Associations of Alcohol and Tobacco Retail Outlet Rates with Neighborhood Disadvantage.

David C Wheeler,Joseph Boyle,F Joseph Mcclernon,D Jeremy Barsell,Trevin Glasgow,Bernard F Fuemmeler,Jason A Oliver

doi:10.3390/ijerph19031134

Abstract

Tobacco causes 29% of cancer-related deaths while alcohol causes 5.5% of cancer-related deaths. Reducing the consumption of these cancer-causing products is a special priority area for the National Cancer Institute. While many factors are linked to tobacco and alcohol use, the placement and density of retail outlets within neighborhoods may be one community-level risk factor contributing to greater use of these products. To elucidate associations between tobacco, alcohol, and tobacco and alcohol retail outlets (TRO, ARO, and TARO) and neighborhood disadvantage over a large geographic area, we employed a novel Bayesian index modeling approach to estimate a neighborhood disadvantage index (NDI) and its associations with rates of the three types of retailers across block groups in the state of North Carolina. We used a novel extension of the Bayesian index model to include a shared component for the spatial pattern common to all three types of outlets and NDI effects that varied by outlet type. The shared component identifies areas that are elevated in risk for all outlets. The results showed significant positive associations between neighborhood disadvantage and TROs (relative risk (RR) = 1.12, 95% credible interval (CI = 1.09, 1.14)) and AROs (RR = 1.15, 95% CI = 1.11, 1.17), but the association was greatest for TAROs (RR = 1.21, 95% CI = 1.18, 1.24). The most important variables in the NDI were percent renters (i.e., low home ownership), percent of homes built before 1940 (i.e., old housing stock), and percent without a high school diploma (i.e., low education).

Highlights

Reducing the consumption and access of cancer-causing products, such as alcohol and tobacco, is of high public health interest
Some correlations between outlet types are observed in the modeled relative risks (Figure 1), where relative risks are high for all outlet types in the northeastern coastal area
The northeastern coastal area is significantly elevated in risk for all three outlet types and several areas are identified for both alcohol retail outlet (ARO) and tobacco retail outlet (TRO) in the northeast and southeastern coastal area

Summary

Introduction

Reducing the consumption and access of cancer-causing products, such as alcohol and tobacco, is of high public health interest. Tobacco use causes 29% and alcohol use causes. 5.5% of cancer-related deaths [1]. Alcohol-attributed female cancer deaths are primarily from breast cancer (55–66%), whereas alcohol-attributed cancers in men are primarily of the aero-digestive tract (53–71%) [2]. The prevalence of heavy alcohol use (i.e., diagnosed with an alcohol use disorder) in the US is 7% among men and 4% among women [3], whereas the smoking prevalence rates are 15.3% among men and 12.7% among women [4]. Youth in the US are at risk of using these products. E-cigarette use is high among youth, with 19% of high school students reporting using e-cigarettes over the past 30 days [5,6]

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