Tobacco use causes nearly a half million premature deaths in the United States each year from cancer, cardiovascular disease and pulmonary illnesses. Most tobacco is purchased from brick-and-mortar retailers, where the tobacco industry spends $1 million every hour on advertising and marketing.
With the goal to help reduce tobacco use, tobacco-related disparities, and the public health burden of tobacco, including cancer, researchers at the University of North Carolina at Chapel Hill, Stanford University and Washington University in St. Louis are using a five-year, $11.6 million National Institutes of Health grant to launch Advancing Science & Practice in the Retail Environment (ASPiRE), a project to investigate tobacco policies and evaluate their effects on health across the United States.
Three innovative and complementary research projects will examine the role of the tobacco retail environment in promoting tobacco use and causing tobacco-related illnesses. Researchers will study how tobacco retailer density contributes to cigarette smoking and tobacco-related illnesses, evaluate the impact of local retail interventions on tobacco use and availability, and develop computational models to learn how changes in the built and consumer environment could lead to improved public health. A Community Advisory Board, whose members include tobacco control leaders from 30 large U.S. cities, and organizations such as the Campaign for Tobacco-Free Kids, will give input and guidance on what is most needed in their communities.
The principal investigators are Kurt M. Ribisl, chair and professor in the Department of Health Behavior at the UNC Gillings School of Global Public Health and program leader for Cancer Prevention and Control at the UNC Lineberger Comprehensive Cancer Center; Lisa Henriksen, senior research scientist at the Stanford Prevention Research Center in Palo Alto, California and a member of the Stanford Cancer Institute; and Douglas A. Luke, professor of public health at the Brown School at Washington University in St. Louis, and director of the Center for Public Health Systems Science.
The newly created research program builds on the 2009 Family Smoking Prevention and Tobacco Control Act, which gave states and localities more authority to regulate the sales and distribution of tobacco products in their communities. The rapid growth and spread of policies and interventions in the tobacco retail setting in the past nine years calls for systematic research to evaluate the efforts.
The ASPiRE group continues its “team science” approach, building on a strong, multidisciplinary 6-year collaboration that began in 2012 with funding from the National Cancer Institute’s State & Community Tobacco Control Initiative. “I am thrilled to be part of this dream team of scientists who will study how the retail environment affects tobacco use and identify promising solutions for communities,” said Ribisl. “Our center has expertise in behavioral science, epidemiology, public policy, and computational modeling. Retail is one of the hottest areas in tobacco control and we are eager to expand the evidence base in this important area.”
Results from three unique research projects will combine to advance the retail tobacco control evidence base. In the Density and Disease project, researchers at Carolina will map 275,000 tobacco retailers across the U.S. from 2000 to 2016 and explore the relationship between the density of these retailers and tobacco-related illness, like cancer.
“This will be a landmark study because it will finally sort out the relationship between the density of tobacco retailers, smoking prevalence, and disease,” said project lead Ribisl. “In areas with more tobacco retailers, do we eventually see higher smoking rates and higher cancer rates? We will examine nearly 15 years of data to figure that out. This is important because communities are starting to enact policies to reduce the number of tobacco retailers, and it is essential to understand whether that will reduce smoking rates as well as cancer and heart disease.”
Shelley Golden, assistant professor of Health Behavior at UNC Gillings, is co-leading the density and disease project with Ribisl. Project co-investigators are Christopher Baggett, assistant professor of Epidemiology and faculty director of the Cancer Information & Population Health Resource (CIPHR), David Richardson, associate professor of Epidemiology and Joseph Lee, formerly of Carolina and now an assistant professor of health education and promotion at Eastern Carolina University. Additional UNC-Chapel Hill personnel supporting the project are analysts Tara Queen, May Kuo, and Cearo Faulk; Sara Vandegrift, assistant project director; Sarah Mills, post-doctoral fellow, and graduate students Amanda Kong, Vivian Tao and Rakiah Anderson.
Researchers at Stanford will lead the Big City Tobacco Control project, which seeks to understand how the tobacco retail environment in a city may impede efforts at quitting smoking. This study will further evaluate the benefits of local policies to regulate and limit retail availability of tobacco. Stanford researchers will survey a panel of 2,400 adult smokers five times over 30 months and will examine changes over time.
“This is a collaborative effort with local tobacco control programs in 30 large cities,” said project lead Henriksen. “The cities are home to 1 in 6 U.S. residents. Our partners at the Public Health Law Center in Minnesota and Truth Initiative in Washington, D.C. will help us document how local policies change over time and enable us to study policy impact on retail availability and tobacco use, particularly menthol and other flavored products use in lower-income neighborhoods.”
Researchers at Washington University in St. Louis will direct the Tobacco Town project, which will use agent-based modeling to study innovative policies in the retail setting and their impact in different types of communities, especially those with low-income and minority populations. Data collected from the Big City Tobacco Control project will help inform model development for Tobacco Town by adding current and realistic tobacco use patterns and user behaviors.
“The Tobacco Town study is exciting because the computational models will be used to better understand how retail policies actually operate to improve community health,” said project lead Luke. “In turn, communities will learn how to tailor these policies to meet their particular tobacco control needs.”
In addition to three distinct synergistic research projects, the ASPiRE Center has three shared resource cores that will provide administrative, data and statistics, and dissemination and implementation support to extend the reach of the findings and improve synergy among the three projects.