Association Between Tobacco Retailer Density and Smoking Among Adults With Diabetes and Serious Mental Illness in New York State.

INTRODUCTION: Smoking prevalence is high among adults with comorbid diabetes and serious mental illness. This population is at elevated risk of smoking-related health consequences and premature death. We focused on the community environment and investigated the association between tobacco retailer density and smoking in this population. METHODS: We obtained individual-level data from the 2017 Patient Characteristics Survey, a medical record-based survey of patients served by the public mental health system in New York State. We computed the density of state-authorized tobacco retailers at the 3-digit zip code level. RESULTS: The data included 19,492 adults (aged ≥18) with comorbid diabetes and serious mental illness. Of these, 55.6% resided in New York City, 53.1% were female, 38.1% were non-Hispanic White, 30.7% were non-Hispanic Black, 25.2% were Hispanic, and 38.1% were smokers, including electronic cigarette users. The density of tobacco retailers (range, 6.1-16.4 per 10,000 population) was positively associated with smoking (odds ratio = 1.05; 95% CI, 1.03-1.07) after adjusting for sex, race or ethnicity, education, employment, health insurance coverage, obesity, and region (New York City vs outside New York City). We observed no interaction between region and tobacco retailer density. CONCLUSION: Findings of this study suggest that allocating more smoking cessation resources to zip code areas with a high density of tobacco retailers, especially in rural areas, along with supporting policy change to reduce tobacco retailor density, may mitigate the negative health consequences of smoking among people with comorbid diabetes and serious mental illness.

Everyday Discrimination Experience and Depressive Symptoms in Urban Black, Guyanese, Hispanic, and White Adults.

BACKGROUND: Discrimination experience is a stressor that may disproportionately affect the mental health of minority populations. AIMS: We examined the association between discrimination experience and depressive symptoms among four urban racial/ethnic groups. METHOD: Cross-sectional community-based health survey data for Black (n = 434), Guyanese (n = 180), Hispanic (n = 173), and White (n = 809) adults aged ⩾18 years were collected in Schenectady, New York, in 2013. Discrimination experience was measured with the Everyday Discrimination Scale (EDS), and depressive symptoms were measured with the Center for Epidemiologic Studies-Depression (CES-D) scale. Logistic regression models for the association between EDS and major depressive symptoms (CES-D ⩾ 16) were fitted for each racial/ethnic group. The final model adjusted for age, sex, education, income, smoking, alcohol binge drinking, emotional/social support, and perceived stress. RESULTS: The mean EDS scores varied significantly across groups (p < .001), with 2.6 in Hispanics, 2.2 in Whites, 2.0 in Blacks, and 1.1 in the Guyanese. There was a consistent and significant independent association between EDS and major depressive symptoms in the crude model and at each step of covariate adjustment in each group. Fully adjusted odds ratios were 1.28 (95% confidence interval [CI; 1.16, 1.41]) in Blacks, 1.83 in the Guyanese [1.36, 2.47], 1.23 in Hispanics [1.07, 1.41], and 1.24 [1.16, 1.33] in Whites. The presence of covariates did not significantly modify the main effect in each group. CONCLUSIONS: This study suggests that discrimination experience can be one of the fundamental social causes of depression. It may be feasible to assess discrimination experience as a risk factor of depression in individuals of all racial/ethnic backgrounds.

Longitudinal Trends in Tobacco Availability, Tobacco Advertising, and Ownership Changes of Food Stores, Albany, New York, 2003-2015.

INTRODUCTION: Frequency of visiting convenience and corner grocery stores that sell tobacco is positively associated with the odds of ever smoking and the risk of smoking initiation among youth. We assessed 12-year trends of tobacco availability, tobacco advertising, and ownership changes in various food stores in Albany, New York. METHODS: Eligible stores were identified by multiple government lists and community canvassing in 2003 (n = 107), 2009 (n = 117), 2012 (n = 135), and 2015 (n = 137). Tobacco availability (all years) and advertising (2009, 2012, and 2015) were directly measured; electronic cigarettes (e-cigarettes) were included in 2015. RESULTS: Percentage of stores selling tobacco peaked at 83.8% in 2009 and declined to 74.5% in 2015 (P for trend = .11). E-cigarettes were sold by 63.7% of tobacco retailers. The largest decline in tobacco availability came from convenience stores that went out of business (n = 11), followed by pharmacies that dropped tobacco sales (n = 4). The gain of tobacco availability mostly came from new convenience stores (n = 24) and new dollar stores (n = 8). Significant declining trends (P < .01) were found in tobacco availability and any tobacco advertising in pharmacies and in low (<3 feet) tobacco advertising in convenience stores and stores overall. Only one-third of stores that sold tobacco in 2003 continued to sell tobacco with the same owner in 2015. CONCLUSION: The observed subtle declines in tobacco availability and advertising were explained in part by local tobacco control efforts, the pharmacy industry's self-regulation of tobacco sales, and an increase in the state's tobacco retailer registration fee. Nonetheless, overall tobacco availability remained high (>16 retailers per 10,000 population) in this community. The high store ownership turnover rate suggests that a moratorium of new tobacco retailer registrations would be an integral part of a multi-prong policy strategy to reduce tobacco availability and advertising.

