The geography of crime and violence surrounding tobacco shops, medical marijuana dispensaries, and off-sale alcohol outlets in a large, urban low-income community of color

Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans

Introduction

Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being.

Methods

Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction.

Results

Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant.

Discussion

Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

Dispensaries and Medical Marijuana Certifications and Indications: Unveiling the Geographic Connections in Pennsylvania, USA

Introduction

Pennsylvania opened its first medical marijuana (MMJ) dispensary in 2018. Qualifying conditions include six conditions determined to have no or insufficient evidence to support or refute MMJ effectiveness. We conducted a study to describe MMJ dispensary access in Pennsylvania and to determine whether dispensary proximity was associated with MMJ certifications and community demographics.

Methods

Using data from the Pennsylvania Department of Health, we geocoded MMJ dispensary locations and linked them to US Census Bureau data. We created dispensary access measures from the population-weighted centroid of Zip Code Tabulation Areas (ZCTAs): distance to nearest dispensary and density of dispensaries within a 15-min drive. We evaluated associations between dispensary access and the proportion of adults who received MMJ certification and the proportion of certifications for low evidence conditions (amyotrophic lateral sclerosis, epilepsy, glaucoma, Huntington's disease, opioid use disorder, and Parkinson's disease) using negative binomial modeling, adjusting for community features. To evaluate associations racial and ethnic composition of communities and distance to nearest dispensary, we used logistic regression to estimate the odds ratios (OR) and 95% confidence intervals (CI), adjusting for median income.

Results

Distance and density of MMJ dispensaries were associated with the proportion of the ZCTA population certified and the proportion of certifications for insufficient evidence conditions. Compared to ZCTAs with no dispensary within 15 min, the proportion of adults certified increased by up to 31% and the proportion of certifications for insufficient evidence decreased by up to 22% for ZCTAs with two dispensaries. From 2018 to 2021, the odds of being within five miles of a dispensary was up to 20 times higher in ZCTAs with the highest proportions of individuals who were not White (2019: OR: 20.14, CI: 10.7-37.8) and more than double in ZCTAs with the highest proportion of Hispanic individuals (2018: OR: 2.81, CI: 1.51-5.24), compared to ZCTAs with the lowest proportions.

Conclusions

Greater dispensary access was associated with the proportions of certified residents and certifications for low evidence conditions. Whether these patterns are due to differences in accessibility or demand is unknown. Associations between community demographics and dispensary proximity may indicate MMJ access differences.

Effect of prevalence of alcohol consumption and tobacco use in Mexican municipalities on early childhood development

One of the most critical time periods in childhood is from birth to five years of age. Children exposed to alcohol and/or tobacco via family members and neighborhood are at risk for childhood developmental delays. This study evaluated the association of early childhood development with the prevalence of alcohol consumption and tobacco use in Mexican municipalities. This is a cross-sectional study. Early childhood development information from 2,345 children aged from 36 to 59 months was obtained from the 2015 Mexican National Survey of Boys, Girls, and Women (ENIM). Data on alcohol consumption and tobacco use come from the 2016 Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (ENCODAT). Multilevel logistic models were fitted to evaluate the association of the prevalence of alcohol consumption and tobacco use with the inadequacy of early childhood development. Children living in municipalities with high prevalence of alcohol consumption (OR = 13.410; 95%CI: 2.986; 60.240) and tobacco use (OR = 15.080; 95%CI: 2.040; 111.400) were less likely to be developmentally on track regarding early childhood development after adjustment for individual variables related to the child's development and other environmental variables at municipal level. Childhood exposure to alcohol and tobacco in the neighborhood may directly contribute to inadequate early childhood development. These findings suggest that there is an urgent need to develop effective interventions aimed at reducing alcohol consumption and tobacco use in municipalities to ensure adequate early childhood development.

Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

Background

Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms.

Objectives

This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps.

Search Methods

We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020.

Selection Criteria

The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws.

Data Collection and Analysis

Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2.

Main Results

The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality.

Authors’ Conclusions

More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.

Seeing is believing: How cannabis marketing exposure is associated with cannabis use attitudes and behavior in a permissive medical cannabis policy environment

BACKGROUND AND OBJECTIVES

Oklahoma has a fast-growing medical cannabis industry, showing a proliferation of industry marketing. While cannabis marketing exposure (CME) is a risk factor for cannabis use and positive attitudes about use, no studies have examined the impact of CME on attitudes and use behavior in a permissive cannabis policy environment, like Oklahoma.

