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Smoking Highlights Health Disparities Among US Cities

MedicalResearch.com Interview with:

Eric Leas PhD, MPH Stanford Prevention Research Center University of California, San Diego

Dr. Leas

Eric Leas PhD, MPH
Stanford Prevention Research Center
University of California, San Diego

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent research has demonstrated the importance that neighborhood context has on life opportunity, health and well-being that can perpetuate across generations. A strongly defining factor that leads to differences in health outcomes across neighborhoods, such as differences in chronic disease, is the concurrent-uneven distribution of modifiable risk factors for chronic disease.

The main goal of our study was to characterize inequities in smoking, the leading risk factor for chronic disease, between neighborhoods in America’s 500 largest cities. To accomplish this aim we used first-of-its-kind data generated from the 500 Cities Project—a collaboration between Robert Wood Johnson Foundation and the US Centers for Disease Control and Prevention—representing the largest effort to provide small-area estimates of modifiable risk factors for chronic disease.

We found that inequities in smoking prevalence are greater within cities than between cities, are highest in the nation’s capital, and are linked to inequities in chronic disease outcomes. We also found that inequities in smoking were associated to inequities in neighborhood characteristics, including race, median household income and the number of tobacco retailers. 

MedicalResearch.com: What should readers take away from your report?

Response: The result shed light on the importance of tackling behavioral risk factors at the local-level and developing interventions that address health disparities. Strengthening existing tobacco control interventions, such as raising excise taxes and implementing cessation programs targeted to resource-poor communities, may aid in counteracting these inequities in smoking. Public health advocates and policy makers should consider inequities between neighborhoods when promoting local programs and designing policy solutions. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future researchers should study whether novel policies could counteract inequities. For instance, policies that restrict the retail environment (eg, by limiting the quantity, location, and type of tobacco retailers) show promise for reducing the unequal distribution of tobacco retailers and warrant further investigation.

MedicalResearch.com: Is there anything else you would like to add?

Response: Researchers interested in studying neighborhood inequities can access the latest release of the data we used in our study from the 500 cities project online: https://chronicdata.cdc.gov/500-Cities/500-Cities-Local-Data-for-Better-Health-2018-relea/6vp6-wxuq

I have no relevant financial disclosures to declare.


Leas EC, Schleicher NC, Prochaska JJ, Henriksen L. Place-Based Inequity in Smoking Prevalence in the Largest Cities in the United States. JAMA Intern Med. Published online January 07, 2019. doi:10.1001/jamainternmed.2018.5990


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Last Updated on January 11, 2019 by Marie Benz MD FAAD