摘要：Objectives. We examined the influence of tobacco outlet density and residential proximity to tobacco outlets on continuous smoking abstinence 6 months after a quit attempt. Methods. We used continuation ratio logit models to examine the relationships of tobacco outlet density and tobacco outlet proximity with biochemically verified continuous abstinence across weeks 1, 2, 4, and 26 after quitting among 414 adult smokers from Houston, Texas (33% non-Latino White, 34% non-Latino Black, and 33% Latino). Analyses controlled for age, race/ethnicity, partner status, education, gender, employment status, prequit smoking rate, and the number of years smoked. Results. Residential proximity to tobacco outlets, but not tobacco outlet density, provided unique information in the prediction of long-term, continuous abstinence from smoking during a specific quit attempt. Participants residing less than 250 meters ( P = .01) or less than 500 meters ( P = .04) from the closest tobacco outlet were less likely to be abstinent than were those living 250 meters or farther or 500 meters or farther, respectively, from outlets. Conclusions. Because residential proximity to tobacco outlets influences smoking cessation, zoning restrictions to limit tobacco sales in residential areas may complement existing efforts to reduce tobacco use. Although the prevalence of smoking has decreased substantially over the past few decades, smoking remains the leading cause of preventable death and disability among adults in the United States. 1 A key public health strategy to reduce the deleterious health effects of tobacco use is to decrease the prevalence of smoking by increasing smoking cessation rates. 2 Previous public health and policy approaches to affect smoking prevalence have included restrictions on tobacco advertising, counter-advertising campaigns, bans on smoking in public places, increases in federal and state cigarette excise taxes, and increases in the availability of treatment programs. The effectiveness of these approaches in increasing smoking cessation rates has been supported by the literature. 3 – 5 However, additional tobacco control strategies are needed to achieve national public health goals. 2 One potential area of expansion for tobacco control policies is the regulation of tobacco retail outlets. Regulation strategies are designed to facilitate behavior change by altering structural aspects of the community context in which problematic behavior occurs. 6 An analogous area in which regulation strategies have been applied is alcohol beverage retail outlets. In this case, regulation strategies have included the implementation of zoning restrictions to reduce the density of alcohol outlets and the proximity of alcohol outlets to residential areas. It was hypothesized that such regulations would affect problematic alcohol use at a community level by decreasing residents’ access to alcohol, reducing exposure to on-site product marketing, and changing social norms about alcohol use. 7 Ultimately, research supported the success of these policies in reducing problematic alcohol use and alcohol-related injury, crimes, and violence. 7 – 9 In contrast to the alcohol arena, little attention has been paid thus far to the potential utility of tobacco outlet regulation strategies as a supplement to existing tobacco control policies. The Family Smoking Prevention and Tobacco Control Act, signed into law in June 2009, greatly expands the federal government's ability to enact new public health policies related to tobacco sales in the United States. If one considers the success of alcohol outlet regulation strategies on curbing alcohol use, an increased understanding of the effects of tobacco retail outlets on smoking behaviors may provide direction to emerging tobacco control policies. Thus far, studies largely support associations between tobacco retail outlets and smoking behaviors. For example, the density of tobacco retail outlets around schools has been linked to adolescent smoking initiation 10 and purchasing habits. 11 Similarly, the density of tobacco outlets around the home, as well as the proximity of tobacco outlets to the home, has been associated with the number of cigarettes consumed per day among adult smokers. 12 In another study, greater smoker sensitivity to point-of-sale advertising at tobacco outlets predicted a reduced likelihood of having quit smoking 18 months later. 13 However, no previous studies have directly examined the effects of tobacco outlet density and proximity on smoking cessation during a specific quit attempt. The purpose of our study was to examine the effect of tobacco retail outlet density and proximity on smoking cessation among a racially/ethnically diverse group of smokers undergoing a specific quit attempt. We had two hypotheses. The first was that greater density of tobacco outlets around participants’ homes would be associated with lower odds of cessation. The second was that close residential proximity to a tobacco retail outlet would be associated with lower odds of cessation. All analyses controlled for participant demographics and tobacco-related variables. To our knowledge, this is the first study to examine the effects of tobacco retail outlets on a smoking quit attempt using a prospective, longitudinal design and biochemically verified smoking abstinence.