METHODS

N = 5428 Oklahoma adults ages 18 and older completed assessments of demographics, past 30-day cannabis use, and past 30-day exposure to each of four types of cannabis marketing: outdoor (billboards, signs), social media, print (magazines), and Internet. Regression models examined associations of CME with positive attitudes towards cannabis use, cannabis harm perceptions, interest in obtaining a medical cannabis license (among nonlicensed participants), and past 30-day cannabis use.

RESULTS

Three quarters (74.5%) reported any past 30-day CME. Outdoor CME was most prevalent (61.1%), followed by social media (46.5%), Internet (46.1%), and print (35.2%). Correlates of CME included younger age, higher educational attainment and income, and medical cannabis license. In adjusted regression models, past 30-day CME and number of sources of CME were associated with current cannabis use behavior, positive attitudes about cannabis, lower cannabis harm perceptions, and greater interest in obtaining a medical cannabis license. Similar associations between CME and positive attitudes about cannabis were shown among noncannabis users.

DISCUSSION AND CONCLUSIONS

Public health messaging should be employed to minimize the potential adverse impacts of CME.

SCIENTIFIC SIGNIFICANCE

No studies have examined correlates of CME in a rapidly growing and relatively unrestrained marketing environment.

How Neighborhood Characteristics Influence Neighborhood Crimes: A Bayesian Hierarchical Spatial Analysis

Urban crimes are a severe threat to livable and sustainable urban environments. Many studies have investigated the patterns, causes, and strategies for curbing the occurrence of urban crimes. It is found that neighborhood socioeconomic status, physical environment, and ethnic composition all might play a role in the occurrence of urban crimes. Inspired by the recent interest in exploring urban crime patterns with spatial data analysis techniques and the development of Bayesian hierarchical analytical approaches, we attempt to explore the inherently intricate relationships between urban assaultive violent crimes and the neighborhood socioeconomic status, physical environment, and ethnic composition in Paterson, NJ, using census data of the American Community Survey, alcohol and tobacco sales outlet data, and abandoned property listing data from 2013. Analyses are set at the census block group level. Urban crime data are obtained from the Paterson Police Department. Instead of examining relationships at a global level with both non-spatial and spatial analyses, we examine in depth the potential locally varying relationships at the local level through a Bayesian hierarchical spatially varying coefficient model. At both the global and local analysis levels, it is found that median household income is decisively negatively related to urban crime occurrence. Percentage of African Americans and Hispanics, number of tobacco sales outlets, and number of abandoned properties are all positively related with urban crimes. At the local level of analysis, however, the different factors have varying influence on crime occurrence throughout the city of Paterson, with median household income having the broadest influence across the city. The practice of applying a Bayesian hierarchical spatial analysis framework to understand urban crime occurrence and urban neighborhood characteristics enables urban planners, stakeholders, and public safety officials to engage in more active and targeted crime-reduction strategies.

In the eyes of the beholder: Race, place and health

Racial and ethnic health disparities are fundamentally connected to neighborhood quality. For example, as a result of historical systemic inequities, racial and ethnic minorities are more likely to live in neighborhoods with signs of physical disorder (e.g., graffiti, vandalism), and physically disordered environments have been noted to associate with increased risk for chronic illness. Degree of exposure to neighborhood disorder may alter peoples' perception of their neighborhoods, however, with those most exposed (e.g., historically marginalized racial/ethnic groups) perhaps perceiving less threat from signs of neighborhood disorder. The purpose of the present study was to examine the complex interrelationships between people and place by investigating whether exposure to neighborhood physical disorder relates to residents' (1) perceptions of neighborhood safety and (2) perceptions of their health, and (3) examining whether these links vary by race/ethnicity. Using 2016-2018 Health and Retirement Study (HRS) data, a representative sample of US adults aged 51 years and older (n = 9,080, mean age 68 years), we conducted a series of weighted linear regressions to examine the role of neighborhood disorder in relation to both perceived neighborhood safety and self-rated health. Results indicated that greater neighborhood physical disorder was statistically significantly related to feeling less safe among non-Hispanic Whites and Hispanics, but not non-Hispanic Blacks. Regarding self-rated health, neighborhood physical disorder was statistically significantly related to poorer health among all racial/ethnic groups. These findings suggest that, despite differential interpretation of neighborhood disorder as a threat to safety, this modifiable aspect of peoples' environment is related to poor health regardless of one's race/ethnicity.

