Social and Physical Environmental Characteristics Associated With Adult Current Cigarette Smoking

Social and Physical Environmental Characteristics Associated With Adult Current Cigarette Smoking

ORIGINAL RESEARCH — Volume 16 — June 6, 2019

Ralph S. Caraballo, PhD1; Ketra L. Rice, PhD1; Linda J. Neff, PhD1; Bridgette E. Garrett, PhD1 (View author affiliations)

Suggested citation for this article: Caraballo RS, Rice KL, Neff LJ, Garrett BE. Social and Physical Environmental Characteristics Associated With Adult Current Cigarette Smoking. Prev Chronic Dis 2019;16:180373. DOI: http://dx.doi.org/10.5888/pcd16.180373external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables
• Appendix

Summary

What is already known on this topic?

International studies show that place-based characteristics (social and physical environment) are associated with cigarette smoking. However, limited data are available about whether place-based characteristics are associated with cigarette smoking among US adults.

What is added by this report?

Of 7 metropolitan county characteristics studied, 3 (counties with a high proportion of non-Hispanic white adults, lower education levels, and high violent crime rates) had a higher smoking prevalence than their counterpart metropolitan counties.

What are the implications for public health practice?

Findings from this study highlight the need for more novel approaches, such as collaborations between tobacco use prevention and control organizations and crime prevention entities, when addressing tobacco-related disparities.

Abstract

Introduction

Our objective was to identify social and physical environmental factors associated with current cigarette smoking among adults by metropolitan county in the United States.

Methods

We linked cigarette smoking data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) Selected Metropolitan Area Risk Trends (SMART) data set to 7 social and physical environmental characteristics: county type (metropolitan designation), primary care physician density, income inequality, percentage of the population that was a racial/ethnic minority, violent crime rate, education, and percentage of county residents with low income and no health insurance, all obtained from several county data sets. Spatial regression and hierarchical logistic regression modeling were performed.

Results

Results showed that metropolitan counties with a high proportion of non-Hispanic white adults (P < .001), lower education levels (high school graduate or less) (P < .001), and high violent crime rates (P < .001) had a higher adult cigarette smoking prevalence than other metropolitan counties. Spatial models showed 63.3% of the variability in county cigarette smoking prevalence was explained by these 3 factors as well as county type (based on population size of the of metropolitan area), primary care physician density, and percentage of county residents with low income and no health insurance. At an individual level, results showed that as the density (population) of primary care physicians increased in a county, the odds of being a current smoker decreased (OR, 0.980; P = .02).

Conclusion

We found a significant association between adult cigarette smoking and county social and physical environmental factors. These place-based factors, especially social environmental characteristics, may reveal tobacco-related disparities to be considered when developing strategies to reduce tobacco use.