基于网络的戒烟干预措施的地理代表性：覆盖公平性分析。
Geographic Representativeness of a Web-Based Smoking Cessation Intervention: Reach Equity Analysis.
作者信息
Amato Michael S, Graham Amanda L
机构信息
Schroeder Institute, Truth Initiative, Washington, DC, United States.
Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, United States.
出版信息
J Med Internet Res. 2018 Oct 24;20(10):e11668. doi: 10.2196/11668.
BACKGROUND
Cigarette smoking is the leading cause of preventable death and disease in the United States. Smoking prevalence is higher in rural areas than in metropolitan areas, due partly to differences in access to cessation treatment. With internet use at 89% of all US adults, digital approaches could increase use of cessation treatment and reduce smoking.
OBJECTIVE
We investigated the extent to which smokers from rural areas use a digital cessation resource. We compared the geographic distribution of registered users of a free Web-based smoking cessation program with the geographic distribution of US smokers.
METHODS
We mapped user-provided ZIP codes to Rural-Urban Continuum Codes. A total of 59,050 of 118,574 users (49.80%) provided valid ZIP codes from 2013 to 2017. We used US National Survey of Drug Use and Health data from 2013 to 2017 to compare the geographic distribution of our sample of Web-based cessation users with the geographic distribution of US smokers. Reach ratios and 95% confidence intervals quantified the extent to which rural smokers' representation in the sample was proportionate to their representation in the national smoking population. Reach ratios less than 1 indicate underrepresentation.
RESULTS
Smokers from rural areas were significantly underrepresented in 2013 (reach ratio 0.89, 95% CI 0.87-0.91) and 2014 (reach ratio 0.89, 95% CI 0.86-0.92), proportionally represented in 2015 (reach ratio 1.08, 95% CI 1.02-1.14) and 2016 (reach ratio 1.03, 95% CI 0.94-1.14), and proportionally overrepresented in 2017 (reach ratio 1.16, 95% CI 1.12-1.21). Smokers from Large Metro areas were proportionally represented in 2013 and 2014 but underrepresented in 2015 (reach ratio 0.97, 95% CI 0.94-1.00), 2016 (reach ratio 0.89, 95% CI 0.85-0.94), and 2017 (reach ratio 0.89, 95% CI 0.86-0.91).
CONCLUSIONS
Results suggest that smokers from rural areas are more than proportionally reached by a long-standing digital cessation intervention. The underrepresentation of smokers from Large Metro areas warrants further study.
背景
在美国，吸烟是可预防死亡和疾病的首要原因。农村地区的吸烟率高于大都市地区，部分原因在于戒烟治疗的可及性存在差异。美国89%的成年人使用互联网，数字方法可能会增加戒烟治疗的使用并减少吸烟。
目的
我们调查了农村地区吸烟者使用数字戒烟资源的程度。我们将一个免费的基于网络的戒烟项目注册用户的地理分布与美国吸烟者的地理分布进行了比较。
方法
我们将用户提供的邮政编码映射到城乡连续体代码。在2013年至2017年期间，118,574名用户中有59,050名（49.80%）提供了有效的邮政编码。我们使用2013年至2017年美国全国药物使用和健康调查数据，将我们基于网络的戒烟用户样本的地理分布与美国吸烟者的地理分布进行比较。覆盖比率和95%置信区间量化了农村吸烟者在样本中的代表性与其在全国吸烟人群中的代表性成比例的程度。覆盖比率小于1表示代表性不足。
结果
2013年（覆盖比率0.89，95%置信区间0.87 - 0.91）和2014年（覆盖比率0.89，95%置信区间0.86 - 0.92）农村地区吸烟者的代表性显著不足，2015年（覆盖比率1.08，95%置信区间1.02 - 1.14）和2016年（覆盖比率1.03，95%置信区间0.94 - 1.14）比例相当，2017年（覆盖比率1.16，95%置信区间1.12 - 1.21）比例过高。2013年和2014年大都市地区吸烟者的代表性比例相当，但在2015年（覆盖比率0.97，95%置信区间0.94 - 1.00）、2016年（覆盖比率0.89，95%置信区间0.85 - 0.94）和2017年（覆盖比率0.89，95%置信区间0.86 - 0.91）代表性不足。
结论
结果表明，长期的数字戒烟干预对农村地区吸烟者的覆盖超过了比例。大都市地区吸烟者代表性不足的情况值得进一步研究。
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