Lin Shuo-Yu, Zhou Weiyu, Koch J Randy, Barnes Andrew J, Yang Ruixin, Xue Hong
Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA.
Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, VA, USA.
Nicotine Tob Res. 2023 Jan 1;25(1):36-42. doi: 10.1093/ntr/ntac154.
We examine the association between tobacco retail outlet density and adult smoking prevalence at the county level in Virginia, controlling for spatial autocorrelations.
Pooling data from 2020 County Health Rankings (compiled data from various sources including, but not limited to, the National Center for Health Statistics-Mortality Files, the Behavioral Risk Factor Surveillance System (BRFSS), and the American Community Survey) and Counter Tools, we conducted regression analyses that accounted for spatial autocorrelation (spatial lag models, LMlag) and adjusted for county-level access to healthcare, demographics, SES, environmental factors, risk conditions or behaviors, and population health measures.
Our estimates provide evidence that every increase of one tobacco retail outlet per 1000 persons was associated with 1.16 percentage points (95% CI: 0.80-1.52) higher smoking prevalence at the county level in Virginia after controlling for spatial autocorrelation. The effect of outlet density was largely explained by social determinants of health such as SES, risky conditions or behaviors, and environmental factors. We further noticed that the impact of social determinants of health were closely related and can be explained by indicators of population health (rates of mental distress (β = 1.49, 95% CI: 1.31-1.67) and physical inactivity (β = 0.07, 95% CI: 0.04-0.10).
Although higher tobacco outlet density was associated with an increase in county-level smoking prevalence, the impact of outlet density was largely explained by social determinants of health and mental illness. Improving well-being at the community level could be a promising strategy in future tobacco control policies.
The influence of tobacco outlet density seems to be explained by other social determinants of health and population level of mental or physical health. Thus, efforts to reduce tobacco use and consequent negative health effects should explore the impact of improving regional living standards. However, a sole focus on economic growth may not be sufficient, whereas a focus on such things as promoting work-life balance and improving overall well-being at the community level may be more.
我们研究弗吉尼亚州县一级烟草零售网点密度与成人吸烟率之间的关联，并控制空间自相关性。
汇总2020年县健康排名（来自包括但不限于国家卫生统计中心死亡率档案、行为风险因素监测系统（BRFSS）和美国社区调查等各种来源的汇编数据）和Counter Tools的数据，我们进行了回归分析，该分析考虑了空间自相关性（空间滞后模型，LMlag），并针对县级医疗保健可及性、人口统计学、社会经济地位（SES）、环境因素、风险状况或行为以及人口健康指标进行了调整。
我们的估计结果表明，在控制空间自相关性后，弗吉尼亚州县一级每1000人烟草零售网点每增加一个，吸烟率就会高出1.16个百分点（95%置信区间：0.80 - 1.52）。网点密度的影响在很大程度上由健康的社会决定因素所解释，如社会经济地位、风险状况或行为以及环境因素。我们进一步注意到，健康的社会决定因素的影响密切相关，并且可以由人口健康指标来解释（精神困扰率（β = 1.49，95%置信区间：1.31 - 1.67）和身体活动不足率（β = 0.07，95%置信区间：0.04 - 0.10））。
尽管较高的烟草网点密度与县一级吸烟率的增加有关，但网点密度的影响在很大程度上由健康和精神疾病的社会决定因素所解释。在社区层面改善福祉可能是未来烟草控制政策中一个有前景的策略。
烟草网点密度的影响似乎由其他健康的社会决定因素以及精神或身体健康的人口水平所解释。因此，减少烟草使用及其对健康的负面影响的努力应该探索改善地区生活水平的影响。然而，单纯关注经济增长可能并不足够，而关注促进工作与生活平衡以及改善社区层面整体福祉等方面可能更有意义。
