The Case for a Concerted Push to Reduce Place-Based Disparities in Smoking-Related Cancers

Development of a Tobacco Control Prescription in a Southern US City

THE PROBLEM

Nationwide efforts to reduce smoking in the United States have been successful. Yet, there is unequal geographic progress in reducing rates of smoking and smoking-related illnesses. Located in a tobacco-producing state with weak tobacco laws, Nashville, Tennessee, has an adult smoking rate of 22.0%, requiring 45,000 smokers to quit to meet the Healthy People 2020 goal of 12%.

PURPOSE

The purpose of this article was to detail the development a community-academic partnership (CAP) and its process for devising a local implementation strategy for tobacco control.

KEY POINTS

Nashville's CAP developed with a community-based organization (CBOs) seeking out an academic partner. This unique approach addressed many of the challenges CAPs face, helped identify priorities and potential barriers to success and led to early wins.

CONCLUSION

The success of Nashville's efforts suggests that CAPs should clearly delineate roles for members of the CAP, engage diverse stakeholders, be responsive to the community, and allow adequate time for planning and prioritizing.

Current advances in research in treatment and recovery: Nicotine addiction

The health harms of combusted tobacco use are undeniable. With market and regulatory pressures to reduce the harms of nicotine delivery by combustion, the tobacco product landscape has diversified to include smokeless, heated, and electronic nicotine vaping products. Products of tobacco combustion are the main cause of smoking-induced disease, and nicotine addiction sustains tobacco use. An understanding of the biology and clinical features of nicotine addiction and the conditioning of behavior that occurs via stimuli paired with frequent nicotine dosing, as with a smoked cigarette, is important for informing pharmacologic and behavioral treatment targets. We review current advances in research on nicotine addiction treatment and recovery, with a focus on conventional combustible cigarette use. Our review covers evidence-based methods to treat smoking in adults and policy approaches to prevent nicotine product initiation in youth. In closing, we discuss emerging areas of evidence and consider new directions for advancing the field.

Local Retail Tobacco Environment Regulation: Early Adoption in the United States

Objectives

To identify sociodemographic and policy environment characteristics of early adopters of retail tobacco control policies in U.S. localities.

Methods

We interviewed a sample of local tobacco control programs on policy progress for 33 specific policies, along with other program characteristics. We combine these results with secondary data in logistic regression analysis.

Results

Eighty (82% of 97) county tobacco control programs from 24 states were interviewed. Localities with lower smoking rates (OR: 0.7; 95%: 0.6-0.9) or higher excise taxes (OR: 6.0; 95%: 1.4-26.0) were more likely to have adopted a retail policy by late 2015. Early adopters were less likely to have voted majority Republican in the 2012 election (OR: 0.03; 95%: 0.00-0.34) or to have higher percentages of African American population (OR: 0.9; 95%: 0.8-0.99).

Conclusions

While localities with more resources, eg, program capacity, political will or policy options, were more likely to adopt policies by 2015, those with higher smoking rates and proportions of priority populations were less likely to do so. As local retail policy work becomes more commonplace, only time will tell if this "rich-get-richer" trend continues, or if the contexts in which retail policies are adopted diversify.

Tobacco Town: Computational Modeling of Policy Options to Reduce Tobacco Retailer Density

OBJECTIVES

To identify the behavioral mechanisms and effects of tobacco control policies designed to reduce tobacco retailer density.

METHODS

We developed the Tobacco Town agent-based simulation model to examine 4 types of retailer reduction policies: (1) random retailer reduction, (2) restriction by type of retailer, (3) limiting proximity of retailers to schools, and (4) limiting proximity of retailers to each other. The model examined the effects of these policies alone and in combination across 4 different types of towns, defined by 2 levels of population density (urban vs suburban) and 2 levels of income (higher vs lower).

RESULTS

Model results indicated that reduction of retailer density has the potential to decrease accessibility of tobacco products by driving up search and purchase costs. Policy effects varied by town type: proximity policies worked better in dense, urban towns whereas retailer type and random retailer reduction worked better in less-dense, suburban settings.

CONCLUSIONS

Comprehensive retailer density reduction policies have excellent potential to reduce the public health burden of tobacco use in communities.