the impacts of alcohol outlet zoning policy on alcohol consumption and access to non-alcoholic services: A spatial agent-based simulation. Health Place 2025; 94:103489. [PMID: 40411920 DOI: 10.1016/j.healthplace.2025.103489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 04/10/2025] [Accepted: 05/20/2025] [Indexed: 05/26/2025]
Abstract
Debates continue over the effectiveness of limiting alcohol outlet density in reducing alcohol consumption, and its broader impacts on access to non-alcoholic services in low-income urban communities remain underexplored. This study addresses this gap by investigating the impacts of alcohol outlet zoning policies on alcohol consumption and walkable access to non-alcoholic services in low-income urban communities with different baseline densities of liquor and grocery stores. We developed a spatial agent-based model of Baltimore City neighborhoods, simulating the closure of non-conforming liquor stores following the city's zoning code rewrite. The model was calibrated using national survey data and empirical research on alcohol consumption and walkable access to alcohol, food, lottery, and ATM outlets by subgroups. We observed non-linear relationships and differences by gender and employment status in the effects of liquor store closures on heavy drinking, with policies showing limited effectiveness in neighborhoods with high baseline liquor store density. While the policies had minimal impact on access to food and ATMs due to high prevalence of grocery stores, they reduced access to lottery services. Our modeling approach serves as a valuable decision-making tool for policymakers to explore hypothetical scenarios, identify tipping points of policy impacts, and provide actionable insights into the complex interactions between zoning policies and neighborhood dynamics concerning alcohol consumption and access to essential goods and services.
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Affiliation(s)
- Tingting Ji
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA; Department of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, China.
| | - Ivana Stankov
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Urban Health Collaborative, Drexel University, Philadelphia, USA
| | | | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rachel L J Thornton
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Qi Wang
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Takeru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Hsi-Hsien Wei
- Department of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, China
| | - Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kong AY, Lee JGL, Halvorson-Fried SM, Sewell KB, Golden SD, Henriksen L, Herbert L, Ribisl KM. Neighbourhood inequities in the availability of retailers selling tobacco products: a systematic review. Tob Control 2025; 34:350-360. [PMID: 38937098 DOI: 10.1136/tc-2024-058718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To examine inequities in tobacco retailer availability by neighbourhood-level socioeconomic, racial/ethnic and same-sex couple composition. DATA SOURCES We conducted a 10 November 2022 search of PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus. STUDY SELECTION We included records from Organisation for Economic Co-operation and Development member countries that tested associations of area-level measures of tobacco retailer availability and neighbourhood-level sociodemographic characteristics. Two coders reviewed the full text of eligible records (n=58), including 41 records and 205 effect sizes for synthesis. DATA EXTRACTION We used dual independent screening of titles, abstracts and full texts. One author abstracted and a second author confirmed the study design, location, unit of analysis, sample size, retailer data source, availability measure, statistical approach, sociodemographic characteristic and unadjusted effect sizes. DATA SYNTHESIS Of the 124 effect sizes related to socioeconomic inequities (60.5% of all effect sizes), 101 (81.5%) indicated evidence of inequities. Of 205 effect sizes, 69 (33.7%) tested associations between retailer availability and neighbourhood composition of racially and ethnically minoritised people, and 57/69 (82.6%) documented inequities. Tobacco availability was greater in neighbourhoods with more Black, Hispanic/Latine and Asian residents (82.8%, 90.3% and 40.0% of effect sizes, respectively). Two effect sizes found greater availability with more same-sex households. CONCLUSIONS There are stark inequities in tobacco retailer availability. Moving beyond documenting inequities to partnering with communities to design, implement, and evaluate interventions that reduce and eliminate inequities in retail availability is needed to promote an equitable retail environment. PROSPERO REGISTRATION NUMBER CRD42019124984.
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Affiliation(s)
- Amanda Y Kong
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Sarah M Halvorson-Fried
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kerry B Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, North Carolina, USA
| | - Shelley Diane Golden
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, Stanford, California, USA
| | - Lily Herbert
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kurt M Ribisl
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Kasman M, Sedlak AB, Reader L, Heerman WJ, Pate RR, Ramirez AG, Sommer EC, Barkin SL, Hammond RA. Leveraging agent-based modeling and a randomized intervention to advance childhood physical activity: A study protocol. PLoS One 2025; 20:e0321301. [PMID: 40233067 PMCID: PMC11999168 DOI: 10.1371/journal.pone.0321301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 03/03/2025] [Indexed: 04/17/2025] Open
Abstract
This study (1R01HD107002-01A1) protocol describes the planned creation and use of an agent-based model (ABM) of early childhood physical activity (PA). Successful early childhood PA interventions can potentially play an important role in both increasing overall population health as well as closing health disparities across subpopulations. At present, effective strategies for doing so are currently unknown. In large part, this is because PA determinants operate across levels dynamically, interact with one another, and can differ substantially across children. A complex systems approach-specifically, ABM-can be used to provide important insights about effect pathways driving child PA. Design of the proposed ABM will be based on high-quality extant research on childhood physical activity while allowing for the testing of hypotheses that extend beyond this body of literature. Its primary source of input data will be participants in GROW (NCT01316653), a completed cohort-based randomized controlled trial (RCT) that includes extensive longitudinal PA data collected from accelerometer observations of children from ages 3-9. We will iteratively test and improve upon an etiologic ABM of childhood PA, ensuring that it can satisfactorily reproduce micro- and macro-level influences and trends comparable to those seen in GROW. The tested ABM will then be used to extrapolate beyond the context of the GROW RCT, experimentally identifying potentially efficacious intervention strategies to improve childhood physical activity through program implementation or changes in policies and practices. We will use expert input to identify promising intervention approaches. We will use the model to systematically experiment with a wide array of different hypothetical combinations of intervention specifications and combinations. At the end of the model experimentation step, we expect to generate insights of broad applicability to the field of PA science regarding what might work, and for whom, in promoting PA and reducing disparities in these behaviors.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia, United States of America
| | - Adam B. Sedlak
- Department of Mechanical and Aerospace Engineering, University of California San Diego Jacobs School of Engineering, San Diego, California, United States of America
| | - Lydia Reader
- Division of Computational and Data Sciences, Washington University in St. Louis, St Louis, Missouri, United States of America
| | - William J. Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Russell R. Pate
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Amelie G. Ramirez
- Institute for Health Promotion Research and Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Evan C. Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Shari L. Barkin
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia, United States of America
- Brown School at Washington University, St. Louis, Missouri, United States of America
- The Santa Fe Institute, Santa Fe, New Mexico, United States of America
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Gamal Y, Heppenstall A, Strachan W, Colasanti R, Zia K. An analysis of spatial and temporal uncertainty propagation in agent-based models. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2025; 383:20240229. [PMID: 40172560 DOI: 10.1098/rsta.2024.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 01/15/2025] [Accepted: 01/27/2025] [Indexed: 04/04/2025]
Abstract
Spatially explicit simulations of complex systems lead to inherent uncertainties in spatial outcomes. Visualizing the temporal propagation of spatial uncertainties is crucial to communicate the reliability of such models. However, the current Uncertainty Analyses (UAs) either consider spatial uncertainty at the end of model runs, or consider non-spatial uncertainties at different model states. To address this, we propose a Spatio-Temporal UA (ST-UA) approach to generate an uncertainty propagation index and visualize the temporal propagation of different uncertainty measures between two temporal model states. We select the total effects sensitivity measure (a Sobol index) for a sample application within the ST-UA approach. The application is the Tobacco Town ABM, a spatial model simulating smoking behaviours. We showcase the effect of the statistical distributions of wages and smoking rates on the propensity to buy cigarettes, which leads to the propagation of uncertainty in the number of purchased cigarettes by individuals. The findings highlight the usefulness of the ST-UA in (i) communicating the reliability of the spatial outcomes of the model; and (ii) guiding modellers towards the spatial areas with relatively high uncertainties at different temporal steps. This approach can be readily transferred to other application areas that are characterized with spatio-temporal uncertainty.This article is part of the theme issue 'Uncertainty quantification for healthcare and biological systems (Part 2)'.
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Affiliation(s)
- Yahya Gamal
- Urban Big Data Centre, University of Glasgow School of Social and Political Sciences, Glasgow, UK
| | - Alison Heppenstall
- Urban Big Data Centre, University of Glasgow School of Social and Political Sciences, Glasgow, UK
- The Alan Turing Institute, London, UK
- Social and Public Health Sciences Unit, University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - William Strachan
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Kashif Zia
- Social and Public Health Sciences Unit, University of Glasgow School of Health and Wellbeing, Glasgow, UK
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Trangenstein PJ, Patterson DM, Karriker-Jaffe KJ, Schleicher NC, Kerr WC, Henriksen L. Limiting tobacco accessibility by transitioning tobacco sales to state alcohol stores: estimated increases in travel time and changes in associated disparities. Tob Control 2025:tc-2024-059033. [PMID: 40139796 DOI: 10.1136/tc-2024-059033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 03/03/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND Transitioning tobacco sales (TTSs) to state-controlled stores would reduce tobacco retailer density, making tobacco less accessible while also providing infrastructure to support retailer licensing, raise prices and restrict marketing. Using 10 US states with an alcohol retail monopoly as an example, this study estimated population average increases in driving time associated with implementing TTS, reporting changes overall and by race, ethnicity and poverty status. METHODS This cross-sectional study combined 2020 licensing data, business records and American Community Survey 5-year estimates. Network (road-based) driving times to the nearest tobacco retailer were calculated at the census tract level for the status quo (existing tobacco retailers) and TTS counterfactual (state alcohol stores) in 2020. Travel times were weighted by subpopulations to assess equity reach of decreases in tobacco retailer accessibility. RESULTS On average, TTS would more than double travel times to the nearest tobacco retailer, resulting in a mean 119% increase in driving time (range: 30%-232%). The average per cent increase in travel time was slightly greater for black (127%) and Hispanic or Latino people (126%) than for white people (117%), and travel times increased more for black and/or Hispanic or Latino people in all states except Alabama, New Hampshire and Utah. There were larger increases in travel time for persons with incomes below the federal poverty line (vs above) in 7 of the 10 states. CONCLUSIONS The TTS policy would make tobacco less accessible and reduce racial, ethnic and socioeconomic disparities in tobacco retail accessibility in most of the states examined.
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Affiliation(s)
| | - Deidre M Patterson
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | | | - Nina C Schleicher
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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Dobbs PD, Schisler ED, McCormick C. #Discreetshipping: Selling E-cigarettes on TikTok. Nicotine Tob Res 2025; 27:748-752. [PMID: 38778482 PMCID: PMC11931204 DOI: 10.1093/ntr/ntae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/29/2024] [Accepted: 03/23/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Youth and young adult use of e-cigarette products continues to remain high despite regulatory approaches to reduce youth access. This study sought to examine TikTok content regarding the sale and distribution of e-cigarettes. AIMS AND METHODS TikTok videos (n = 475) and metadata posted between June 2022 and August 2023 were scraped using a TikTok application programming interface and popular hashtags used to sell vaping products (ie, #discreetshipping [40.8 million], #puffbundle [14.8 million], #hiddennic [1.0 million]). After watching the 25 most viewed videos (39 600-868 800 views), a codebook was developed. All metadata were annotated using 11 unique codes: Small business, brand, cannabis, bundled, hidden, fake, international sales, no ID, order via Instagram, order via another method, and cost. RESULTS Overall, 367 videos (with an average of 2017 likes) were deemed relevant. Videos advertised popular vaping brands (50.4%) that included cannabis products (45%). Products were described as bundled (28.6%), hidden (8.7%), and able to be shipped internationally (6%) without age verification (45.2%). Some videos (8.2%) evaded algorithms' detection of illegal activity by describing the post as "Fake." Customers were directed to other social media platforms (most often Instagram, 57.5%) and/or other websites/links (58.3%) to purchase products; 22.1% advertised discounts, free shipping, or low costs (ranging from $25-$35). CONCLUSIONS Social media platforms, such as TikTok and Instagram, are being used to circumvent e-cigarette regulatory policies. Regulatory agencies should expand enforcement strategies to include social media platforms where users are illegally selling and distributing e-cigarettes internationally to young audiences. IMPLICATIONS TikTok users across the globe are violating local, state, and federal laws by selling e-cigarettes concealed inside other products or bundled in packages that avoid detection. TikTok videos posted by self-proclaimed small business owners advertise discreet shipping practices that evade age verification in order to sell nicotine and cannabis bundles worldwide. Accounts used phrases describing the post to be "fake" to avoid detection by algorithms or TikTok administrators. E-cigarette regulatory agencies can partner with social media platforms to close regulatory gaps.