Trends of fruit and vegetable availability in neighbourhoods in Albany, NY, USA, 2003-2012.

OBJECTIVE: To investigate a 9-year trend of fresh fruit and vegetable availability and factors associated with the net availability change in two contrasting neighbourhoods. DESIGN: Longitudinal design. Data were collected in 2003, 2009 and 2012 through in-store observations. Fresh fruit and vegetable availability was presented by weight-adjusted counts of stores having designated varieties per 10 000 population. SETTING: A low-income minority neighbourhood and an adjacent middle-income racially mixed neighbourhood in Albany, NY, USA. These neighbourhoods became sites of fresh produce interventions after baseline data were collected. SUBJECTS: A total of 111, 128 and 146 eligible food stores in respective years. RESULTS: Fresh fruit availability (two or more varieties) increased in both neighbourhoods. Inventory expansion of existing stores and the convenience store intervention contributed to the significant increase (P for trend=0·04) of fresh fruit availability in the minority neighbourhood. Although not statistically significant (P>0·05), the availability of two or more dark-coloured fresh vegetables also increased in the mixed neighbourhood, but declined slightly in the minority neighbourhood. The secular (non-intervention) fresh vegetable availability rate ratio by neighbourhood reached 3·0 in 2012 (P<0·01). The net decline of fresh vegetable availability in the minority neighbourhood was primarily attributed to inventory reduction of existing stores. CONCLUSIONS: Longitudinal observations revealed narrowed neighbourhood disparities of fresh fruit availability and widened gaps of fresh vegetable availability. Inventory shifts of existing stores impacted the net availability change more profoundly than store opening or closing in the minority neighbourhood. Findings support increasing the programme capacity of the convenience store intervention to address the fresh vegetable disparity.

A Comprehensive Health Profile of Guyanese Immigrants Aged 18-64 in Schenectady, New York.

Guyanese immigrants are the 5th largest foreign-born group in NY State, but sparse literature is available on their health status and health needs. A community-based health interview survey of Schenectady NY residents aged 18-64 (N = 1861) was analyzed. Bivariate comparisons between Guyanese respondents and White, Black, and Hispanic respondents were made for each variable to identify disparities. As predominantly low SES immigrants, Guyanese adults were less likely to be covered by health insurance, have a usual place for care, and receive cancer screenings. They were more likely to engage in alcohol binge drinking, but generally in good overall physical and mental health and less likely to smoke or report disability. Stable family structure and supportive interpersonal relationships are major assets of this group. Improved access to affordable health insurance, linkages to primary care, targeted cancer screening programs, and culturally-sensitive behavioral health services are recommended for Guyanese immigrants.

The association between antidepressant use and glycemic control in the Southern Community Cohort Study (SCCS).

INTRODUCTION: Among people with diabetes, comorbid depression has been associated with suboptimal health outcomes. However, the independent impact of antidepressant use on glycemic control (A1C) has not been well understood. RESEARCH DESIGN AND METHODS: The Southern Community Cohort Study collected self-reported antidepressant use and measured continuous A1C in a sample of racially diverse adults with and without diabetes who visited community health clinics serving low-income families in the southeastern United States (N=2445). Crude and adjusted linear regression models were used to examine the relationships between using specific antidepressant subclasses and continuous A1C. RESULTS: Although use of any single antidepressant subclass was not a significant predictor of A1C level, there was a significant association between using multiple antidepressant subclasses and higher A1C, specifically among individuals with diabetes (standardized effect size=.12, p=.04). CONCLUSION: Among adults with diabetes, the use of multiple antidepressant subclasses may be a risk factor for suboptimal glycemic control. Prospective studies are needed to confirm the direction of this observation, as the present study was limited by a cross-sectional design and small sample size.