2012 MD Anderson Summer Exposition The Influence of Tobacco Retail Outlets on Smoking Urges Among Economically Disadvantaged Participants Enrolled in a Smoking Cessation Program

1. Title of the Poster Presentation Goes Here
Authors of the Poster Presentation Goes Here
Institutional and/or Graduate School of Biomedical Sciences Affiliation Goes Here
The Influence of Tobacco Retail Outlets on Smoking Urges Among Economically
Disadvantaged Participants Enrolled in a Smoking Cessation Program
Kellie L. Watkins MS1, Seann D. Regan MA1, Nga Nyugen MS1, Michael S. Businelle PhD2,4, Darla E. Kendzor PhD2,4, Yumei Cao MS1
Adolfo G. Cuevas MS1, Insiya B. Poonawalla MS3, Erica Cuate MPH3, Anshula Kesh BA3, David Balis MD3,5, & Lorraine R. Reitzel PhD1
1 UT MD Anderson Cancer Center, Department of Health Disparities Research, 2 UT School of Public Health, 3 UT Southwestern Medical Center,
4 Harold C. Simmons Comprehensive Cancer Center, 5 Parkland Health and Hospital System
Background
• Visual cues, like cigarette marketing, may trigger the
urge to smoke.
• The presence of neighborhood tobacco retail outlets is
associated with smoking prevalence, rates, and cessation
which suggests that they may trigger smoking urges, in
part due to associated cigarette marketing.
• The “real-time” associations of tobacco retail outlet
locations and smoking urges have not been previously
examined.
Study Aims
Using smartphone collected participant location data and
real-time Ecological Momentary Assessment (EMA) urge
data, our aim was to examine associations between the
location of tobacco retail outlets and smoking urges, both
before and after a quit attempt, among participants enrolled
in a smoking cessation program .
Hypothesis 1: Closer participant proximity to tobacco retail
outlets during random assessments is associated with
stronger urges to smoke.
Hypothesis 2: A higher density of tobacco retail outlets
around the participant during random assessments is
associated with stronger urges to smoke.
Study Methods
• Participants (N=55) were enrolled in a smoking cessation
program at the Parkland Hospital System in Dallas,
Texas. Data collection spanned pre-quit (1 week prior to
quit attempt) and post-quit (1 week following quit day)
periods.
• EMA urge data were collected via smartphone, which
prompted participants to record their smoking urges
during four random assessments per day.
• Participant location data (latitude and longitude
coordinates) were collected at each random assessment.
• Urge was assessed using the item: “Right now, I have an
urge to smoke.” Responses were measured on a scale
of 1 (strongly disagree) through 5 (strongly agree).
Data Analysis
• Associations between tobacco retail outlet proximity/density and smoking urges were examined using multilevel
generalized linear regression models.
• Pre-quit analyses were adjusted for tobacco dependence (the Heaviness of Smoking Index). Post-quit analyses were
adjusted for daily smoking status (abstinent/relapsed). All analyses controlled for sociodemographic variables (age,
gender, employment, race, partner status, education) and treatment group (see Table I).
• EMA compliance was 70.22% for the pre-quit period and 79.48% for the post-quit period. 19% (N =262) of these pre-
quit and 18% (N =291) of these post-quit assessments had valid GPS coordinates.
• There were no significant differences between participants missing GPS coordinates versus participants with GPS
coordinates.
Figure I. Proximity of Participants to Tobacco Outlets Figure II. Tobacco Outlet Density and Participant Location
Proximity Density
Results
Hypothesis 1 - Proximity: Closer proximity to tobacco retail
outlets was marginally predictive of stronger urges to smoke
during the pre-quit period (β=-0.4499, SE=0.2361, p=0.0580).
Relationships were not significant during the post-quit period
(β=-0.1558, SE=0.1791, p=0.3854).
Hypothesis 2 - Density: The density of tobacco retail outlets did
not predict smoking urges during either the pre-quit period
(β=-0.0003, SE=0.0081, p=0.9715) or the post-quit period
(β=-0.0010, SE=0.0069, p=0.8805).
Conclusions
• Results suggest that a closer proximity to tobacco outlets is
associated with a stronger urge to smoke among lower-income
treatment seeking smokers who are about to quit.
• Proximity to tobacco outlets may serve as a cue for smoking,
perhaps via exposure to cigarette marketing, possibly because
smokers experience greater susceptibility to smoking cues
when they are anticipating an upcoming period of abstinence.
• Smokers may want to avoid tobacco outlets and other smoking
cues before quitting since greater urges might derail the quit
attempt.
• A high density of tobacco outlets may not necessarily
correspond with a smoker’s awareness of their location;
therefore the urge to smoke is not triggered.
Funding for this research was provided by the University of Texas Health Science Center, School of Public Health (PIs: Businelle & Kendzor). Data analysis and presentation preparation were additionally supported through grant MRSGT-10-104-01-CPHPS (PI: Kendzor) and MRSGT-12-114-01-CPPB (PI Businelle) awarded by the American Cancer Society. Further, this research was supported in
part by a cancer prevention fellowship supported by the National Cancer Institute grant R25E CA56452 (PI: Chang). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the sponsoring organizations. The authors appreciate the contributions of all research and support staff at affiliated institutions.
Geographic Information Systems (GIS) Methods
1. Locations of cigarette retail outlets (N=6770) were extracted from the Texas Comptroller of Public Accounts for the
sixteen Dallas-Ft. Worth Counties. Cigarette retail outlet locations were geocoded using the North America Geocode
Service.
2. Proximity was obtained using the Incidence to Facility measurement. The shortest travel time, in miles, via roads from
the GPS coordinate location of each urge assessment to the closest tobacco retail outlet was calculated (see Figure I).
3. A density layer was obtained using Kernel Density 1 mile buffer around tobacco retail outlets. Participants were given a
value for tobacco retail outlet density at each urge assessment based on their GPS coordinate location (see Figure II).
* Real participant data are not displayed * Real participant data are not displayed
Covariate Mean (SD)/Percentage Total N
Age (years) 52.5 (7.5) 55
Gender
Male
Female
43.6%
56.4%
24
31
Employment
Employed
Unemployed
Unable/Disabled
12.7%
40.0%
47.3%
7
22
26
Race
White
Non-White
34.5%
65.5%
19
36
Partner/Spouse
No
Yes
49.1%
50.9%
27
28
Education
High School or Less
Greater than High School
50.9%
49.1%
28
27
Treatment Group
Usual Care
Contingency Management
45.5%
54.5%
25
30
Table I. Participant Demographics at Baseline