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Affiliation(s)
- Page D Dobbs
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
- Center for Public Health and Technology, University of Arkansas, Fayetteville, AR, USA
| | - Eric D Schisler
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
- Center for Public Health and Technology, University of Arkansas, Fayetteville, AR, USA
| | - Charlotte McCormick
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
- Center for Public Health and Technology, University of Arkansas, Fayetteville, AR, USA
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Delamater PL, Herbert L, Golden SD, Kong AY. Correlation Among Neighborhood-Level Measures of the Tobacco Retail Environment. Nicotine Tob Res 2025; 27:217-224. [PMID: 39093685 PMCID: PMC11750742 DOI: 10.1093/ntr/ntae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/26/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Tobacco retailer density and distance to tobacco retailers are understood to influence tobacco-related behaviors; however, there is no general agreement on how to best characterize or measure the tobacco retail environment (TRE). In this data-driven analysis, we examine similarities among neighborhood-level measures of the TRE and assess how the geographic resolution of the neighborhood units may affect them. AIMS AND METHODS We used locations of likely tobacco retailers in the United States to calculate multiple retailer count, density, and distance measures. Measures were calculated at the Census block group, tract, and county (including county equivalents) levels of geographic aggregation. Spearman's correlation was used to evaluate the similarity among the TRE measures. RESULTS At the block group and tract level, correlation among all TRE measures ranged from slightly negative (ρ = -0.03) to nearly perfect (ρ = 0.99). At both levels of aggregation, distance-based TRE measures were highly correlated (ρ > 0.76). At the block group level, the simple count of retailers was highly correlated with the density measures (ρ > 0.83), and at the tract level, simple count was moderately to highly correlated with the density measures (ρ > 0.5). Findings were generally similar at the county level; a notable deviation was that retailers per person were negatively correlated with all other TRE measures (range from ρ = -0.08 to ρ = -0.32). CONCLUSIONS Some common measures were not correlated, suggesting they capture different aspects of the TRE; similarity among the various measures also varied by level of geographic aggregation. IMPLICATIONS Because the TRE shapes people's tobacco-related behaviors, using appropriate measures to characterize it at a neighborhood level is paramount. Our work highlights both the similarities and differences among a set of common measures, thereby suggesting the measures may be capturing different aspects of the overall retail environment. Our findings regarding geographic level of aggregation underscore the importance of neighborhood definition in any TRE analysis.
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Affiliation(s)
- Paul L Delamater
- Department of Geography and Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lily Herbert
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shelley D Golden
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda Y Kong
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Family and Preventive Medicine, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Squires H, Kelly MP, Gilbert N, Sniehotta F, Purshouse RC, Garcia L, Breeze P, Brennan A, Gardner B, Bright S, Fischer A, Heppenstall A, Wetton JD, Hernandez-Alava M, Boyd J, Buckley C, Vlaev I, Smith R, Abbas A, Gibb R, Henney M, Moore E, Chater AM. The PHEM-B toolbox of methods for incorporating the influences on Behaviour into Public Health Economic Models. BMC Public Health 2024; 24:2794. [PMID: 39395958 PMCID: PMC11475213 DOI: 10.1186/s12889-024-20225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 09/30/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND It is challenging to predict long-term outcomes of interventions without understanding how they work. Health economic models of public health interventions often do not incorporate the many determinants of individual and population behaviours that influence long term effectiveness. The aim of this paper is to draw on psychology, sociology, behavioural economics, complexity science and health economics to: (a) develop a toolbox of methods for incorporating the influences on behaviour into public health economic models (PHEM-B); and (b) set out a research agenda for health economic modellers and behavioural/ social scientists to further advance methods to better inform public health policy decisions. METHODS A core multidisciplinary group developed a preliminary toolbox from a published review of the literature and tested this conceptually using a case study of a diabetes prevention simulation. The core group was augmented by a much wider group that covered a broader range of multidisciplinary expertise. We used a consensus method to gain agreement of the PHEM-B toolbox. This included a one-day workshop and subsequent reviews of the toolbox. RESULTS The PHEM-B toolbox sets out 12 methods which can be used in different combinations to incorporate influences on behaviours into public health economic models: collaborations between modellers and behavioural scientists, literature reviewing, application of the Behaviour Change Intervention Ontology, systems mapping, agent-based modelling, differential equation modelling, social network analysis, geographical information systems, discrete event simulation, theory-informed statistical and econometric analyses, expert elicitation, and qualitative research/process tracing. For each method, we provide a description with key references, an expert consensus on the circumstances when they could be used, and the resources required. CONCLUSIONS This is the first attempt to rigorously and coherently propose methods to incorporate the influences on behaviour into health economic models of public health interventions. It may not always be feasible or necessary to model the influences on behaviour explicitly, but it is essential to develop an understanding of the key influences. Changing behaviour and maintaining that behaviour change could have different influences; thus, there could be benefits in modelling these separately. Future research is needed to develop, collaboratively with behavioural scientists, a suite of more robust health economic models of health-related behaviours, reported transparently, including coding, which would allow model reuse and adaptation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Robert Smith
- University of Sheffield, Sheffield, UK
- Dark Peak Analytics, Sheffield, UK
| | - Ali Abbas
- University of Cambridge, Cambridge, UK
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Canty R, Gartner CE, Hoek J, Hefler M. Global policy scan of commercial combustible tobacco product retailing regulations by WHO region. Tob Control 2024:tc-2023-058523. [PMID: 39059815 DOI: 10.1136/tc-2023-058523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/03/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND/AIMS Regulatory schemes for tobacco retailing help restrict the supply and availability of smoked tobacco products. Tobacco retailer density and the proximity of tobacco outlets to youth spaces, such as schools, are greater in more disadvantaged areas. Exposure to tobacco retailing normalises smoking and increases ease of access, thus increasing smoking uptake and undermining quitting. To inform future policy, we conducted a global scan of combustible tobacco retail regulatory schemes (We use the term schemes to refer to any kind of relevant initiative, policy, regulations or legislation that we found). METHODS All types of English language records concerning the regulation of commercial tobacco product availability were considered, including peer-reviewed journal articles, key reports and policy documents. The key features of regulatory schemes were documented. In addition, we contacted key informants in different countries and regions for advice on additional sources and undertook targeted searching in regions where we initially found little data. RESULTS/FINDINGS Although many countries have well-established and comprehensive tobacco control programmes, tobacco retail policy that actively addresses the availability of tobacco is underutilised. Many jurisdictions have implemented a minimum purchase age and restricted point-of-sale advertising and marketing. Other tobacco retailing regulations also included licensing systems with licence fees, caps on licences and restrictions on store location, type and retailer density/proximity. A very small number of jurisdictions have ended tobacco retailing altogether. CONCLUSIONS At a minimum, policy-makers should implement licensing schemes, licence caps and proximity limits and invest in robust monitoring systems and compliance enforcement. Tobacco products' ubiquity is incompatible with its status as a dangerous addictive substance and does not align with tobacco endgame goals.
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Affiliation(s)
- Ruth Canty
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Janet Hoek
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Public Health, University of Otago, Dunedin, New Zealand
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Boyle J, Barsell DJ, Zhang JJ, Oliver JA, McClernon FJ, Dahman B, Hoyo C, Fuemmeler BF, Wheeler DC. Modeling the Effects of Policies that Restrict Tobacco Retail Outlets on Prenatal Smoke Exposure and Perinatal Health Care Utilization. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:910-918. [PMID: 39230657 PMCID: PMC11390818 DOI: 10.1007/s11121-024-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 09/05/2024]
Abstract
Tobacco retail outlet (TRO) density has been associated with increased cotinine levels in pregnant persons and their children. As such, the higher densities of TROs may represent higher levels of active smoking during pregnancy. The purpose of this study is to simulate the reduction in cotinine (a biomarker of smoke exposure) and health care utilization that could occur in pregnant persons under enactment of several candidate TRO reduction policy recommendations. Using existing retail outlet data from the state of North Carolina and from the Newborn Epigenetic Study (NEST), the present study created hypothetical policy-informed datasets of TROs that a) limited the number of TROs to the same density as the 2014 San Francisco (SF) policy (Policy 1), b) set the minimum distance to 500 feet between TROs from a school and from other TROs (Policy 2), c) restricted the types of TROs to exclude pharmacies (Policy 3), and d) a combination of Policies 1-3 (Policy 4). We estimated the effects of each policy individually and in a separate model with their combined effects in terms of the reduction on cotinine levels and health care utilization, as measured by number of visits to the emergency department (ED). We found that the hypothetical policies were likely to be effective in reducing maternal cotinine and ED visits, with the majority of the mothers in the dataset demonstrating reductions in these outcomes after implementation of the policies. We found that Policy 1 led to moderate reductions in TRO exposure for the majority of the sample as well as stratified by race/ethnicity. Additionally, Policy 4 had slightly larger estimated effects than Policy 1, but could be more onerous to implement in practice. Overall, we identified evidence supporting the efficacy of TRO reduction strategies that could impact smoke exposure during pregnancy in our diverse sample in North Carolina.
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Affiliation(s)
- Joseph Boyle
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - D Jeremy Barsell
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Junfeng Jim Zhang
- Environmental Science and Policy Division, Duke Global Health Institute and Nicholas School of the Environment, Durham, NC, 27708, USA
| | - Jason A Oliver
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Bassam Dahman
- Department of Social Behavioral Science, School of Population Health, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Cathrine Hoyo
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, 27695, USA
| | - Bernard F Fuemmeler
- Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298, USA.
| | - David C Wheeler
- Department of Biostatistics, School of Population Health, Virginia Commonwealth University, Richmond, VA, 23298, USA
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11
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Zheng C, Pearce J, Feng Z. Potential impacts of spatial restrictions on tobacco retail availability in China: a simulation study in Shanghai. Tob Control 2024; 33:503-510. [PMID: 36889913 DOI: 10.1136/tc-2022-057704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES Regulating tobacco retail availability provides promising new opportunities for effective tobacco control. This study simulates the potential impacts of introducing spatial restrictions on the availability of tobacco in Shanghai, the largest city in China. METHODS Twelve stakeholder-informed simulation scenarios under four types of spatial restrictions were considered: (1) capping, (2) ban of sales, (3) minimum spacing and (4) school-buffer exclusion zone. Tobacco retailer data for Shanghai (n=19 413) were used. The main outcome was per cent reduction in retail availability measured by population-weighted kernel density estimation across neighbourhoods, and impacts on social inequality in availability were estimated using the Kruskal-Wallis test and effect size estimation. All analyses were further stratified by three levels of urbanity to examine geographical disparities in overall effectiveness and equity of the simulation scenarios. RESULTS All simulation scenarios have the potential to reduce availability, with overall reductions ranging from 8.60% to 85.45%. Compared with the baseline, the effect size regarding the association between availability and neighbourhood deprivation quintiles suggests that the most effective scenario, '500 m minimum spacing' between retailers, increased the social inequality in availability (p<0.001). Conversely, school-buffer scenarios were both effective and equitable. Additionally, the effectiveness and the equity impact of scenarios varied by urbanity level. CONCLUSION Spatial restrictions offer potential new policy opportunities to reduce retail availability, but some may increase social inequality in accessing tobacco. For effective tobacco control, policymakers should consider the overall and equity impacts of spatial restrictions when developing comprehensive tobacco retail regulations.
