Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23298, USA.
Environmental Science and Policy Division, Duke Global Health Institute and Nicholas School of the Environment, Durham, NC, 27708, USA.
Prev Sci. 2024 Aug;25(6):910-918. doi: 10.1007/s11121-024-01718-2. Epub 2024 Sep 4.
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.
烟草零售点（TRO）密度与孕妇及其子女体内可铁宁（吸烟的生物标志物）水平升高有关。因此，TRO 密度越高，可能代表孕妇在怀孕期间吸烟的活跃度越高。本研究的目的是模拟在实施几项 TRO 减少政策建议的情况下，孕妇体内可铁宁水平降低和医疗保健利用率提高的情况。本研究利用北卡罗来纳州现有的零售点数据和新生儿表观遗传学研究（NEST），创建了 TRO 的假设政策知情数据集，这些数据集 a）将 TRO 数量限制在与 2014 年旧金山（SF）政策相同的密度（政策 1），b）设定了从学校和其他 TRO 到 TRO 的最小距离为 500 英尺（政策 2），c）限制了 TRO 的类型以排除药店（政策 3），以及 d）政策 1-3 的组合（政策 4）。我们分别估计了每项政策的效果，以及在一个单独的模型中估计了它们的综合效果，以减少可铁宁水平和医疗保健利用率为指标，即急诊室就诊次数。我们发现，这些假设政策可能会有效地降低孕妇的可铁宁和急诊室就诊率，数据集中的大多数母亲在实施这些政策后，这些结果都有所降低。我们发现，政策 1 导致大多数样本以及按种族/族裔划分的样本中 TRO 暴露的适度减少。此外，政策 4 的估计效果略大于政策 1，但在实践中可能更难实施。总体而言，我们发现了支持 TRO 减少策略有效性的证据，这些策略可能会影响我们在北卡罗来纳州多样化样本中孕妇的吸烟暴露情况。
