title: The impact of the tobacco retail outlet environment on adult cessation and differences by neighborhood poverty.
abstract: OBJECTIVE
  This study examined the impact of tobacco retail outlets on cessation outcomes over time among non-treatment-seeking smokers and assessed differences by neighborhood poverty and individual factors.
  
  
  METHODS
  Observational longitudinal cohort study using geospatial data. We used generalized estimating equations to examine cessation outcomes in relation to the proximity and density of tobacco retail outlets near the home.
  
  
  METHODS
  Eight large Designated Media Areas across the United States.
  
  
  METHODS
  A total of 2377 baseline smokers followed over three waves from 2008 to 2010.
  
  
  METHODS
  Outlet addresses were identified through North American Industry Classification System codes and proximity and density measures were constructed for each participant at each wave. Outcomes included past 30-day abstinence and pro-cessation attitudes.
  
  
  RESULTS
  Smokers in high poverty census tracts living between 500 m and 1.9 km from an outlet were over two times more likely to be abstinent than those living fewer than 500 m from an outlet (P < 0.05). Density within 500 m of home was associated with reduced abstinence [odds ratio (OR) = 0.94; confidence interval (CI) = 0.90, 0.98) and lower pro-cessation attitudes (Coeff = -0.07, CI = -0.10, -0.03) only in high poverty areas. In low poverty areas, density within 500 m was associated with greater pro-cessation attitudes (OR = 0.06; CI = 0.01, 0.12). Gender, education and heaviness of smoking did not moderate the impact of outlet proximity and density on cessation outcomes.
  
  
  CONCLUSIONS
  In the United States, density of tobacco outlets within 500 m of the home residence appears to be negatively associated with smoking abstinence and pro-cessation attitudes only in poor areas.
authors.affiliation: Department of Research and Evaluation, Legacy, Washington, DC, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cantrell
authors.forename: Andrew
authors.initials: A
authors.lastname: Anesetti-Rothermel
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pearson
authors.forename: Haijun
authors.initials: H
authors.lastname: Xiao
authors.forename: Donna
authors.initials: D
authors.lastname: Vallone
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Kirchner
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003132:Commerce; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D011204:Poverty Areas; D012111:Residence Characteristics / Q000706:statistics & numerical data; D016540:Smoking Cessation / Q000191:economics / Q000706:statistics & numerical data*; D062789:Tobacco Products / Q000191:economics*; D014481:United States; D055815:Young Adult
keywords: Density; marketing; neighborhood; point of sale; poverty; retail; smoking; socioeconomic status; tobacco; tobacco industry