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Affiliation(s)
- Chunyu Zheng
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | - Zhiqiang Feng
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, The University of Edinburgh, Edinburgh, UK
- Scottish Centre for Administrative Data Research, The University of Edinburgh, Edinburgh, UK
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12
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Luke DA, Powell BJ, Paniagua-Avila A. Bridges and Mechanisms: Integrating Systems Science Thinking into Implementation Research. Annu Rev Public Health 2024; 45:7-25. [PMID: 38100647 DOI: 10.1146/annurev-publhealth-060922-040205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
We present a detailed argument for how to integrate, or bridge, systems science thinking and methods with implementation science. We start by showing how fundamental systems science principles of structure, dynamics, information, and utility are relevant for implementation science. Then we examine the need for implementation science to develop and apply richer theories of complex systems. This can be accomplished by emphasizing a causal mechanisms approach. Identifying causal mechanisms focuses on the "cogs and gears" of public health, clinical, and organizational interventions. A mechanisms approach focuses on how a specific strategy will produce the implementation outcome. We show how connecting systems science to implementation science opens new opportunities for examining and addressing social determinants of health and conducting equitable and ethical implementation research. Finally, we present case studies illustrating successful applications of systems science within implementation science in community health policy, tobacco control, health care access, and breast cancer screening.
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Affiliation(s)
- Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School; Center for Dissemination & Implementation, Institute for Public Health; and Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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13
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Marsh L, Doscher C, Iosua E, Quigg R, Tomintz M. What impact would tobacco retailer proximity limit have on tobacco availability in New Zealand? Tob Control 2024; 33:215-220. [PMID: 35953283 DOI: 10.1136/tc-2022-057462] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION One policy option to reduce the density of tobacco retailers is to restrict the distance retailers can be located to each other. This study examined the impacts of proximity limits of 150 m, 300 m and 450 m between tobacco retailers in New Zealand and if critical threshold reduction in tobacco retailers of 90%-95% would be achieved. METHODS Using a spatial modelling approach, tobacco retailers were randomly removed based on a minimum distance between retailers until there were zero retailers within each scenario's minimum distance. This was repeated for all three proximity limit scenarios and descriptive statistics are provided for each. RESULTS Implementation of 150 m, 300 m or 450 m distance restrictions between tobacco retailers would result in an average reduction in availability of 35%, 49% and 58%, respectively. On average, the current median distance to the closest retailer increases from 110 m to 377 m, to 568 m or to 718 m, respectively. The average median distance from a retailer to the closest school also increases across the three proximity limits, from 1017 m to 1087 m, to 1149 m or to 1231 m, respectively. Reduced clustering in deprived areas would be most apparent if a 450 m restriction policy was implemented. CONCLUSIONS A proximity limit of 450 m would reduce retailers by 58%, but would not reach proposed critical behaviour-change threshold of 90%-95% required to reduce smoking prevalence independently. There is a need for a combination of policies, which focus on promoting equity, to achieve this bold endgame goal.
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Affiliation(s)
- Louise Marsh
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Crile Doscher
- Faculty of Environment, Society and Design, Lincoln University, Christchurch, New Zealand
| | - Ella Iosua
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Robin Quigg
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Melanie Tomintz
- Geospatial Research Institute, University of Canterbury, Christchurch, New Zealand
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14
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Valiente R, Tunstall H, Kong AY, Wilson LB, Gillespie D, Angus C, Brennan A, Shortt NK, Pearce J. Geographical differences in the financial impacts of different forms of tobacco licence fees on small retailers in Scotland. Tob Control 2024:tc-2023-058342. [PMID: 38326025 DOI: 10.1136/tc-2023-058342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Retailer licencing fees are a promising avenue to regulate tobacco availability. However, they face strong opposition from retailers and the tobacco industry, who argue significant financial impacts. This study compares the impacts of different forms of tobacco licence schemes on retailers' profits in Scotland. METHODS We calculated gross profits from tobacco sales in 179 convenience stores across Scotland using 1 099 697 electronic point-of-sale records from 16 weeks between 2019 and 2022. We estimated different fees using universal, volumetric and separate urban/rural schemes. We identified the point at which 50% of retailers would no longer make a gross profit on tobacco sales for each scheme and modelled the financial impact of 10 incremental fee levels. The financial impact was assessed based on changes in retailers' tobacco gross profits. Differences by neighbourhood deprivation and urban/rural status were examined. RESULTS The gross profit from tobacco per convenience store averaged £15 859/year. Profits were 2.29 times higher in urban (vs rural) areas and 1.59 times higher in high-deprivation (vs low-deprivation) areas, attributable to higher sales volumes. Tobacco gross profit decreased proportionally with increasing fee levels. Universal and urban/rural fees had greater gross profit reductions in rural and/or less deprived areas, where profits were lower, compared with volumetric fees. CONCLUSION The introduction of tobacco licence fees offers a potential opportunity for reducing the availability of tobacco retailers. The likely impact of a tobacco licence fee is sensitive to the type of licence scheme implemented, the level at which fees are set and the retailers' location in relation to neighbourhood deprivation and rurality.
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Affiliation(s)
- Roberto Valiente
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Helena Tunstall
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Amanda Y Kong
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Luke B Wilson
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Duncan Gillespie
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Colin Angus
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- SPECTRUM Consortium, UK
- Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Niamh K Shortt
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, UK
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15
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Giovenco DP, Morrison CN, Mehranbod CA, Spillane TE, Easter AG, Hernández D, Humphreys DK, Mauro CM, Kong AY, Branas CC. Impact and Equity of New York City's Tobacco Retail Reduction Initiative. Am J Prev Med 2024; 66:235-242. [PMID: 37816459 PMCID: PMC10872861 DOI: 10.1016/j.amepre.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION High levels of tobacco retailer density in communities is associated with a range of tobacco use behaviors and is a key structural driver of tobacco-related disparities. This study evaluates the impacts of New York City's (NYC) novel policy intervention to cap tobacco retail licenses on tobacco retailer density levels and neighborhood inequities in tobacco access. METHODS Using geocoded tobacco retail licensing data from 2010 to 2022, Bayesian conditional autoregressive Poisson panel models estimated the association between policy implementation in 2018 and retailer density per 1,000 population, controlling for neighborhood-level sociodemographic factors. Data were analyzed in 2023. RESULTS The number of tobacco retail licenses decreased from 9,304 in 2010 to 5,107 in 2022, with the rate of decline significantly accelerating post-policy (-14·2% versus -34·2%). Policy effects were stronger in districts with lower income and greater proportions of non-Hispanic Black residents. CONCLUSIONS NYC's policy substantially reduced tobacco retailer density and appeared to close longstanding patterns of inequity in tobacco access, serving as a rare example of a tobacco control policy that may effectively reduce tobacco-related disparities. This emergent approach to restructure tobacco retail in communities may reach populations that have not benefitted from traditional tobacco control policies and should be considered by other localities.
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Affiliation(s)
- Daniel P Giovenco
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY, USA.
| | - Christopher N Morrison
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA; Monash University, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Christina A Mehranbod
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
| | - Torra E Spillane
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY, USA
| | - Alexa G Easter
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY, USA
| | - Diana Hernández
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, New York, NY, USA
| | - David K Humphreys
- University of Oxford, Department of Social Policy and Intervention, Oxford, UK
| | - Christine M Mauro
- Columbia University Mailman School of Public Health, Department of Biostatistics, New York, NY, USA
| | - Amanda Y Kong
- The University of Oklahoma Health Sciences Center, Department of Family and Preventive Medicine, Oklahoma City, OK, USA; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Charles C Branas
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
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16
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Zheng C, Feng Z, Pearce J. A longitudinal analysis of the impact of the local tobacco retail availability and neighbourhood deprivation on male smoking behaviours in Shanghai, China. Health Place 2024; 85:103171. [PMID: 38181462 PMCID: PMC10922680 DOI: 10.1016/j.healthplace.2023.103171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024]
Abstract
Some evidence from Western high-income countries suggests local tobacco retail availability and neighbourhood deprivation may influence smoking behaviours. However, this assertion has not been considered in China, where 44% of males continue to smoke. Data were analysed from Chinese males (n = 2054) who participated in Waves 3-5 (2009-2015) of the International Tobacco Control (ITC) China Survey by linking information on tobacco retail availability (estimated through population weighted Kernel Density of tobacco retailers in 2019) and neighbourhood deprivation (calculated as a composite score derived from the 2010 Chinese census) across Shanghai. Generalised Estimating Equation models were fitted to examine the impacts of local tobacco availability and neighbourhood deprivation on smoking behaviours (current smoking versus current non-smoking, quitting versus current smoking, longer durations of smoking abstinence versus current smoking) using the longitudinal data. Examining the impacts separately, participants living in neighbourhoods with greater availability and higher levels of deprivation were less likely to maintain longer durations of smoking abstinence in both unadjusted and adjusted models. Neighbourhood deprivation, but not availability, was found to be associated with higher odds of being a current smoker. Examining the impacts jointly, neighbourhood deprivation was still positively associated with current smoking and negatively associated with longer durations of smoking abstinence, but the negative association between availability and longer durations of smoking abstinence disappeared. The findings offer some evidence that greater tobacco retail availability and deprivation are obstacles on prolonged smoking cessation among males in Shanghai, China. Policymakers should consider small-area level place-based restrictions in China, such as reducing the availability of tobacco, as part of a comprehensive tobacco control strategy aimed at addressing the high prevalence of smoking.
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Affiliation(s)
- Chunyu Zheng
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, UK.
| | - Zhiqiang Feng
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, UK; Scottish Centre for Administrative Data Research, University of Edinburgh, UK.
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, UK.
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17
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Kenzie ES, Seater M, Wakeland W, Coronado GD, Davis MM. System dynamics modeling for cancer prevention and control: A systematic review. PLoS One 2023; 18:e0294912. [PMID: 38039316 PMCID: PMC10691687 DOI: 10.1371/journal.pone.0294912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023] Open
Abstract
Cancer prevention and control requires consideration of complex interactions between multilevel factors. System dynamics modeling, which consists of diagramming and simulation approaches for understanding and managing such complexity, is being increasingly applied to cancer prevention and control, but the breadth, characteristics, and quality of these studies is not known. We searched PubMed, Scopus, APA PsycInfo, and eight peer-reviewed journals to identify cancer-related studies that used system dynamics modeling. A dual review process was used to determine eligibility. Included studies were assessed using quality criteria adapted from prior literature and mapped onto the cancer control continuum. Characteristics of studies and models were abstracted and qualitatively synthesized. 32 studies met our inclusion criteria. A mix of simulation and diagramming approaches were used to address diverse topics, including chemotherapy treatments (16%), interventions to reduce tobacco or e-cigarettes use (16%), and cancer risk from environmental contamination (13%). Models spanned all focus areas of the cancer control continuum, with treatment (44%), prevention (34%), and detection (31%) being the most common. The quality assessment of studies was low, particularly for simulation approaches. Diagramming-only studies more often used participatory approaches. Involvement of participants, description of model development processes, and proper calibration and validation of models showed the greatest room for improvement. System dynamics modeling can illustrate complex interactions and help identify potential interventions across the cancer control continuum. Prior efforts have been hampered by a lack of rigor and transparency regarding model development and testing. Supportive infrastructure for increasing awareness, accessibility, and further development of best practices of system dynamics for multidisciplinary cancer research is needed.
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Affiliation(s)
- Erin S. Kenzie
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Systems Science Program, Portland State University, Portland, Oregon, United States of America
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Mellodie Seater
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, Oregon, United States of America
| | - Gloria D. Coronado
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States of America
| | - Melinda M. Davis
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
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18
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Reimold AE, D'Angelo H, Rose SW, Ribisl KM. Changes in retail tobacco product sales and market share among retail payroll establishments in the U.S. Economic Census between 1997 and 2017. Prev Med Rep 2023; 35:102294. [PMID: 37449007 PMCID: PMC10336246 DOI: 10.1016/j.pmedr.2023.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The tobacco industry spends the vast majority of their marketing and promotional budget at retail outlets. However, few studies have used publicly available data to examine trends in the number and types of retail establishments where tobacco products are sold. Using the U.S. Economic Census for 1997, 2002, 2007, 2012 and 2017 (the latest year), we examined the number, type, and sales of payroll establishments selling tobacco products. Nine store types accounted for 94% - 99% of tobacco product sales between 1997 and 2017. Gas/convenience stores had the greatest market share (33% - 49% of tobacco sales). The number of warehouse clubs selling tobacco quadrupled; however, market share only increased from 9.6% to 10.3%. Supermarkets experienced the largest decrease in percent of stores selling tobacco. Pharmacy tobacco sales increased in 2012 then decreased in 2017; per store sales volume more than doubled between 1997 and 2012. Online shopping accounted for less than 1% of the market share between 1997 and 2012, but rose to 6.3% in 2017. Between 1997 and 2017, consumers shifted where they purchased tobacco products. Declining tobacco sales in supermarkets is a promising trend for consumers seeking healthy food without exposure to tobacco product marketing; however, the consistently large number of tobacco retailers, and thus widespread tobacco availability, is concerning. Consumer tobacco purchase changes over time support the case for point-of-sale policies that affect different retail types, including pharmacy bans, to reduce tobacco retailer density. Additionally, the rapid shift to online tobacco purchasing in 2017 identifies a new target for enhanced regulation and enforcement.
