Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY.
Nicotine Tob Res. 2019 Jun 21;21(7):896-902. doi: 10.1093/ntr/nty244.
Alternative tobacco products (ATPs), such as cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS), have a strong presence in the US retail environment amid declining cigarette consumption. This study documented the promotion of ATPs in tobacco retailers in New York City and examined associations with neighborhood demographics.
Data on product availability and advertising were collected from a stratified, random sample of tobacco retailers in 2017 (n = 796). Multilevel models estimated adjusted prevalence ratios (aPRs) for each outcome by neighborhood racial/ethnic composition and median household income.
Nearly half (49.8%) of retailers carried 99-cent cigarillos, but availability was significantly greater in neighborhoods in the highest (vs. lowest) quartile for the percentage of Black residents [68.2%, aPR: 1.59 (1.19, 2.11)] and in the lowest (vs. highest) income quartile [67.3%, aPR: 1.56 (1.04, 2.35)]. Conversely, retailers in neighborhoods with the highest percentage of White residents were significantly more likely to carry ENDS [66.4%, aPR: 1.71 (1.11, 2.62)]. Advertisements for ENDS were less common in neighborhoods in the highest (vs. lowest) quartiles for the percentage of Black and Hispanic residents [20.3%, aPR: 0.64 (0.41, 0.99); 22.9%, aPR: 0.62 (0.40, 0.98)].
The marketing of inexpensive, combusted tobacco products disproportionately saturates low-income, minority communities, while potentially lower risk, noncombusted products are more accessible in largely White and higher income neighborhoods. This pattern may exacerbate tobacco-related inequities. Public health policies should prioritize reducing the appeal and affordability of the most harmful tobacco products to help reduce health disparities.
Although cigarette promotion at the point-of-sale is well documented in the literature, questions remain about the ways in which alternative tobacco products (ATPs) are marketed in communities. Importantly, these products fall on a continuum of harm, with combusted tobacco overwhelmingly responsible for tobacco-related death and disease. We found that retailers in minority and low-income communities were more likely to carry and advertise inexpensive ATPs such as cigarillos, while potentially less risky, noncombusted products such as smokeless tobacco and e-cigarettes were more accessible in higher income and predominantly White neighborhoods. Policies aligned with product risk may help reduce health disparities.
介绍：在美国卷烟消费下降的背景下，另类烟草产品（ATPs），如雪茄、无烟烟草和电子烟，在美零售市场占据了重要地位。本研究记录了纽约市烟草零售商对 ATP 的推广情况，并考察了其与社区人口统计学特征的关联。
方法：2017 年，对分层随机抽取的烟草零售商（n=796）进行了产品供应和广告数据收集。使用多水平模型，按社区的种族/民族构成和家庭收入中位数，估算了每种结果的调整后患病率比（aPR）。
结果：近一半（49.8%）的零售商销售 99 美分雪茄，但在黑人居民比例最高（vs. 最低）的社区[68.2%，aPR：1.59（1.19，2.11）]和收入最低（vs. 最高）的社区[67.3%，aPR：1.56（1.04，2.35）]，零售商供应雪茄的可能性显著更大。相反，在白人居民比例最高的社区，零售商销售电子烟的可能性显著更高[66.4%，aPR：1.71（1.11，2.62）]。在黑人居民和西班牙裔居民比例最高（vs. 最低）的社区，电子烟广告则较少见[20.3%，aPR：0.64（0.41，0.99）；22.9%，aPR：0.62（0.40，0.98）]。
结论：廉价、可燃烟草产品的营销严重充斥着低收入、少数族裔社区，而风险较低的非可燃产品在主要为白人且收入较高的社区更易获得。这种模式可能会加剧与烟草相关的不平等现象。公共卫生政策应优先减少最有害烟草产品的吸引力和可负担性，以帮助减少健康差距。
意义：尽管销售点的卷烟促销在文献中已有充分记录，但关于替代烟草产品（ATPs）在社区中营销方式的问题仍未得到解答。重要的是，这些产品存在危害程度的差异，可燃烟草产品对与烟草相关的死亡和疾病负有主要责任。我们发现，少数族裔和低收入社区的零售商更有可能销售廉价的 ATP，如雪茄，而在收入较高和以白人为主要居民的社区，风险较低的非可燃产品如烟斗烟草和电子烟则更容易获得。与产品风险相一致的政策可能有助于减少健康差距。
