Tobacco and Alcohol Retailer Availability and Neighborhood Racialized, Economic, and Racialized Economic Segregation in North Carolina.

BACKGROUND: Despite evidence of racialized and socioeconomic inequities in tobacco and alcohol outlet availability, few studies have investigated spatial inequities in areas experiencing both concentrated residential racialized segregation and socioeconomic disadvantage. This study examined whether segregation-racialized, economic or both-was associated with alcohol and tobacco retailer counts in North Carolina (NC). METHODS: The NC Alcoholic Beverage Control Commission provided lists of 2021 off-premise alcohol retailers. We created a list of 2018 probable tobacco retailers using ReferenceUSA. We calculated three census tract-level measures of the Index of Concentrations at the Extremes (ICE), indicating racialized segregation between non-Hispanic White and Black residents and economic segregation based on household income. We used negative binomial regression to test associations between quintiles of each ICE measure and tobacco and, separately, alcohol retailer counts. RESULTS: Tracts with the greatest racialized disadvantage had 38% (IRR, 1.38; 95% CI, 1.15-1.66) and 65% (IRR, 1.65; 95% CI, 1.34-2.04) more tobacco and alcohol outlets, respectively, as tracts with the lowest. Tracts with the highest racialized economic disadvantage had a predicted count of 1.51 tobacco outlets per 1000 people while those in the lowest had nearly one fewer predicted outlet. Similar inequities existed in the predicted count of alcohol outlets. DISCUSSION: Tobacco and alcohol outlet availability are higher in NC places experiencing concentrated racialized and economic segregation. A centralized agency overseeing tobacco and alcohol outlet permits and strategies to reduce the retail availability of these harmful products (e.g., capping the number of permits) are needed to intervene upon these inequities.

What Anansi Did for Us: Storytelling's Value in Equitably Exploring Public Health.

There is growing implementation of storytelling as a specific application of narrative in public health. As the field's latest epoch evolves to consider cultural determinants, reimagination of how scientists conceptualize, operationalize, and capture populations' unique elements is necessary, and storytelling provides a genuine and efficacious methodology that can assist with that reimagination. Professionals are creating more spaces that demonstrate how storytelling elucidates, promotes, and supports contextual factors that are not captured by orthodox methodologies. However, more opportunities are needed to exhibit storytelling's impact on capturing the nuances in human experiences, such as those of historically and systemically underrepresented populations. This study synthesizes the past decade of research in public health and related fields that primarily utilized storytelling and reports significant implications. Additionally, this study highlights explorations in public health that primarily use storytelling as a research and practice approach. Each case study includes a description of the background and aims, elaborates on storytelling's utilization, and discusses findings, observations, and future directions. Finally, this study discusses conceptual issues in public health raised by use of storytelling, such as how to best capture impact on human beings and the importance of context. This article's goal is to present current evidence of critical reevaluations to the epistemological, conceptual, and practical paradigms within public health through storytelling. Additionally, this article aims to provide support and empowerment to public health scientists considering creative approaches to better acknowledge and appreciate humanity's inherent subjectivity.

Black, white, or green? The effects of racial composition and socioeconomic status on neighborhood-level tobacco outlet density.

Objective: To compare predominantly-Black and predominantly-White Maryland areas with similar socioeconomic status to examine the role of both race and socioeconomic status on tobacco outlet availability and tobacco outlet access.Design: Maryland tobacco outlet addresses were geocoded with 2011-2015 American Community Survey sociodemographic data. Two-sample t-tests were conducted comparing the mean values of sociodemographic variables and tobacco outlet density per Census Tract, and spatial lag based regression models were conducted to analyze the direct association between covariables and tobacco outlet density while accounting for spatial dependence between and within jurisdictions.Results: Predominantly-White jurisdictions had lower tobacco outlet availability and access than predominantly-Black jurisdictions, despite similar socioeconomic status. Spatial lag model results showed that median household income and vacant houses had consistent associations with tobacco outlet density across most of the jurisdictions analyzed, and place-based spatial lag models showed direct associations between predominantly-Black jurisdictions and tobacco outlet availability and access.Conclusion: Predominantly-White areas have lower levels of tobacco outlet density than predominantly-Black areas, despite both areas having similar socioeconomic statuses.

Overcoming Barriers to Sustaining Health Equity Interventions: Insights from the National Institutes of Health Centers for Population Health and Health Disparities.