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Affiliation(s)
- Alexandria E. Reimold
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Heather D'Angelo
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Shyanika W. Rose
- College of Medicine, Department of Behavioral Science and Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Kurt M. Ribisl
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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19
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van Deelen TRD, Kunst AE, van den Putte B, Veldhuizen EM, Kuipers MAG. Ex ante evaluation of the impact of tobacco control policy measures aimed at the point of sale in the Netherlands. Tob Control 2023; 32:620-626. [PMID: 35512850 PMCID: PMC10447367 DOI: 10.1136/tobaccocontrol-2021-057205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/29/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Netherlands aims to implement stricter tobacco control policies targeting the retail environment. This paper is an ex ante policy evaluation of the potential impact of the current tobacco display and advertising ban as well as future tobacco sales bans on tobacco outlet visibility and availability. METHODS Between September 2019 and June 2020, all potential tobacco retailers in four Dutch cities (Amsterdam, Eindhoven, Haarlem and Zwolle) were visited and mapped using Global Positioning System. For each retailer selling tobacco, we completed a checklist on the visibility of tobacco products and advertising. Expected reductions in tobacco outlet visibility and availability were calculated per policy measure in absolute numbers (percentage or percentage point decrease) as well as density and proximity. RESULTS Out of 870 tobacco outlets, 690 were identified with visible tobacco products/advertising. The display ban in supermarkets and small outlets (respectively) is expected to decrease the number (-15; -42 percentage points), outlet density per 10 000 capita (-0.9; -2.6) and proximity in metres (+27 m; +400 m) of outlets with visible products/advertising. The upcoming bans on vending machines and sales in supermarkets are expected to decrease the number (-12%; -31%), density (-0.7; -1.9) and proximity (+12 m; +68 m) of tobacco outlets. Further changes in the number, density and proximity (respectively) of tobacco outlets may be achieved with future sales bans in petrol stations (-7%; -0.4; +60 m) and particularly with a ban on sales in small outlets (-43%; -2.7; +970 m). CONCLUSION A display ban and a sales ban in small outlets will contribute most to reducing tobacco outlet visibility and availability, assuming that no market shift towards other tobacco outlets will take place.
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Affiliation(s)
- Tessa R D van Deelen
- Public and Occupational Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Public and Occupational Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Bas van den Putte
- Amsterdam School of Communication Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Els M Veldhuizen
- Department of Geography and Planning, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirte A G Kuipers
- Public and Occupational Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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20
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Huang V, Head A, Hyseni L, O'Flaherty M, Buchan I, Capewell S, Kypridemos C. Identifying best modelling practices for tobacco control policy simulations: a systematic review and a novel quality assessment framework. Tob Control 2023; 32:589-598. [PMID: 35017262 PMCID: PMC10447402 DOI: 10.1136/tobaccocontrol-2021-056825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Policy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework. METHODS We searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. FINDINGS We found 146 eligible papers and 25 distinct models. Most models used population data from public or administrative registries, and all performed sensitivity analysis. However, smoking behaviour was commonly modelled into crude categories of smoking status. Eight models only presented overall changes in mortality rather than explicitly considering smoking-related diseases. Only four models reported impacts on health inequalities, and none offered the source code. Overall, the higher scored models achieved higher citation rates. CONCLUSIONS While fragments of good practices were widespread across the reviewed PSMs, only a few included a 'critical mass' of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.
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Affiliation(s)
- Vincy Huang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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21
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Marsh L, Iosua E, Parkinson L, Doscher C, Quigg R. Is the neighbourhood context important for a tobacco retailer proximity policy? Health Place 2023; 82:103032. [PMID: 37148704 DOI: 10.1016/j.healthplace.2023.103032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
A spatial modelling approach was used to explore how a proximity limit (150 m, 300 m, and 450 m) between tobacco retailers may impact different neighbourhoods in New Zealand. Neighbourhoods were categorised into three density groups (0, 1-2, 3+ retailers). As the proximity limit increases, there is a progressive redistribution of neighbourhoods in the three density groups with, the 3+ density group incorporating fewer neighbourhoods and the 0 and 1-2 density groups conversely each consisting of more. The differing measures available at the neighbourhood level enabled our study to discern potential inequities. More directed policies targeting these inequities are needed.
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Affiliation(s)
- Louise Marsh
- Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Ella Iosua
- Biostatistics Centre, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Luke Parkinson
- Geospatial Research Institute, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.
| | - Crile Doscher
- Faculty of Environment, Society and Design, Lincoln University, PO Box 85084, Ellesmere Junction Road, Lincoln, 7647, Canterbury, New Zealand.
| | - Robin Quigg
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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22
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Kasman M, Hammond RA, Purcell R, Saliba LF, Mazzucca-Ragan S, Padek M, Allen P, Luke DA, Moreland-Russell S, Erwin PC, Brownson RC. Understanding Misimplementation in U.S. State Health Departments: An Agent-Based Model. Am J Prev Med 2023; 64:525-534. [PMID: 36509634 PMCID: PMC10033358 DOI: 10.1016/j.amepre.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The research goal of this study is to explore why misimplementation occurs in public health agencies and how it can be reduced. Misimplementation is ending effective activities prematurely or continuing ineffective ones, which contributes to wasted resources and suboptimal health outcomes. METHODS The study team created an agent-based model that represents how information flow, filtered through organizational structure, capacity, culture, and leadership priorities, shapes continuation decisions. This agent-based model used survey data and interviews with state health department personnel across the U.S. between 2014 and 2020; model design and analyses were conducted with substantial input from stakeholders between 2019 and 2021. The model was used experimentally to identify potential approaches for reducing misimplementation. RESULTS Simulations showed that increasing either organizational evidence-based decision-making capacity or information sharing could reduce misimplementation. Shifting leadership priorities to emphasize effectiveness resulted in the largest reduction, whereas organizational restructuring did not reduce misimplementation. CONCLUSIONS The model identifies for the first time a specific set of factors and dynamic pathways most likely driving misimplementation and suggests a number of actionable strategies for reducing it. Priorities for training the public health workforce include evidence-based decision making and effective communication. Organizations will also benefit from an intentional shift in leadership decision-making processes. On the basis of this initial, successful application of agent-based model to misimplementation, this work provides a framework for further analyses.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, District of Columbia.
| | - Ross A Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, District of Columbia; Brown School, Washington University in St. Louis, St. Louis, Missouri; Santa Fe Institute, Santa Fe, New Mexico
| | - Rob Purcell
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, District of Columbia
| | - Louise Farah Saliba
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Stephanie Mazzucca-Ragan
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Margaret Padek
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Sarah Moreland-Russell
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri
| | - Paul C Erwin
- School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, Missouri; Public Health Sciences Division, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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23
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Otálvaro S, Gallego JM, Rodríguez-Lesmes P. De-normalizing smoking in urban areas: Public smoking bans and smoking prevalence. ECONOMICS AND HUMAN BIOLOGY 2023; 48:101202. [PMID: 36463577 DOI: 10.1016/j.ehb.2022.101202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/26/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
The effectiveness of command-and-control policies related to tobacco use has been studied in high-income countries. Still, there is limited evidence of their effects in low and middle-income countries. We explore the case of Colombia, a country that introduced a business-supported smoking ban in bars and restaurants and all public indoor spaces in 2010. This paper investigates the effect of smoking bans in bars and restaurants on smoking prevalence in Bogotá, Colombia. In this paper, we use the matching with triple-differences technique in analyzing household consumption data from the 2007 and 2011 quality of life surveys. This is done by exploiting their geographical proximity and variation in the density of commercial areas. We found that after the smoking ban implementation, smoking prevalence reduced in households near high-density commercial blocks compared to households near low-density commercial blocks (-10.8 pp.). The impact is larger for households with children and older household heads. Since households near high-density commercial blocks are more frequently exposed to smoking than households near low-density commercial blocks, the former would be more willing to internalize the smoking de-normalization process.
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Affiliation(s)
- Susana Otálvaro
- University of California, Santa Barbara, Santa Barbara, CA 93106, United States.
| | - Juan Miguel Gallego
- School of Economics, Universidad del Rosario, Calle 12C No. 4 - 69, Bogotá 111711, Colombia.
| | - Paul Rodríguez-Lesmes
- School of Economics, Universidad del Rosario, Calle 12C No. 4 - 69, Bogotá 111711, Colombia.
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24
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Lee JGL, Kong AY, Sewell KB, Golden SD, Combs TB, Ribisl KM, Henriksen L. Associations of tobacco retailer density and proximity with adult tobacco use behaviours and health outcomes: a meta-analysis. Tob Control 2022; 31:e189-e200. [PMID: 34479990 PMCID: PMC9421913 DOI: 10.1136/tobaccocontrol-2021-056717] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/21/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We sought to conduct a systematic review and meta-analysis of evidence to inform policies that reduce density and proximity of tobacco retailers. DATA SOURCES Ten databases were searched on 16 October 2020: MEDLINE via PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus, plus grey literature searches using Google and the RAND Publication Database. STUDY SELECTION Included studies used inferential statistics about adult participants to examine associations between tobacco retailer density/proximity and tobacco use behaviours and health outcomes. Of 7373 studies reviewed by independent coders, 37 (0.5%) met inclusion criteria. DATA EXTRACTION Effect sizes were converted to a relative risk reduction (RRR) metric, indicating the presumed reduction in tobacco use outcomes based on reducing tobacco retailer density and decreasing proximity. DATA SYNTHESIS We conducted a random effects meta-analysis and examined heterogeneity across 27 studies through subgroup analyses and meta-regression. Tobacco retailer density (RRR=2.55, 95% CI 1.91 to 3.19, k=155) and proximity (RRR=2.38, 95% CI 1.39 to 3.37, k=100) were associated with tobacco use behaviours. Pooled results including both density and proximity found an estimated 2.48% reduction in risk of tobacco use from reductions in tobacco retailer density and proximity (RRR=2.48, 95% CI 1.95 to 3.02, k=255). Results for health outcomes came from just two studies and were not significant. Considerable heterogeneity existed. CONCLUSIONS Across studies, lower levels of tobacco retailer density and decreased proximity are associated with lower tobacco use. Reducing tobacco supply by limiting retailer density and proximity may lead to reductions in tobacco use. Policy evaluations are needed.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education & Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Amanda Y Kong
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kerry B Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, North Carolina, USA
| | - Shelley D Golden
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Todd B Combs
- Center for Public Health Systems Science, Washington University in St Louis, St Louis, Missouri, USA
| | - Kurt M Ribisl
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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25
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Travis N, Levy DT, McDaniel PA, Henriksen L. Tobacco retail availability and cigarette and e-cigarette use among youth and adults: a scoping review. Tob Control 2022; 31:e175-e188. [PMID: 34301839 PMCID: PMC9126034 DOI: 10.1136/tobaccocontrol-2020-056376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/28/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE States and localities are formulating strategies to reduce the widespread retail availability of tobacco products. Evidence of associations between retailer density/proximity and tobacco use outcomes can help inform those strategies. We conducted a scoping review on tobacco retail availability and cigarette/e-cigarette use in adults and youth, and considered variations in spatial units, measures of retailer exposure and outcomes across studies. METHODS A systematic search for studies examining the association between retailer density/proximity and youth and adult cigarette/e-cigarette use was conducted across MEDLINE (PubMed), Web of Science and Google Scholar through 27 August 2020 with no restrictions. RESULTS Thirty-five studies were included in our qualitative synthesis. While there were differences in neighbourhood definitions (eg, egocentric vs administrative), there is evidence for a positive association between higher retailer density in egocentric neighbourhoods around homes and current smoking in adults and adolescents. Administrative unit measures in some studies showed associations with adult current smoking, and adolescent lifetime and current smoking. Studies on tobacco outlet proximity to homes obtained mixed results. Density/proximity of tobacco outlets around schools showed no or inverse association with adolescent smoking, but suggests higher susceptibility to smoking. Evidence of an association between e-cigarette retail availability and e-cigarette use is limited due to a small number of studies. CONCLUSION The current literature provides limited empirical evidence of the association between tobacco retailer availability and smoking or e-cigarette use. More research with uniform measures of environmental exposure to tobacco retailers is needed to allow for greater comparability between studies.
