The Impact of Tobacco Control Policies on Health Equity in the United States

烟草控制政策对美国健康公平的影响

• 批准号: 10047448
• 负责人: Nancy Fleischer
• 金额: $ 5.48万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-19 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10047448
• 关键词: Address; Adoption; Adult; Affect; Canada; Data; Data Sources; Development; Education; Environment; Ethnic Origin; Evaluation; Family; Future; Gender; Health; Health Professional; Hispanics; Incidence; Income; Individual; Investments; Knowledge; Label; Malignant neoplasm of lung; Mass Media; Media Campaign; Mind; Modeling; Monitor; National Cancer Institute; Not Hispanic or Latino; Outcome; Policies; Policy Maker; Population; Public Health; Race; Research; Sales; Smoke; Smoking; Socioeconomic Status; Subgroup; Surveys; Taxation; Testing; Time; Tobacco; Tobacco Control Research; Tobacco use; United States; Variant; Workplace; Youth; attributable mortality; comparative; design; ethnic minority population; evidence base; health disparity; health equity; low socioeconomic status; models and simulation; mortality; movie; named group; population based; population survey; prospective; public policy on tobacco; racial and ethnic; smoke-free policy; smoking cessation; smoking prevalence; sociodemographics; socioeconomic disparity; success; time use

Project Summary Abstract Since the mid-1900s, tobacco control policies have effectively decreased smoking prevalence in the United States. However, important disparities by socioeconomic status (SES) and race/ethnicity in smoking prevalence and tobacco-related health outcomes persist. People with relatively lower education and income are more likely to smoke than their more affluent counterparts. In addition, although non-Hispanic Blacks and non-Hispanic Whites have a similar prevalence of smoking, Blacks have lower quit rates and higher lung cancer incidence and mortality than Whites. Hispanics, on the other hand, smoke less than Blacks or Whites. This suggests that current tobacco control policies do not adequately reduce, let alone eliminate, smoking disparities in vulnerable subgroups. However, few policy evaluations address smoking disparities, and the effects of policies across different SES and racial/ethnic subgroups are mostly unknown. Moreover, tobacco control policies are generally designed with broad populations in mind, without a focus on reducing the prevalence of smoking among specific populations. As a consequence, some policies may actually be exacerbating smoking disparities, even if their net population effect is positive. The objective of this study is to determine the health equity impact of established and emerging tobacco control policies in the US. The proposed project will: (1) determine how tobacco control policies influence disparities in smoking initiation among youth; (2) determine how tobacco control policies influence disparities in smoking cessation among adults; and (3) predict which combination of policies are needed to reduce health disparities in tobacco- attributable mortality over time using a tobacco policy simulation model. Aims 1 and 2 will systematically analyze two large, nationally-representative surveys over time to determine the extent to which tobacco control policies in the US affect disparities for smoking initiation and cessation, focusing on the differential impact of policies by education, income, and race/ethnicity (i.e., Whites, Blacks, Hispanics), and their possible intersection with gender. Aim 3 will integrate the evidence developed in Aims 1 and 2 into a simulation model to predict how policies, individually and in combination, will affect smoking disparities and future downstream tobacco-attributable deaths. The proposed study will take the field beyond describing smoking disparities to producing concrete, actionable evidence informing which tobacco control policies may be most effective in simultaneously reducing both overall smoking and tobacco-related health disparities. Knowledge gained from this study will guide policy-makers’ decisions regarding implementation of specific tobacco control policies by highlighting the importance of considering their contribution to tobacco-related health disparities.

项目摘要摘要 自1900年代中期以来，烟草控制政策有效地降低了曼联的吸烟率 国家。但是，通过社会经济地位（SES）和种族/种族在吸烟中进行的重要分布 患病率和与烟草有关的健康结果持续存在。受教育和收入相对较低的人 比他们情感更具情感的对应物更有可能吸烟。此外，尽管非西班牙裔黑人和 非西班牙裔白人的吸烟率相似，黑人的戒烟率较低，肺部较高 癌症的发病率和死亡率比白人。另一方面，西班牙裔烟雾少于黑人或白人。 这表明当前的烟草控制政策不能充分减少，更不用说消除吸烟了 弱势子组的差异。但是，很少有政策评估解决吸烟差异，以及 政策在不同的SES和种族/种族亚组中的影响大多是未知的。而且，烟草 控制政策通常考虑到广泛的人群，而无需关注减少 特定人群中吸烟的患病率。结果，某些政策实际上可能是 即使吸烟差异为阳性，也会加剧吸烟差异。这项研究的目的是 确定美国已建立和新兴的烟草控制政策的健康公平影响。 拟议的项目将：（1）确定烟草控制政策如何影响吸烟开始的分布 在青年中； （2）确定烟草控制政策如何影响戒烟的分布 成年人; （3）预测需要哪些政策组合来减少烟草中的健康差异 使用烟草政策模拟模型随着时间的推移而归因的死亡率。目标1和2将系统地 随着时间的流逝，分析两项大型全国代表性调查，以确定烟草控制的程度 美国的政策会影响分配吸烟和停止，重点是 教育，收入和种族/种族的政策（即白人，黑人，西班牙裔）及其可能 与性别的交集。 AIM 3将将目标1和2中的证据集成到模拟模型中 为了预测政策如何单独和结合，将如何影响吸烟差距和未来下游 烟草可死亡。拟议的研究将使该领域超越描述吸烟差异 生成具体的可行证据，告知哪些烟草控制政策可能最有效 同样减少了整体吸烟和与烟草有关的健康分布。从中获得的知识 这项研究将指导决策者对实施特定烟草控制政策的决定 强调考虑它们对与烟草相关的健康分配的贡献的重要性。