Spatial Disparities: The Role of Nativity in Neighborhood Exposure to Alcohol and Tobacco Retailers

Studies of retail environment, one of the social determinants of health, document racial/ethnic disparities in exposure to alcohol and tobacco (A and T) retailers, but have largely overlooked nativity. We examined associations between A and T retailer density and rates of foreign-born Latinx and foreign-born Asian residents in California census tracts (N = 7888), using spatial regressions and controlling for population and ecological confounders (e.g., population density, zoning, residential instability, urbanicity). Socio-demographic data came from the American Community Survey (2012-2016); census tract density of A and T retailers came from geocoded addresses from state license data for off-sale alcohol distributors and purchased data on tobacco retailers from a commercial provider. Models predicting A and T tract retailer density showed that the rate of foreign-born Latinx residents was associated with higher tobacco retailer density but lower alcohol retailer density, and demonstrate no significant associations between rate of foreign-born Asian residents tobacco and alcohol retail density. Retail environment could contribute to observed declines in immigrant health over time in the US and across generations.

Food Access, Food Insecurity, and Gun Violence: Examining a Complex Relationship

PURPOSE OF REVIEW

Food insecurity and gun violence are timely and relevant public health issues impacting many regions within the USA with a potential association. Terminology surrounding food access and food security can be confusing, which is important to understand when examining the relationship between these issues and gun violence.

RECENT FINDINGS

Food insecurity is an individual level risk factor that appears to correlate with an increased rate of exposure and future involvement in violence. Food deserts represent geographic regions with limited access to food but do not necessarily represent regions with high prevalence of food insecurity. Although both food insecurity and food deserts in urban regions have been linked with increased incidence of gun violence, a high prevalence of food insecurity was found to be more predictive. A high prevalence of food insecurity in urban regions likely serves as a marker for socioeconomic disadvantage and intentional disinvestment. These regions are predictably associated with a higher incidence of interpersonal gun violence. Food deserts in rural areas have not, to date, been shown to correlate with interpersonal gun violence. Urban food insecurity and gun violence are both likely the byproduct of structural violence. Despite the significant overlap and similar contributors, the application of the public health framework in addressing these two issues has historically been quite different.

Perceived neighborhood cohesion buffers COVID-19 impacts on mental health in a United States sample

Objective

This study examined whether perceived neighborhood cohesion (the extent to which neighbors trust and count on one another) buffers against the mental health effects of the 2020 COVID-19 pandemic.

Methods

The XXX University National COVID-19 and Mental Health Study surveyed US adults (N = 3965; M age = 39 years), measuring depressive symptoms, staying home more during than before the 2020 pandemic, and perceived neighborhood cohesion.

Results

A series of linear regressions indicated that perceiving one's neighborhood as more cohesive was not only associated with fewer depressive symptoms, but also attenuated the relationship between spending more time at home during the pandemic and depressive symptoms. These relationships persisted even after taking into account several individual-level sociodemographic characteristics as well as multiple contextual features, i.e., median household income, population density, and racial/ethnic diversity of the zip codes in which participants resided.

Conclusions

Neighborhood cohesion may be leveraged to mitigate pandemic impacts on depressive symptoms.

Neighborhood Ethnic Composition and Self-rated Health Among Chinese and Vietnamese American Immigrants

Immigrants tend to live in areas with higher co-ethnic density, and the effect of neighborhood ethnic composition could be particularly salient for health. This study explored associations between neighborhood ethnic composition and self-rated health among Asian immigrants. We analyzed data collected at baseline from 670 Chinese and Vietnamese immigrants enrolled in a lifestyle intervention trial. Residential addresses were geocoded and combined with neighborhood socio-demographic profiles based on census data. We used generalized estimating equations to examine neighborhood ethnic composition and self-rated health. Independent of individual-level factors, living in neighborhoods more densely populated by whites was associated with poor/fair self-rated health. Neighborhood household income and density of participants' own ethnic group were not associated with poor/fair self-rated health. More research is warranted to disentangle reasons why Chinese and Vietnamese immigrants living in white-concentrated neighborhoods reported poorer self-rated health, including investigating effects of discrimination, relative deprivation, and availability of social resources.