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Affiliation(s)
- Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Patricia A McDaniel
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
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26
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Kasman M, Hammond RA, Purcell R, Heuberger B, Moore TR, Grummon AH, Wu AJ, Block JP, Hivert MF, Oken E, Kleinman K. An agent-based model of child sugar-sweetened beverage consumption: implications for policies and practices. Am J Clin Nutr 2022; 116:1019-1029. [PMID: 36041179 PMCID: PMC9535525 DOI: 10.1093/ajcn/nqac194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/08/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A strong body of evidence links young children's intake of sugar-sweetened beverages (SSBs) with myriad negative outcomes. OBJECTIVES Our research provides insight into whether and to what extent potential intervention strategies can reduce young children's consumption of SSBs. METHODS We built an agent-based model (ABM) of SSB consumption representing participants in the Project Viva longitudinal study between ages 2 and 7 y. In addition to extensive data from Project Viva, our model used nationally representative data as well as recent, high-quality literature. We tested the explanatory power of the model through comparison to consumption patterns observed in the Project Viva cohort. Then, we applied the model to simulate the potential impact of interventions that would reduce SSB availability in 1 or more settings or affect how families receive and respond to pediatrician advice. RESULTS Our model produced age-stratified trends in beverage consumption that closely match those observed in Project Viva cohort data. Among the potential interventions we simulated, reducing availability in the home-where young children spend the greatest amount of time-resulted in the largest consumption decrease. Removing access to all SSBs in the home resulted in them consuming 1.23 (95% CI: 1.21, 1.24) fewer servings of SSBs per week on average between the ages of 2 and 7 y, a reduction of ∼60%. By comparison, removing all SSB availability outside of the home (i.e., in schools and childcare) had a smaller impact (0.77; CI: 0.75, 0.78), a reduction of ∼40%. CONCLUSIONS These results suggest that interventions reducing SSB availability in the home would have the strongest effects on SSB consumption.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Ross A Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
- The Santa Fe Institute, Santa Fe, NM, USA
| | - Rob Purcell
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Benjamin Heuberger
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Travis R Moore
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Community Health, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Anna H Grummon
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Allison J Wu
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts–Amherst, Amherst, MA, USA
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27
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Combs TB, Ornstein JT, Chaitan VL, Golden SD, Henriksen L, Luke DA. Draining the tobacco swamps: Shaping the built environment to reduce tobacco retailer proximity to residents in 30 big US cities. Health Place 2022; 75:102815. [PMID: 35598345 PMCID: PMC10288515 DOI: 10.1016/j.healthplace.2022.102815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Combining geospatial data on residential and tobacco retailer density in 30 big US cities, we find that a large majority of urban residents live in tobacco swamps - neighborhoods where there is a glut of tobacco retailers. In this study, we simulate the effects of tobacco retail reduction policies and compare probable changes in resident-to-retailer proximity and retailer density for each city. While measures of proximity and density at baseline are highly correlated, the results differ both between effects on proximity and density and across the 30 cities. Context, particularly baseline proximity of residents to retailers, is important to consider when designing policies to reduce retailer concentration.
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Affiliation(s)
- Todd B Combs
- Center for Public Health Systems Science, Brown School at Washington University in St. Louis, 1 Brookings Drive, MSC 1196-0251-46, St. Louis, MO, 63130, USA.
| | - Joseph T Ornstein
- School of Public and International Affairs, The University of Georgia, 180 Baldwin Hall, Athens, GA, 30602, USA
| | - Veronica L Chaitan
- Center for Public Health Systems Science, Brown School at Washington University in St. Louis, 1 Brookings Drive, MSC 1196-0251-46, St. Louis, MO, 63130, USA
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599-7295, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, 3300 Hillview Ave, Mail Code 5537, Palo Alto, CA, 94304-1334, USA
| | - Douglas A Luke
- Center for Public Health Systems Science, Brown School at Washington University in St. Louis, 1 Brookings Drive, MSC 1196-0251-46, St. Louis, MO, 63130, USA
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28
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Kaviany P, Senter JP, Collaco JM, Corrigan AE, Brigham E, Wood M, Woo H, Liu C, Koehl R, Galiatsatos P, Koehler K, Hansel N, McCormack M. Spatial analysis of tobacco outlet density on secondhand smoke exposure and asthma health among children in Baltimore City. Tob Control 2022; 32:tobaccocontrol-2021-056878. [PMID: 35046128 PMCID: PMC9294062 DOI: 10.1136/tobaccocontrol-2021-056878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Tobacco outlets are concentrated in low-income neighbourhoods; higher tobacco outlet density is associated with increased smoking prevalence. Secondhand smoke (SHS) exposure has significant detrimental effects on childhood asthma. We hypothesised there was an association between higher tobacco outlet density, indoor air pollution and worse childhood asthma. METHODS Baseline data from a home intervention study of 139 children (8-17 years) with asthma in Baltimore City included residential air nicotine monitoring, paired with serum cotinine and asthma control assessment. Participant addresses and tobacco outlets were geocoded and mapped. Multivariable regression modelling was used to describe the relationships between tobacco outlet density, SHS exposure and asthma control. RESULTS Within a 500 m radius of each participant home, there were on average six tobacco outlets. Each additional tobacco outlet in a 500 m radius was associated with a 12% increase in air nicotine (p<0.01) and an 8% increase in serum cotinine (p=0.01). For every 10-fold increase in air nicotine levels, there was a 0.25-point increase in Asthma Therapy Assessment Questionnaire (ATAQ) score (p=0.01), and for every 10-fold increase in serum cotinine levels, there was a 0.54-point increase in ATAQ score (p<0.05). CONCLUSIONS Increased tobacco outlet density is associated with higher levels of bedroom air nicotine and serum cotinine. Increasing levels of SHS exposure (air nicotine and serum cotinine) are associated with less controlled childhood asthma. In Baltimore City, the health of children with asthma is adversely impacted in neighbourhoods where tobacco outlets are concentrated. The implications of our findings can inform community-level interventions to address these health disparities.
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Affiliation(s)
- Parisa Kaviany
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James Paul Senter
- Pediatrics Residency Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Michael Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anne E Corrigan
- Spatial Science for Public Health Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily Brigham
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Megan Wood
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Han Woo
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chen Liu
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachelle Koehl
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Panagis Galiatsatos
- Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia Hansel
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meredith McCormack
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Craigmile PF, Onnen N, Schwartz E, Glasser A, Roberts ME. Evaluating how licensing-law strategies will impact disparities in tobacco retailer density: a simulation in Ohio. Tob Control 2021; 30:e96-e103. [PMID: 32826386 PMCID: PMC7897331 DOI: 10.1136/tobaccocontrol-2020-055622] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess tobacco licensing-law strategies (eg, restricting the sale of tobacco near schools, banning the sale of tobacco in pharmacies) in terms of the equity of their impact and ability to correct existing disparities in tobacco retailer density. METHODS We geocoded all 11 392 tobacco retailers in Ohio, categorised neighbourhoods based on their demographic characteristics and calculated current disparities in tobacco retailer density. We next simulated the four main types of licensing-law strategies (capping-based, declustering-based, school-based and pharmacy-based), as well as strategy combinations. Finally, using statistical methods that account for residual spatial dependence, we evaluated how each strategy would impact density disparities. FINDINGS The most impactful licensing-law strategy depended on the type of community. School-based reductions were equitable for low-income, African-American and urban neighbourhoods (eg, eliminating retailers from 1000 feet of all schools produced a 9.2% reduction in the log retailer rate for neighbourhoods with a low prevalence of African-Americans and a 17.7% reduction for neighbourhoods with a high prevalence of African-Americans). Conversely, capping-based reductions were equitable for rural neighbourhoods. Pharmacy-based reductions demonstrated inequitable impacts. CONCLUSION Licensing-law strategies could be a central tobacco control effort that benefits both the overall population and vulnerable communities. Policymakers will need to consider their community's characteristics when selecting licensing-law strategies to correct (rather than inadvertently widen) density disparities. But when matched with the appropriate strategy, high-risk communities could remove over 20% of their tobacco retailers.
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Affiliation(s)
- Peter F Craigmile
- Department of Statistics, The Ohio State University, Columbus, OH, USA
| | - Nathaniel Onnen
- Department of Statistics, The Ohio State University, Columbus, OH, USA
| | - Elli Schwartz
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Allison Glasser
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Megan E Roberts
- College of Public Health, The Ohio State University, Columbus, OH, USA
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30
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Caryl FM, Pearce J, Reid G, Mitchell R, Shortt NK. Simulating the density reduction and equity impact of potential tobacco retail control policies. Tob Control 2021; 30:e138-e143. [PMID: 33148694 PMCID: PMC7612095 DOI: 10.1136/tobaccocontrol-2020-056002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Reducing the provision of tobacco is important for decreasing inequalities in smoking and smoking-related harm. Various policies have been proposed to achieve this, but their impacts-particularly on equity-are often unknown. Here, using national-level data, we simulate the impacts of potential policies designed to reduce tobacco outlet density (TOD). METHODS Tobacco retailer locations (n=9030) were geocoded from Scotland's national register, forming a baseline. Twelve policies were developed in three types: (1) regulating type of retailer selling tobacco, (2) regulating location of tobacco sales, and (3) area-based TOD caps. Density reduction was measured as mean percentage reduction in TOD across data zones and number of retailers nationally. Equity impact was measured using regression-based Relative Index of Inequality (RII) across income deprivation quintiles. RESULTS Policies restricting tobacco sales to a single outlet type ('Supermarket'; 'Liquor store'; 'Pharmacy') caused >80% TOD reduction and >90% reduction in the number of tobacco outlets nationally. However, RIIs indicated that two of these policies ('Liquor store', 'Pharmacy') increased socioeconomic inequalities in TOD. Equity-promoting policies included 'Minimum spacing' and exclusion zones around 'Child spaces'. The only policy to remove statistically significant TOD inequalities was the one deliberately targeted to do so ('Reduce clusters'). CONCLUSIONS Using spatial simulations, we show that all selected policies reduced provision of tobacco retailing to varying degrees. However, the most 'successful' at doing so also increased inequalities. Consequently, policy-makers should consider how the methods by which tobacco retail density is reduced, and success measured, align with policy aims.
