A Penn State researcher testing a new way to assess tobacco use with a neighbourhood mapping platform and in-person interviews have found that community engagement is key to addressing risky health behaviours. Cigarette smoking remains the leading cause of preventable disease and death in the US, and smoking-related illness costs more than $300 billion each year.
‘While there is an extensive literature on neighbourhoods and health, substance-use behaviour has not typically been explored thoroughly,’ said Louisa Holmes, assistant professor of geography. ‘What we do know is that the tobacco industry targets neighbourhoods with higher concentrations of Black, Latino and low-income residents for marketing and promotion and that there are persistent disparities in tobacco use and cessation between neighbourhoods.’
Holmes collaborated with colleagues at the University of California San Francisco and Streetwyze Inc. to conduct a pilot study using a new web-based mapping platform to explore issues of neighbourhood equity and tobacco use behaviour.
‘Collecting data on product availability, pricing, and advertising from area tobacco retailers allows us to investigate how these differ across neighbourhoods, and the interviews add needed context to the retail data,’ Holmes said. ‘For example, health researchers tend to view convenience stores as a net negative because of their heavy concentration in less advantaged neighbourhoods and their access o unhealthy food and tobacco and alcohol.’
‘However, participants in our study reported that some tobacco retailers also added community value, as they were places of social interaction and sources for products not readily available elsewhere in that neighbourhood.’
Holmes said: ‘Mixed-methods approach using quantitative data collection, in-depth geographically explicit interviews, and neighbourhood-level maps help understand the complexities of human behaviour around tobacco use. ‘To understand reasons for health-related behaviours, individual thought processes and choices, and how people view and interact with their environments beyond trends, we have to talk to them,’ Holmes said.
‘While the quantitative side of the research shows that wealthy neighbourhoods tend to have fewer tobacco retailers, higher tobacco prices and healthier food choices compared to lower-income neighbourhoods that have more tobacco retailers, lower tobacco prices and unhealthy food choices, the qualitative side allows the residents to interpret what those differences mean in everyday life and how they may drive behaviour.’
‘What this might mean for policy is that it’s important to cultivate public spaces of positive social interaction in neighbourhoods, but this can be done in various ways that do not also require sales of tobacco and unhealthy foods,’ Holmes said. ‘For example, efforts like the Tenderloin Healthy Corner Store Initiative in San Francisco and the Healthy Corner Store Initiative in Philadelphia aim to transform convenience stores like those mentioned by our participants into affordable healthy options for neighbourhoods rather than eliminating them.’
Holmes said: ‘I hope the methods used in her pilot study can be refined and applied to other health topics. The essential framework of the study is to gain multi-layered information in local contexts, including broader population and environmental trends as well as narratives of the lived experiences of people interacting in those environments daily, to paint as comprehensive a picture as possible of how facets of neighbourhood life contribute to whatever the outcome of interest may be. For this study, we looked at tobacco, but given the right data, any number of other topics, such as food environments, could benefit from this approach as well.’