Geolocation of Maryland Medical Marijuana Dispensaries by Community Income and Racial Characteristics: An Ecological Design

Background: Prior investigations have documented disparities in the supply side of Maryland's Medical Marijuana program. Initially a disproportionate share of licenses to cultivate and distribute medical marijuana were awarded to Non-Hispanic White owned businesses. The state has implemented measures to ameliorate the inequity by prioritizing license awards to qualified minority owned businesses. Objectives: The objective of this study is to examine the racial and income characteristics of communities where licensed dispensaries are located. We quantify the racial and income characteristics of communities where Maryland medical cannabis dispensaries are located and explore whether Maryland medical marijuana dispensaries disproportionately locate in high-income, majority-White zip codes. Method: Using data from the Maryland Medical Cannabis Commission and the American Communities Survey, we create geocodes for each of the operating dispensaries as of December 2019. We examine the distribution of medical cannabis dispensaries by zip code level household income and zip code level racial distribution. The data set encompasses 85 operating cannabis dispensaries in Maryland and 6.1 million Marylanders distributed across 468 zip codes in 2018-2019. Results: The analysis indicates that dispensaries are concentrated in zip codes whose residents are racially diverse, and with higher concentrations of retail establishments. Conclusion: Community level racial or income disparities in access to medical cannabis were not observed in Maryland. Access to medical cannabis, based on ability to pay out of pocket for the product, may be uneven.

Using Participatory Mapping to Diagnose Upstream Determinants of Health and Prescribe Downstream Policy-Based Interventions

Participatory mapping is a powerful methodology for working with community residents to examine social and environmental determinants of public health disparities. However, this empowering methodology has only been applied sparingly in public health research and practice, with limited examples in the literature. To address this literature gap, we 1) review participatory mapping approaches that may be applied to exploring place-based factors that affect community health, and 2) present a mixed-methods participatory geographic information systems (PGIS) examination of neighborhood assets (eg, streetlights) and challenges (eg, spaces of crime and violence) related to access to public parks in South Los Angeles, California. By taking a participatory, fine-grained spatial approach to examining public park access with input from 40 South Los Angeles adolescent and adult residents, our community-engaged PGIS approach identified tobacco shops as previously unrecognized community institutions that are associated with increased neighborhood crime and violence. Our investigation revealed unique challenges in community-level public park access that would likely have been overlooked by conventional spatial epidemiology and social science methods, such as surveys and questionnaires. Furthermore, our granular community-informed approach supported resident and stakeholder advocacy efforts toward reducing the proliferation of tobacco shops through community organizing and policy change initiatives. We thus contend that it would benefit public health research and practice to further integrate empowering, grassroots-based participatory mapping approaches toward informing advocacy efforts and policies that promote health and well-being in disadvantaged communities.

Structural racism in the built environment: Segregation and the overconcentration of alcohol outlets

Structural racism, evidenced in practices like residential racial segregation, has been linked to health inequities. We examined the relationship between an adverse environmental factor (alcohol outlet overconcentration), segregated neighborhoods, and county alcohol policy in Louisiana and Alabama to investigate this link. Multilevel analysis revealed high outlet density associated with segregated counties and predominantly black census tracts in counties with restrictive alcohol policy. This inverse association between policies designed to limit alcohol availability and overconcentration of outlets in black neighborhoods warrants consideration by policymakers given links between outlet density and health inequities. Consideration of these findings in historical context suggests these policies may function as a contemporary actualization of the historical use of alcohol policy to subjugate black people in the South, now over-concentrating instead of prohibiting access.

Physical environment and violence perpetration among male youth in Pittsburgh: a spatial analysis

PURPOSE

Examine associations between features of the built environment and violence perpetration among male youth.

METHODS

We enrolled 866 male adolescents, ages 13-19 years, as part of a violence prevention study in 20 lower-resource neighbourhoods in Pittsburgh, Pennsylvania, USA. Exposure to built environmental features was defined using participants' neighbourhood study site. Violence perpetration was measured by three survey items: physical fighting, threatening someone with a weapon, and injuring someone with a weapon. Logistic regression models examined associations between each environmental feature and violence perpetration.