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Affiliation(s)
- Fiona M Caryl
- MRC/CSO Social and Public Health Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of GeoSciences, The University of Edinburgh, Edinburgh, UK
| | | | - Richard Mitchell
- MRC/CSO Social and Public Health Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Niamh K Shortt
- Centre for Research on Environment, Society and Health, School of GeoSciences, The University of Edinburgh, Edinburgh, UK
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31
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Morrison CN, Lee JP, Giovenco DP, West B, Hidayana I, Astuti PAS, Mooney SJ, Jacobowitz A, Rundle A. The geographic distribution of retail tobacco outlets in Yogyakarta, Indonesia. Drug Alcohol Rev 2021; 40:1315-1324. [PMID: 33779016 DOI: 10.1111/dar.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Tobacco smoking prevalence in Indonesia is among the highest in the world. Research worldwide identifies that physical access to tobacco through retail outlets is related to increased tobacco smoking. Tobacco outlet density is very high in many Indonesian cities, so tobacco access may contribute to the high prevalence of tobacco use in that country. The aim of this study was to examine distributions of tobacco outlets in one Indonesian city, Yogyakarta, in relation to social and physical environmental conditions. METHODS For this cross-sectional ecological study, we virtually audited randomly selected street segments (n = 1099) using Google Street View. The outcome of interest was a count of tobacco advertising banners (indicating the presence of retail outlets). Exposures were physical environmental conditions (scales of main roads, physical decay, presence of schools, mosques, churches) and social conditions measured at the neighbourhood level (concentrated disadvantage, age composition, population density). RESULTS Tobacco banners were present on 36.4% of sampled street segments, including 55 (37%) of 147 streets with schools; a total of 1381 banners were identified. Multilevel negative binomial regression models for street segments nested within neighbourhoods found the prevalence of tobacco banners per 100 m was lower near schools (RR = 0.66, 95% CI 0.45, 0.97) and was not associated with other exposure measures. DISCUSSION AND CONCLUSIONS Retail tobacco outlets are ubiquitous in Yogyakarta. Although they are relatively less prevalent on streets with schools, the high absolute values and wide spatial distribution means all residents of Yogyakarta are exposed to tobacco outlets.
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Affiliation(s)
- Christopher N Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, USA
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Brooke West
- Columbia School of Social Work, Columbia University, New York, USA
| | - Irma Hidayana
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, USA
| | - Putu A S Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Ahuva Jacobowitz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Almagor J, Martin A, McCrorie P, Mitchell R. How can an agent-based model explore the impact of interventions on children's physical activity in an urban environment? Health Place 2021; 72:102688. [PMID: 34628149 PMCID: PMC8633766 DOI: 10.1016/j.healthplace.2021.102688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 12/28/2022]
Abstract
Insufficient physical activity (PA) among most children and adolescents is a global problem that is undermining the realisation of numerous developmental and health benefits. The aim of this study was to explore the potential impact of interventions on PA by using an agent-based model (ABM) simulating children's daily activities in an urban environment. Three domains for interventions were explored: outdoor play, school physical education and active travel. Simulated interventions increased children's average daily moderate-to-vigorous PA by 2–13 min and reduced the percentage of children not meeting PA guidelines, from 34% to 10%–29%, depending on the intervention. Promotion of active travel and outdoor play benefited more those in a higher socio-economic position. Agents' interactions suggested that: encouraging activity in diverse groups will reduce percentage of the least active in the population; and initiating outdoor events in neighbourhoods can generate an enhancing effect on children's engagement in PA. The ABM provided measurable outcomes for interventions that are difficult to estimate using reductionist methods. We suggest that ABMs should be used more commonly to explore the complexity of the social-environmental PA system. We developed an agent-based model simulating children's daily physical activity. Agents perform typical daily activities in a virtual urban model of Glasgow city. Simulations explore impact of interventions on outdoor play, school, active travel. Promotion of active travel had a differential impact across socio-economic position. Outdoor play intervention produced a non-linear increase in physical activity.
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Affiliation(s)
- Jonatan Almagor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, G3 7HR, Glasgow, Scotland, UK.
| | - Anne Martin
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, G3 7HR, Glasgow, Scotland, UK
| | - Paul McCrorie
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, G3 7HR, Glasgow, Scotland, UK
| | - Rich Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, G3 7HR, Glasgow, Scotland, UK
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Lindau ST, Makelarski JA, Kaligotla C, Abramsohn EM, Beiser DG, Chou C, Collier N, Huang ES, Macal CM, Ozik J, Tung EL. Building and experimenting with an agent-based model to study the population-level impact of CommunityRx, a clinic-based community resource referral intervention. PLoS Comput Biol 2021; 17:e1009471. [PMID: 34695116 PMCID: PMC8568099 DOI: 10.1371/journal.pcbi.1009471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/04/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
CommunityRx (CRx), an information technology intervention, provides patients with a personalized list of healthful community resources (HealtheRx). In repeated clinical studies, nearly half of those who received clinical "doses" of the HealtheRx shared their information with others ("social doses"). Clinical trial design cannot fully capture the impact of information diffusion, which can act as a force multiplier for the intervention. Furthermore, experimentation is needed to understand how intervention delivery can optimize social spread under varying circumstances. To study information diffusion from CRx under varying conditions, we built an agent-based model (ABM). This study describes the model building process and illustrates how an ABM provides insight about information diffusion through in silico experimentation. To build the ABM, we constructed a synthetic population ("agents") using publicly-available data sources. Using clinical trial data, we developed empirically-informed processes simulating agent activities, resource knowledge evolution and information sharing. Using RepastHPC and chiSIM software, we replicated the intervention in silico, simulated information diffusion processes, and generated emergent information diffusion networks. The CRx ABM was calibrated using empirical data to replicate the CRx intervention in silico. We used the ABM to quantify information spread via social versus clinical dosing then conducted information diffusion experiments, comparing the social dosing effect of the intervention when delivered by physicians, nurses or clinical clerks. The synthetic population (N = 802,191) exhibited diverse behavioral characteristics, including activity and knowledge evolution patterns. In silico delivery of the intervention was replicated with high fidelity. Large-scale information diffusion networks emerged among agents exchanging resource information. Varying the propensity for information exchange resulted in networks with different topological characteristics. Community resource information spread via social dosing was nearly 4 fold that from clinical dosing alone and did not vary by delivery mode. This study, using CRx as an example, demonstrates the process of building and experimenting with an ABM to study information diffusion from, and the population-level impact of, a clinical information-based intervention. While the focus of the CRx ABM is to recreate the CRx intervention in silico, the general process of model building, and computational experimentation presented is generalizable to other large-scale ABMs of information diffusion.
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Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, United States of America
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, United States of America
- Department of Medicine, Section of Geriatrics & Palliative Medicine, University of Chicago, Chicago, Illinois, United States of America
- Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, Illinois, United States of America
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, United States of America
| | - Chaitanya Kaligotla
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Beedie School of Business, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Emily M. Abramsohn
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, United States of America
| | - David G. Beiser
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, United States of America
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
| | - Elbert S. Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Charles M. Macal
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
| | - Elizabeth L. Tung
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
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Zucca C, Long E, Hilton J, McCann M. Appraising the Implementation of Complexity Approaches Within the Public Health Sector in Scotland. An Assessment Framework for Pre-Implementation Policy Evaluation. Front Public Health 2021; 9:653588. [PMID: 34631638 PMCID: PMC8492954 DOI: 10.3389/fpubh.2021.653588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
Complexity approaches have gained international attention as potentially effective strategies to address population health challenges. In light of this, the Scottish government (Scot. Gov.) set the implementation of these approaches as the recommended practice for its public health sector organizations. This study evaluates the opportunity and feasibility of implementing complexity approaches in public health Scotland employees' everyday routine by employing a qualitative study that involves 20 stakeholders, representative of different organizations and roles. We made use of an assessment framework based on Soft Systems Methodology (SSm) and Normalization Process Theory (NPT) comprised of five phases: Phase One defines the boundaries, aims, and goals of the issue under study; Phase Two consists of data collection, drawing on the e-Health Implementation Toolkit (e-HIT); Phase Three involves short presentations and breakout group activities to provide information on the new policy; Phase Four employs system thinking tasks to structure debate and builds shared understanding among participants; Phase Five applies NPT to appraise the organizational position around complexity based on information from the preceding steps. We found two main obstacles to implementing complexity approaches: (1) a lack of a shared understanding of the key concepts in complexity and their practical implications; (2) stakeholders' fear of significant disruption to work routines and power relationships. We recommend addressing these issues with appropriate training and customization of goals and tools that may enable complexity approaches to succeed within the Scottish public health context. Our assessment framework allows the recognition of key mechanisms to support how Scotland's Public Health body can enhance the implementation of complexity approaches. The appraisal framework could be used to study early-stage policy implementation in other contexts.
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Affiliation(s)
- Claudia Zucca
- Jheronimus Academy of Data Science, Tilburg University, Tilburg, Netherlands,*Correspondence: Claudia Zucca
| | - Emily Long
- MRC/CSO Social and Public Health Sciences Unit (MRC), University of Glasgow, Glasgow, United Kingdom
| | - Jeremy Hilton
- School of Defence and Security, Cranfield University at the Defence Academy of the UK, Cranfield, United Kingdom
| | - Mark McCann
- MRC/CSO Social and Public Health Sciences Unit (MRC), University of Glasgow, Glasgow, United Kingdom
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Coalition-Committees as Network Interventions: Baseline Network Composition in Context of Childhood Obesity Prevention Interventions. SYSTEMS 2021. [DOI: 10.3390/systems9030066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community coalitions can address local issues with deep, historic, and contextual understanding that enables customized implementation of evidence-based strategies. The individuals within the coalition, their partnerships, and the social context is likely an important component of unraveling the challenges of implementation so interventions reach people in need. We focus on the relevance of baseline coalition-committee network (CCN), the networks of purposely formed subcommittees within community coalitions, structure as one of the moderating, theoretical links between community coalition social networks and intervention success. We explore the baseline composition and characteristics of five CCNs at the beginning of childhood obesity prevention interventions. Using a combination of social network, multidimensional scaling, and correspondence analyses, we examine the structure and heterogeneity of five CCNs, each consisting of a core group of stakeholders in the coalition and sometimes the broader community itself. Cross-sectional analyses are used to examine the composition of coalition-committees related to network density, centralization, hierarchy, and coalition demographics and characteristics. Results indicate that CCNs are patterned in their structure and characteristics, and we discuss whether adjustments to childhood obesity prevention interventions according to baseline structure and characteristics could be advantageous for intervention implementation. Together, these findings can inform future longitudinal investigations into CCN network structure.
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Oliver JA, Sweitzer MM, Engelhard MM, Hallyburton MB, Ribisl KM, McClernon FJ. Identifying neural signatures of tobacco retail outlet exposure: Preliminary validation of a "community neuroscience" paradigm. Addict Biol 2021; 26:e13029. [PMID: 33663023 DOI: 10.1111/adb.13029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 11/27/2022]
Abstract
An extensive epidemiological literature indicates that increased exposure to tobacco retail outlets (TROs) places never smokers at greater risk for smoking uptake and current smokers at greater risk for increased consumption and smoking relapse. Yet research into the mechanisms underlying this effect has been limited. This preliminary study represents the first effort to examine the neurobiological consequences of exposure to personally relevant TROs among both smokers (n = 17) and nonsmokers (n = 17). Individuals carried a global positioning system (GPS) tracker for 2 weeks. Traces were used to identify TROs and control outlets that fell inside and outside their ideographically defined activity space. Participants underwent functional MRI (fMRI) scanning during which they were presented with images of these storefronts, along with similar store images from a different county and rated their familiarity with these stores. The main effect of activity space was additive with a Smoking status × Store type interaction, resulting in smokers exhibiting greater neural activation to TROs falling inside activity space within the parahippocampus, precuneus, medial prefrontal cortex, and dorsal anterior insula. A similar pattern was observed for familiarity ratings. Together, these preliminary findings suggest that the otherwise distinct neural systems involved in self-orientation/self-relevance and smoking motivation may act in concert and underlie TRO influence on smoking behavior. This study also offers a novel methodological framework for evaluating the influence of community features on neural activity that can be readily adapted to study other health behaviors.
