Abstract
IntroductionOur objective was to identify social and physical environmental factors associated with current cigarette smoking among adults by metropolitan county in the United States.MethodsWe linked cigarette smoking data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) Selected Metropolitan Area Risk Trends (SMART) data set to 7 social and physical environmental characteristics: county type (metropolitan designation), primary care physician density, income inequality, percentage of the population that was a racial/ethnic minority, violent crime rate, education, and percentage of county residents with low income and no health insurance, all obtained from several county data sets. Spatial regression and hierarchical logistic regression modeling were performed.ResultsResults showed that metropolitan counties with a high proportion of non-Hispanic white adults (P < .001), lower education levels (high school graduate or less) (P < .001), and high violent crime rates (P < .001) had a higher adult cigarette smoking prevalence than other metropolitan counties. Spatial models showed 63.3% of the variability in county cigarette smoking prevalence was explained by these 3 factors as well as county type (based on population size of the of metropolitan area), primary care physician density, and percentage of county residents with low income and no health insurance. At an individual level, results showed that as the density (population) of primary care physicians increased in a county, the odds of being a current smoker decreased (OR, 0.980; P = .02).ConclusionWe found a significant association between adult cigarette smoking and county social and physical environmental factors. These place-based factors, especially social environmental characteristics, may reveal tobacco-related disparities to be considered when developing strategies to reduce tobacco use.
Highlights
Our objective was to identify social and physical environmental factors associated with current cigarette smoking among adults by metropolitan county in the United States
Results showed that metropolitan counties with a high proportion of non-Hispanic white adults (P < .001), lower education levels (P < .001), and high violent crime rates (P < .001) had a higher adult cigarette smoking prevalence than other metropolitan counties
Spatial models showed 63.3% of the variability in county cigarette smoking prevalence was explained by these 3 factors as well as county type, primary care physician density, and percentage of county residents with low income and no health insurance
Summary
Our objective was to identify social and physical environmental factors associated with current cigarette smoking among adults by metropolitan county in the United States. Progress has been made in reducing cigarette smoking among the general population, cigarette smoking is still the leading cause of preventable disease and death in the United States [1]. Current cigarette smoking is associated with individual characteristics, such as age, sex, race/ethnicity, income, education, and mental health status [2,3,4]; less information is available about the association between cigarette smoking and social and physical environmental characteristics (ie, place characteristics) among communities. Determining the influence of place-based characteristics on cigarette smoking can help reduce tobacco-related disparities. Addressing place-based factors may further reduce the disparities in cigarette smoking, leading to improved health equality among all residents wherever they live [1]
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