We conducted qualitative semi-structured telephone interviews with the directors of the 10 National Institutes of Health Centers for Population Health and Health Disparities (NIH/CPHHD) to identify factors that were associated with the sustainability of 19 interventions developed to address cancer disparities and 17 interventions developed to address cardiovascular disease disparities in the United States. Interview transcripts were analyzed using the constant comparative method of analysis to identify key themes and synthesize findings. Directors at NIH/CPHHD reported that barriers to sustainability included uncertainty about future funding and insufficient resources to build and maintain diverse stakeholder partnerships. Strategies that helped to overcome these barriers included developing and engaging community partnerships with health care systems; early pursuit of multiple funding sources; and investments in infrastructure to address the social determinants of health. Sustainability planning should be incorporated during the early stages of intervention development to facilitate maintenance of successful programs that address health disparities.

Does Tobacco Outlet Inequality Extend to High-White Mid-Atlantic Jurisdictions? A Study of Socioeconomic Status and Density.

Tobacco outlet density research has evolved to require a more refined examination of socioeconomic status' influence beyond median household income. This study investigates the effects of SES on census-tract-level tobacco outlet density in five predominantly White Maryland jurisdictions. Tobacco license addresses and demographic data were analyzed via t tests and spatial lag modeling. Results showed that higher SES jurisdictions had lower tobacco outlet density than lower SES jurisdictions despite similar White populations and that median household income had consistent associations with tobacco outlet density. This study corroborates findings that differences in SES correlate with differences in tobacco outlet density between racially similar areas.

E-Cigarettes in Baltimore Alcohol Outlets: Geographic and Demographic Correlates of Availability.

There is limited research on e-cigarette availability despite increased use. E-cigarette availability within Baltimore alcohol outlets was analyzed for disparities among residential neighborhoods. Data were obtained via field surveys of alcohol outlets, and then spatially merged with sociodemographic data; 18.8% of alcohol outlets had any e-cigarette availability. Regression models showed greater odds ratios for e-cigarette availability when cigarettes, cigars, or hookah paraphernalia were sold, and lower odds ratios when alcohol outlets had an on-site consumption license. Outlets with e-cigarette availability were in predominantly lower-income, nonwhite neighborhoods. It is important to assess exposure of another potentially damaging substance among perpetually disadvantaged populations.

Racial Disparity in Time Between First Diagnosis and Initial Treatment of Prostate Cancer.

BACKGROUND: Disparities among patients with prostate cancer exist across the continuum of care. The interval of time that lapses between first diagnosis and treatment is another disparity that may exist but has not been fully explored. METHODS: Our study looked at the data of 749 men (353 black and 396 white) who were 40 to 81 years of age when they entered the North Carolina Central Cancer Registry during the years 2007 and 2008. Our dependent variable was the amount of months that had passed between first diagnosis and treatment. Our main independent variable was self-reported race. Covariates included age, income, level of education, insurance status, treatment received, Gleason score, and level of medical mistrust. We used negative binomial regression analysis to determine the association between the amount of time that lapsed between a diagnosis of prostate cancer and treatment by race. RESULTS: Compared with white men, black men were more likely to experience a longer wait time between diagnosis and treatment of prostate cancer (incidence rate ratio [IRR] 1.19; 95% confidence interval [CI], 1.04-1.36). Controls for demographical, clinical, and psychosocial variables (IRR 1.24; 95% CI, 1.04-1.43) did not explain this difference between the races. CONCLUSIONS: These results suggest that the amount of time that lapses between first diagnosis and treatment of prostate cancer is longer for black men compared with white men. Our findings have identified an underreported racial disparity in the disease continuum of prostate cancer.

Not in My Back Yard: A Comparative Analysis of Crime Around Publicly Funded Drug Treatment Centers, Liquor Stores, Convenience Stores, and Corner Stores in One Mid-Atlantic City.

OBJECTIVE: This research examined whether publicly funded drug treatment centers (DTCs) were associated with violent crime in excess of the violence happening around other commercial businesses. METHOD: Violent crime data and locations of community entities were geocoded and mapped. DTCs and other retail outlets were matched based on a Neighborhood Disadvantage score at the census tract level. Street network buffers ranging from 100 to 1,400 feet were placed around each location. Negative binomial regression models were used to estimate the relationship between the count of violent crimes and the distance from each business type. RESULTS: Compared with the mean count of violent crime around drug treatment centers, the mean count of violent crime (M = 2.87) was significantly higher around liquor stores (M = 3.98; t test; p < .01) and corner stores (M = 3.78; t test; p < .01), and there was no statistically significant difference between the count around convenience stores (M = 2.65; t test; p = .32). In the adjusted negative binomial regression models, there was a negative and significant relationship between the count of violent crime and the distance from drug treatment centers (ß = -.069, p < .01), liquor stores (ß = -.081, p < .01), corner stores (ß = -.116, p < .01), and convenience stores (ß = -.154, p < .01). CONCLUSIONS: Violent crime associated with drug treatment centers is similar to that associated with liquor stores and is less frequent than that associated with convenience stores and corner stores.