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Affiliation(s)
- Jason A. Oliver
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
- Cancer Control and Population Sciences Program Duke Cancer Institute Durham North Carolina USA
| | - Maggie M. Sweitzer
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
| | - Matthew M. Engelhard
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
| | - Matthew B. Hallyburton
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
| | - Kurt M. Ribisl
- Department of Health Behavior UNC Gillings School of Global Public Health Chapel Hill North Carolina USA
- Cancer Prevention and Control UNC Lineberger Comprehensive Cancer Center Chapel Hill North Carolina USA
| | - Francis Joseph McClernon
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
- Cancer Control and Population Sciences Program Duke Cancer Institute Durham North Carolina USA
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Kong AY, Gottfredson NC, Ribisl KM, Baggett CD, Delamater PL, Golden SD. Associations of County Tobacco Retailer Availability With U.S. Adult Smoking Behaviors, 2014-2015. Am J Prev Med 2021; 61:e139-e147. [PMID: 34134883 PMCID: PMC8384706 DOI: 10.1016/j.amepre.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/26/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Greater availability of tobacco product retailers in an area may be associated with smoking behaviors, and the majority of people who smoke purchase their cigarettes at gas stations and convenience stores. This cross-sectional study investigates the associations of overall tobacco retailer density and gas/convenience density with adult smoking behaviors. METHODS This study built a list of tobacco retailers in 2014 and calculated the county-level number of retailers per 1,000 people. Individual-level smoking behavior data were drawn from the 2014-2015 Tobacco Use Supplement for a sample of adults (n=88,850) residing in metropolitan counties across the U.S. General estimating equation models were fit to investigate the associations between retailer density and cigarette smoking behaviors (smoking status, quit attempt, quit length). Analyses were conducted in 2020. RESULTS A greater number of tobacco retailers (AOR=1.63, 95% CI=1.35, 1.96) and gas stations and convenience stores (AOR=3.29, 95% CI=2.39, 4.52) per 1,000 people were each associated with a higher odds of a respondent smoking every day than the odds of a respondent not smoking. In addition, both measures were associated with a higher odds of a respondent being an every-day than being a some-day smoker. Associations for gas/convenience density were similar in models that additionally controlled for other tobacco retailers (excluding gas/convenience). Study results did not support associations between retailer density and cessation. CONCLUSIONS Tobacco retailer density, especially gas/convenience density, is correlated with daily smoking, the most harmful tobacco use behavior. Calculating tobacco retailer density using gas/convenience stores may be a feasible proxy for overall tobacco retailer density.
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Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Nisha C Gottfredson
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kurt M Ribisl
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris D Baggett
- UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul L Delamater
- UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Geography, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shelley D Golden
- Department of Health Behavior, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kong AY, Delamater PL, Gottfredson NC, Ribisl KM, Baggett CD, Golden SD. Sociodemographic inequities in tobacco retailer density: Do neighboring places matter? Health Place 2021; 71:102653. [PMID: 34461529 PMCID: PMC8490323 DOI: 10.1016/j.healthplace.2021.102653] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
We apply a spatial perspective to measure the extent to which the 2018 U.S. racial, ethnic, and socioeconomic composition of census tracts were each associated with tobacco retailer density within a tract and in its neighboring tracts (n = 71,409). A 10-percentage point increase in the Black population was associated with 0.07 (p < 0.05) more retailers per square mile within a focal tract and 0.35 (p < 0.001) more retailers per square mile in its neighbors on average. A greater percent of Hispanic/Latino residents was associated with more retailers per square mile, both within a focal tract (b = 0.95, p < 0.001) and in its neighbors 0.39 (p < 0.001). Inverse associations were observed for percent white. We also observed inequities by socioeconomic status. The overall magnitude of inequities may be underestimated if the spatial dependence between focal tracts and their neighbors are not taken into consideration. Policymakers should prioritize interconnected geographic areas experiencing high racialized and socioeconomic segregation when designing and implementing policies to reduce retail tobacco product availability.
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Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA.
| | - Paul L Delamater
- Department of Geography, University of North Carolina, Carolina Hall, Chapel Hill, NC, 27599-7435, USA
| | - Nisha C Gottfredson
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599-7295, USA
| | - Chris D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599-7295, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7440, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27599-7295, USA
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Andersen-Rodgers E, Zhang X, Vuong TD, Hendrix L, Edora C, Williams RJ, Groves L, Roeseler A, Rogers T, Voelker DH, Schleicher NC, Johnson TO, Henriksen L. Are California's Local Flavored Tobacco Sales Restrictions Effective in Reducing the Retail Availability of Flavored Tobacco Products? A Multicomponent Evaluation. EVALUATION REVIEW 2021; 45:134-165. [PMID: 34693773 PMCID: PMC8600589 DOI: 10.1177/0193841x211051873] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Flavored tobacco appeals to new users. This paper describes evaluation results of California's early ordinances restricting flavored tobacco sales. METHODS A multicomponent evaluation of proximal policy outcomes involved the following: (a) tracking the reach of local ordinances; (b) a retail observation survey; and (c) a statewide opinion poll of tobacco retailers. Change in the population covered by local ordinances was computed. Retail observations compared availability of flavored tobacco at retailers in jurisdictions with and without an ordinance. Mixed models compared ordinance and matched no-ordinance jurisdictions and adjusted for store type. An opinion poll assessed retailers' awareness and ease of compliance with local ordinances, comparing respondents in ordinance jurisdictions with the rest of California. RESULTS The proportion of Californians living in a jurisdiction with an ordinance increased from 0.6% in April 2015 to 5.82% by January 1, 2019. Flavored tobacco availability was significantly lower in ordinance jurisdictions than in matched jurisdictions: menthol cigarettes (40.6% vs. 95.0%), cigarillos/cigar wraps with explicit flavor descriptors (56.4% vs. 85.0%), and vaping products with explicit flavor descriptors (6.1% vs. 56.9%). Over half of retailers felt compliance was easy; however, retailers in ordinance jurisdictions expressed lower support for flavor sales restrictions. CONCLUSIONS The proportion of California's population covered by a flavor ordinance increased nine-fold between April 2015 and January 2019. Fewer retailers in ordinance jurisdictions had flavored tobacco products available compared to matched jurisdictions without an ordinance, but many still advertised flavored products they could not sell. Comprehensive ordinances and retailer outreach may facilitate sales-restriction support and compliance.
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Affiliation(s)
- Elizabeth Andersen-Rodgers
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
- Elizabeth Andersen-Rodgers, California
Tobacco Control Program, California Department of Public Health, P.O. Box
997377, MS 7206, Sacramento, CA 95899-7377, USA.
| | - Xueying Zhang
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
| | - Tam D. Vuong
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
- UC Davis Comprehensive Cancer
Center, University of California
Davis, Sacramento, CA, USA
| | - Liz Hendrix
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
| | - Cheryl Edora
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
| | - Rebecca J. Williams
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
| | - Lauren Groves
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
| | - April Roeseler
- California Tobacco Control Program, California Department of Public
Health, Sacramento, CA, USA
| | - Todd Rogers
- Center for Health Analytics, Media,
and Policy, RTI International, Research Triangle Park, NC, USA
| | - David H. Voelker
- Stanford Prevention Research
Center, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Nina C. Schleicher
- Stanford Prevention Research
Center, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Trent O. Johnson
- Stanford Prevention Research
Center, Stanford University School of
Medicine, Palo Alto, CA, USA
| | - Lisa Henriksen
- Stanford Prevention Research
Center, Stanford University School of
Medicine, Palo Alto, CA, USA
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Cuomo RE, Yang JS, Purushothaman VL, Nali M, Li J, Mackey TK. A geospatial analysis of age disparities in resolute localities of tobacco and vaping-specific storefronts in California. Tob Prev Cessat 2021; 7:32. [PMID: 34017926 PMCID: PMC8114581 DOI: 10.18332/tpc/133933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/03/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Concomitant with the popularization of vaping, vape shops have dramatically proliferated over the past years. This study assesses whether vape storefronts in California are significantly associated with density of different age groups, and whether this differs between tobacco storefronts or non-specific tobacco retailers. METHODS Addresses for licensed tobacco retailers were obtained from the California Department of Tax and Fee Administration. Business names and addresses were used to obtain store categories cross-referenced from Yelp. Using a cross-sectional ecological design, stores categorized as ‘Vape Shop’ or ‘Tobacco Shop’ were geolocated and compared with age-related variables from the American Community Survey. Regression was conducted in R to determine relationships between age group concentration, in ventiles, and proportion of tracts with tobacco-specific or vape-specific stores. Geospatial visualization was conducted using ArcGIS. RESULTS We found 848 vape shops, 820 tobacco shops, 419 categorized as both, and 20320 retailers with neither category. Overall, 1800 tobacco and/or vape shops were categorized in 1557 of California’s 23194 census tracts. A positive linear association was found between ventiles of two age categories, 20–24 and 25–34 years, and proportion of tracts with vape-specific or tobacco-specific shops separately. CONCLUSIONS Positive associations were found for ages 20–34 years but not for other ages, suggesting vape shops are strategically located in areas populated by young adults. Location-based targeting increases access, thereby increasing proportion of tobacco users, and could be a critical factor in e-cigarette uptake and use. Further study to identify additional age-related demographic characteristics among clientele of tobacco storefronts is warranted.
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Affiliation(s)
- Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, United States.,Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Joshua S Yang
- Department of Public Health, California State University, Fullerton, United States
| | - Vidya L Purushothaman
- Global Health Policy and Data Institute, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Matthew Nali
- Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
| | - Jiawei Li
- Global Health Policy and Data Institute, San Diego, United States
| | - Tim K Mackey
- Global Health Policy and Data Institute, San Diego, United States.,Department of Healthcare Research and Policy, University of California, San Diego - Extension, San Diego, United States.,Department of Anesthesiology, School of Medicine, University of California, San Diego, United States
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McKay VR, Cambey CL, Combs TB, Stubbs AW, Pichon LC, Gaur AH. Using a Modeling-Based Approach to Assess and Optimize HIV Linkage to Care Services. AIDS Behav 2021; 25:886-896. [PMID: 33000356 PMCID: PMC7887057 DOI: 10.1007/s10461-020-03051-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/31/2022]
Abstract
Evidence-based linkage to care interventions (LTCs) help recently diagnosed HIV+ individuals engage in care in a timely manner yet are heavily impacted by the systems in which they are embedded. We developed a prototype agent-based model informed by data from an established LTC program targeting youth and young adults aged 13-24 in Memphis, Tennessee. We then tested two interventions to improve LTC in a simulated environment: expanding testing sites versus using current testing sites but improving direct referral to LTC staff from organizations providing testing, to understand the impact on timely linkage to care. Improving direct referral to the LTC program decreased days to successful linkage from an average of 30 to 23 days but expanding testing sites increased average days to 31 days unless those sites also made direct referrals. We demonstrated how LTC is impacted by the system and interventions for shortening days to linkage to care.
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Affiliation(s)
- V R McKay
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus Box #1196, St. Louis, MO, 63130, USA.
| | - C L Cambey
- Department of Biology, Vassar College, Poughkeepsie, NY, USA
| | - T B Combs
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus Box #1196, St. Louis, MO, 63130, USA
| | - A W Stubbs
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - L C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - A H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
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McGill E, Er V, Penney T, Egan M, White M, Meier P, Whitehead M, Lock K, Anderson de Cuevas R, Smith R, Savona N, Rutter H, Marks D, de Vocht F, Cummins S, Popay J, Petticrew M. Evaluation of public health interventions from a complex systems perspective: A research methods review. Soc Sci Med 2021; 272:113697. [PMID: 33508655 DOI: 10.1016/j.socscimed.2021.113697] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/27/2020] [Accepted: 01/07/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Applying a complex systems perspective to public health evaluation may increase the relevance and strength of evidence to improve health and reduce health inequalities. In this review of methods, we aimed to: (i) classify and describe different complex systems methods in evaluation applied to public health; and (ii) examine the kinds of evaluative evidence generated by these different methods. METHODS We adapted critical review methods to identify evaluations of public health interventions that used systems methods. We conducted expert consultation, searched electronic databases (Scopus, MEDLINE, Web of Science), and followed citations of relevant systematic reviews. Evaluations were included if they self-identified as using systems- or complexity-informed methods and if they evaluated existing or hypothetical public health interventions. Case studies were selected to illustrate different types of complex systems evaluation. FINDINGS Seventy-four unique studies met our inclusion criteria. A framework was developed to map the included studies onto different stages of the evaluation process, which parallels the planning, delivery, assessment, and further delivery phases of the interventions they seek to inform; these stages include: 1) theorising; 2) prediction (simulation); 3) process evaluation; 4) impact evaluation; and 5) further prediction (simulation). Within this framework, we broadly categorised methodological approaches as mapping, modelling, network analysis and 'system framing' (the application of a complex systems perspective to a range of study designs). Studies frequently applied more than one type of systems method. CONCLUSIONS A range of complex systems methods can be utilised, adapted, or combined to produce different types of evaluative evidence. Further methodological innovation in systems evaluation may generate stronger evidence to improve health and reduce health inequalities in our complex world.