RESULTS

Better neighbourhood walkability was associated with significantly lower odds of fighting (adjusted odds ratio (AOR)=0.86, 95% CI 0.76 to 0.99). Alcohol and tobacco outlets were associated with slightly lower odds of violence perpetration (AORs=0.89-0.96).

CONCLUSIONS

This work extends previous studies from large urban centres to a mid-sized city context and suggests that walkable neighbourhoods create opportunities for social interactions and may serve as a protective factor in youth violence.

Social Capital and Tobacco Retail Outlet Density: An Empirical Test of the Relationship

PURPOSE

To examine the relationship between tobacco outlet density and social capital.

PARTICIPANTS

Parents of at least one teen (N = 2734) in a representative sample of US households with teens (ages 13-16).

DESIGN

Population-based, cross-sectional survey of a web panel of adolescent-parent pairs matched with spatial data for address to characterize household neighborhoods.

SETTING

US households identified by latitude and longitude with a 50-ft random shift.

MEASURES

Perceived social capital (trust and informal social control as reported by parents), tobacco outlet density (retailers per land area in 1/2-mile buffer around each household), neighborhood demographics (derived from American Community Survey), and parent demographics.

ANALYSIS

Multivariable regression examined the relationship between tobacco outlet density and social capital controlling for household buffer and individual-level covariates, including correlates of social capital.

RESULTS

Tobacco outlet density was inversely correlated with perceived trust in neighbors (B = -1.12, P = .0004), but not social control (B = 0.11, P = .731).

CONCLUSION

This study is the first we are aware of to find that social capital is related to tobacco outlet density. The results imply that individuals with low social capital may benefit from policies regulating tobacco outlet density and may benefit from policies that address neighborhood inequality by increasing social capital and reducing poverty.

Density of Medical Marijuana Dispensaries and Current Marijuana Use among Young Adult Marijuana Users in Los Angeles

Background: While tobacco and alcohol studies have focused on density of outlets as a determinant of consumption, research has begun examining the effects of medical marijuana (MM) dispensaries on marijuana use. Objectives: Examine the relationship between density of MM dispensaries and frequency of marijuana use among young adult medical marijuana patients (MMP) and nonpatient users (NPU). Methods: Young adult marijuana users (n = 329) aged 18- to 26-year old were sampled in Los Angeles in 2014-2015 and separated into MMP (n = 198) and NPU (n = 131). In 2014, 425 operational MM dispensaries were identified within the City of Los Angeles. Sequential multilevel Poisson random effect models examined density of MM dispensaries per square mile and 90 d marijuana use among MMP and NUP at the ZIP code level while controlling for demographic, behavioral, and community characteristics. Results: Density of MM dispensaries was not related to 90 d use of marijuana (days of use or hits per day) among either MMP or NPU. MMP reported significantly greater days of marijuana use in the past 90 d compared to NPU but no differences were found for hits per day. African-Americans reported significantly greater hits per day compared to whites. Hispanics reported significantly fewer hits per day compared to non-Hispanics. Conclusion: Concentration of MM dispensaries surrounding young adult marijuana users in Los Angeles was unrelated to days of marijuana use irrespective of having a MM recommendation or not. Rather, individual factors related to consumer choices and behaviors were more important in determining recent marijuana use among MMP and NPU.

Engaging Disadvantaged Communities in Targeting Tobacco-Related Health Disparities and Other Health Inequities

Tobacco-related health disparities (TRHD) (e.g., respiratory disease, cancer) have been repeatedly shown to disproportionately affect individuals living in disadvantaged communities. In our recent community-guided geospatial study, we found evidence for a previously unrecognized TRHD involving tobacco shops, which were associated with increased crime and violence in South Los Angeles: a large, disadvantaged urban community. Our findings revealed tobacco shops may directly endanger the health of community residents in South Los Angeles by negatively shaping neighborhood crime and violence. In this commentary, we explore reasons why tobacco shops may perpetuate TRHDs and other health disparities in disadvantaged communities. Using our study as a case example, we further describe how community-partnered research grounded in community-based participatory research principles may empower stakeholders in disadvantaged communities to generate positive downstream outcomes such as tobacco-related policy changes.