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Affiliation(s)
- Elizabeth McGill
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Vanessa Er
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tarra Penney
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR) and University of Cambridge, Cambridge, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Martin White
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR) and University of Cambridge, Cambridge, United Kingdom
| | - Petra Meier
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Karen Lock
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Richard Smith
- University of Exeter Medical School, Exeter, United Kingdom
| | - Natalie Savona
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, United Kingdom
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Jennie Popay
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
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Kong AY, Baggett CD, Gottfredson NC, Ribisl KM, Delamater PL, Golden SD. Associations of tobacco retailer availability with chronic obstructive pulmonary disease related hospital outcomes, United States, 2014. Health Place 2021; 67:102464. [PMID: 33276261 PMCID: PMC7854476 DOI: 10.1016/j.healthplace.2020.102464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Abstract
There are associations between tobacco retailer density and smoking behaviors, but little is known about whether places with more tobacco retailers have more smoking-related health problems. Using cross-sectional data from 2014, we investigated the relationships between tobacco retailer density and chronic obstructive pulmonary disease (COPD) related outcomes in a sample of 1510 counties across the United States. Higher retailer density was associated with a 19% (IRR, 1.19; 95% CI, 1.12-1.27) higher COPD-related hospital discharge rate and 30% (IRR, 1.30; 95% CI 1.21-1.39) higher total COPD-related hospital costs per population. The tobacco retailer environment may be an important target for reducing smoking-related health burdens and costs.
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Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599-7440, USA.
| | - Christopher D Baggett
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599-7435, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27599-7295, USA
| | - Nisha C Gottfredson
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599-7440, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599-7440, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27599-7295, USA
| | - Paul L Delamater
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27599-7295, USA; Department of Geography, University of North Carolina, Carolina Hall, Chapel Hill, NC 27599-7435, USA
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC 27599-7440, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27599-7295, USA
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Glasser AM, Roberts ME. Retailer density reduction approaches to tobacco control: A review. Health Place 2021; 67:102342. [PMID: 33526207 PMCID: PMC7856310 DOI: 10.1016/j.healthplace.2020.102342] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 11/18/2022]
Abstract
Tobacco retailer density is consistently associated with poor tobacco-use outcomes. The aim of this review was to synthesize the international evidence on density reduction policies. Searches in multiple databases resulted in 31 studies covering various policy approaches evaluated for their impact on retailer density. Findings indicate that bans on tobacco sales in pharmacies reduced retailer density, but perhaps not equitably. Prohibiting sale of tobacco near schools produced greater density reductions in higher-risk neighborhoods. Policies in combination were most effective. Future studies should measure the impact of these policies on tobacco use. Density-reduction policies offer a promising approach to tobacco control.
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Affiliation(s)
- Allison M Glasser
- The Ohio State University, College of Public Health, Columbus, OH, USA.
| | - Megan E Roberts
- The Ohio State University, College of Public Health, Columbus, OH, USA
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45
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Ornstein JT, Hammond RA, Padek M, Mazzucca S, Brownson RC. Rugged landscapes: complexity and implementation science. Implement Sci 2020; 15:85. [PMID: 32993756 PMCID: PMC7523395 DOI: 10.1186/s13012-020-01028-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/07/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mis-implementation-defined as failure to successfully implement and continue evidence-based programs-is widespread in public health practice. Yet the causes of this phenomenon are poorly understood. METHODS We develop an agent-based computational model to explore how complexity hinders effective implementation. The model is adapted from the evolutionary biology literature and incorporates three distinct complexities faced in public health practice: dimensionality, ruggedness, and context-specificity. Agents in the model attempt to solve problems using one of three approaches-Plan-Do-Study-Act (PDSA), evidence-based interventions (EBIs), and evidence-based decision-making (EBDM). RESULTS The model demonstrates that the most effective approach to implementation and quality improvement depends on the underlying nature of the problem. Rugged problems are best approached with a combination of PDSA and EBI. Context-specific problems are best approached with EBDM. CONCLUSIONS The model's results emphasize the importance of adapting one's approach to the characteristics of the problem at hand. Evidence-based decision-making (EBDM), which combines evidence from multiple independent sources with on-the-ground local knowledge, is a particularly potent strategy for implementation and quality improvement.
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Affiliation(s)
- Joseph T Ornstein
- Brown School, Washington University in St. Louis, Brookings Drive, St. Louis, MO, USA.
- Department of Political Science, School of Public and International Affairs, University of Georgia, Jackson St, Athens, GA, USA.
| | - Ross A Hammond
- Brown School, Washington University in St. Louis, Brookings Drive, St. Louis, MO, USA
- Center on Social Dynamics and Policy, The Brookings Institution, Massachusetts Ave, Washington DC, USA
| | - Margaret Padek
- Brown School, Washington University in St. Louis, Brookings Drive, St. Louis, MO, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, 63130, Missouri, USA
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, 63110, Missouri, USA
| | - Stephanie Mazzucca
- Brown School, Washington University in St. Louis, Brookings Drive, St. Louis, MO, USA
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, Brookings Drive, St. Louis, MO, USA
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Grattan LE, Schmitt CL, Porter L. Community Program Activities Predict Local Tobacco Policy Adoption in Florida Counties. Am J Health Promot 2020; 34:722-728. [PMID: 32030993 DOI: 10.1177/0890117120904005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Bureau of Tobacco Free Florida's community program funds county-level grantees who promote local policy change through activities that educate the public, policy-makers, and decision-makers. There is robust literature linking tobacco control policies such as smoke-free air laws and tax increases to reductions in tobacco use. There is less evidence documenting the local activities programs conduct to achieve local policy change. In the current study, we used a quantitative model to assess the relationship between community tobacco control activities and local tobacco policy adoption. Grantee activities and policy adoption for each county are recorded in a database. To evaluate the community program, we compiled inputs and used a fixed-effects negative binomial regression to examine the relationship between grantee activities and policy adoption across all 67 community-based programs in Florida from 2010 to 2017 and analyzed the data in 2018. Measures included categories of policies (organization policies and jurisdiction policies) and community-based activities associated with tobacco control programs. Organization policy (school and business policy) and jurisdiction policy (county or city ordinances, proclamations, and resolutions) were dependent on partner meetings (incident rate ratio [IRR] = 1.03, confidence interval [CI] = 1.00-1.07 and IRR = 1.04, CI = 1.01-1.07, respectively) and local decision-maker communication (IRR = 1.01, CI = 1.00-1.03 and IRR = 1.05, CI = 1.03-1.07, respectively). Jurisdiction policy was also dependent on media advocacy (IRR = 1.07, CI = 1.02-1.12) and state policy-maker education (IRR = 1.16, CI = 1.06-1.26. Community outreach was negatively associated with jurisdiction policy (IRR = 0.97, CI = 0.94-0.99), and data collection was negatively associated with organization and jurisdiction policy (IRR = 0.97, CI = 0.95-1.00 and IRR = 0.97, CI = 0.95-1.00, respectively). Results from the study demonstrate that the type and timing of community grantee activities may influence local tobacco control policy adoption.
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Affiliation(s)
- Lauren E Grattan
- Social Policy, Health and Economics Research, 6856RTI International, Research Triangle Park, NC, USA
| | - Carol L Schmitt
- Social Policy, Health and Economics Research, 6856RTI International, Fort Collins, CO, USA
| | - Lauren Porter
- Bureau of Tobacco Free Florida, Florida Department of Health, Tallahassee, FL, USA
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Agent-based Modeling in Tobacco Regulatory Science: Exploring 'What if' in Waterpipe Smoking. TOB REGUL SCI 2020; 6:171-178. [PMID: 32582820 DOI: 10.18001/trs.6.3.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Waterpipe tobacco smoking (WTS) is an emerging public health crisis, particularly among youth and young adults. Different from the use of other tobacco products and e-cigarettes, WTS tends to be a social activity occurring among friends or persons associated with social networks. In this paper, we review a potential strategy for WTS-related research. Methods As a bottom-up computational model, agent-based modeling (ABM) can simulate the actions and interactions of agents, as well as the dynamic interactions between agents and their environments, to gain an understanding of the functioning of a system. ABM is particularly useful for incorporating the influence of social networks in WTS, and capturing people's space-time activity and the spatial distribution of WTS venues. Results Comprehensive knowledge of WTS-related behaviors at the individual level is needed to take advantage of ABM and use it to examine policies such as the interaction between WTS and cigarette smoking and the effect of flavors used in waterpipe tobacco. Longitudinal and WTS-specific surveys and laboratory experiments are particularly helpful to understand WTS basic mechanisms and elicit individual preferences, respectively. Conclusions We argue that the uniqueness of WTS makes ABM a promising tool to be used in WTS-related research, as well as understanding use of other tobacco products.
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Luke DA, Ornstein JT, Combs TB, Henriksen L, Mahoney M. Moving From Metrics to Mechanisms to Evaluate Tobacco Retailer Policies: Importance of Retail Policy in Tobacco Control. Am J Public Health 2020; 110:431-433. [PMID: 32159978 PMCID: PMC7067099 DOI: 10.2105/ajph.2020.305578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Douglas A Luke
- Douglas A. Luke, Joseph T. Ornstein, and Todd B. Combs are with the Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO. Lisa Henriksen is with the Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA. Maggie Mahoney is a tobacco policy and legal consultant in Minneapolis, MN
| | - Joseph T Ornstein
- Douglas A. Luke, Joseph T. Ornstein, and Todd B. Combs are with the Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO. Lisa Henriksen is with the Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA. Maggie Mahoney is a tobacco policy and legal consultant in Minneapolis, MN
| | - Todd B Combs
- Douglas A. Luke, Joseph T. Ornstein, and Todd B. Combs are with the Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO. Lisa Henriksen is with the Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA. Maggie Mahoney is a tobacco policy and legal consultant in Minneapolis, MN
| | - Lisa Henriksen
- Douglas A. Luke, Joseph T. Ornstein, and Todd B. Combs are with the Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO. Lisa Henriksen is with the Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA. Maggie Mahoney is a tobacco policy and legal consultant in Minneapolis, MN
| | - Maggie Mahoney
- Douglas A. Luke, Joseph T. Ornstein, and Todd B. Combs are with the Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO. Lisa Henriksen is with the Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA. Maggie Mahoney is a tobacco policy and legal consultant in Minneapolis, MN
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Azagba S, Manzione L. Retail Outlets and Point-of-Sale Marketing of Alternative Tobacco Products: Another Threat to Tobacco Control. J Adolesc Health 2020; 66:385-386. [PMID: 32199518 DOI: 10.1016/j.jadohealth.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Sunday Azagba
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah
| | - Lauren Manzione
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah
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50
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Kong AY, Myers AE, Isgett LF, Ribisl KM. Neighborhood racial, ethnic, and income disparities in accessibility to multiple tobacco retailers: Mecklenburg County, North Carolina, 2015. Prev Med Rep 2020; 17:101031. [PMID: 32021758 PMCID: PMC6993011 DOI: 10.1016/j.pmedr.2019.101031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/09/2019] [Accepted: 12/15/2019] [Indexed: 01/25/2023] Open
Abstract
•Existing studies assess an individual's proximity to a single tobacco retailer.•Measuring proximity to more than one retailer may better capture accessibility.•Disparities in multi-retailer proximity exist by neighborhood race and income.•Policies to address disparities in tobacco retailer exposure are needed.
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Affiliation(s)
- Amanda Y. Kong
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
- Counter Tools, 205 Lloyd Street #210 & 211, Carrboro, NC, 27510, USA
| | - Allison E. Myers
- Counter Tools, 205 Lloyd Street #210 & 211, Carrboro, NC, 27510, USA
- College of Public Health and Human Sciences, Oregon State University, 160 SW 26th Street, Corvallis, OR, 97331, USA
| | - Lisa F. Isgett
- Counter Tools, 205 Lloyd Street #210 & 211, Carrboro, NC, 27510, USA
| | - Kurt M. Ribisl
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Dr, Chapel Hill, NC, 27514, USA
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