Development of a computational modeling laboratory for examining tobacco control policies: Tobacco Town.

A key focus of recent policy efforts to curb tobacco product usage has been the role of place-specifically the density of retail and advertising and the resulting spatial pattern of access and exposure for consumers. Policies can alter the environment by reducing density or shifting distribution of tobacco retail and thus limiting access and exposure. Since little empirical evidence exists for the potential impact of these policies across potentially heterogeneous places, we develop and apply an original spatial computational model to simulate place-based retail tobacco control policies. The model is well-grounded in theory and available empirical evidence. We apply the model in four representative settings to demonstrate the utility of this approach as a policy laboratory, to develop general insights on the relationship between retailer density, retail interventions, and tobacco costs incurred by consumers, and to provide a framework to guide future modeling and empirical studies. Our results suggest that the potential impact on costs of reducing tobacco retailer density are highly dependent on context. Projected impacts are also influenced by assumptions made about agent (smoker) purchasing decision-making processes. In the absence of evidence in this area, we tested and compared three alternative decision rules; these interact with environmental properties to produce different results. Agent properties, namely income and cigarettes per day, also shape purchasing patterns before and after policy interventions. We conclude that agent-based modeling in general, and Tobacco Town specifically, hold much potential as a platform for testing and comparing the impact of various retail-based tobacco policies across different communities. Initial modeling efforts uncover important gaps in both data and theory and can provide guidance for new empirical studies in tobacco control.

Prevalence of cigarette advertising and other promotional strategies at the point of sale in St Louis, Missouri: analysis by store type and distance from a school.

INTRODUCTION: Point-of-sale advertising provides an opportunity for the tobacco industry to communicate with current and potential smokers. The US Family Smoking Prevention and Tobacco Control Act allows states to implement policies requiring that tobacco products be placed out of sight, and the Food and Drug Administration is considering banning point-of-sale advertising within 1,000 feet of schools. Our objective was to compare cigarette point-of-sale advertising near schools with grades prekindergarten through 12 and by store type. METHODS: All registered cigarette retailers (n = 1,229) and schools (n = 581) in the city of St Louis and St Louis County were geocoded and mapped by using ArcGIS. Retailers were divided into 2 groups, those within 1,000 feet and those within 1,001 to 2,000 feet of a school; 200 retailers from each group were randomly selected. We assessed tobacco interior and exterior advertising, brands advertised, discounts, gifts with purchase, "no sales to minors" signage, and cigarette functional items (eg, advertising on shopping baskets). Analyses were done by distance from a school and store type. RESULTS: We analyzed 340 retailers. Most retailers within 1,000 feet (91.2%) and from 1,001 to 2,000 feet (94.2%) of a school displayed cigarette advertising (P = .20). Convenience stores had the highest number of interior ads. In multivariable models, distance from school explained 0.2% of the variance in total advertising. CONCLUSION: Cigarette point-of-sale advertising is highly prevalent in St Louis within 1,000 feet of schools. A ban based on distance from a school might decrease advertising exposure, but its effect on smoking prevalence is yet to be determined because advertising farther from schools would still prevail.

Disparities and menthol marketing: additional evidence in support of point of sale policies.

This study examined factors associated with point-of-sale tobacco marketing in St. Louis, an urban city in the United States. Using spatial analysis, descriptive statistics, and multilevel modeling, we examined point-of-sale data and the proportion of mentholated cigarette and total cigarette marketing from 342 individual tobacco retail stores within St. Louis census tracts characterized by the percent of black adults and children. Menthol and total tobacco product marketing was highest in areas with the highest percentages of black residents. When examining menthol marketing to children, we did not find as strong of a relationship, however results of multilevel modeling indicate that as the proportion of black children in a census tract increased, the proportion of menthol marketing near candy also increased. These results indicate the need for communities globally to counter this targeted marketing by taking policy action specifically through the enactment of marketing restrictions provided by the 2009 Family Smoking Prevention and Tobacco Control Act and the Framework Convention of Tobacco Control.

Social media adoption in local health departments nationwide.

OBJECTIVES: We examined whether characteristics of local health departments (LHD) and their geographic region were associated with using Facebook and Twitter. We also examined the number of tweets per month for Twitter accounts as an indicator of social media use by LHDs. METHODS: In 2012, we searched for Facebook and Twitter accounts for 2565 LHDs nationwide, and collected adoption date and number of connections for each account. Number of tweets sent indicated LHD use of social media. LHDs were classified as innovators, early adopters, or nonadopters. Characteristics of LHDs were compared across adoption categories, and we examined geographic characteristics, connections, and use. RESULTS: Twenty-four percent of LHDs had Facebook, 8% had Twitter, and 7% had both. LHDs serving larger populations were more likely to be innovators, tweeted more often, and had more social media connections. Frequency of tweeting was not associated with adoption category. There were differences in adoption across geographic regions, with western states more likely to be innovators. Innovation was also higher in states where the state health department adopted social media. CONCLUSIONS: Social media has the potential to aid LHDs in disseminating information across the public health system. More evidence is needed to develop best practices for this emerging tool.

Local health department use of twitter to disseminate diabetes information, United States.

INTRODUCTION: Diabetes may affect one-third of US adults by 2050. Adopting a healthful diet and increasing physical activity are effective in preventing type 2 diabetes and decreasing the severity of diabetes-related complications. Educating and informing the public about health problems is a service provided by local health departments (LHDs). The objective of this study was to examine how LHDs are using social media to educate and inform the public about diabetes. METHODS: In June 2012 we used NVivo 10 to collect all tweets ever posted from every LHD with a Twitter account and identified tweets about diabetes. We used a 2010 National Association of County and City Health Officials survey to compare characteristics of LHDs that tweeted about diabetes with those that did not. Content analysis was used to classify each tweet topic. RESULTS: Of 217 LHDs with Twitter accounts, 126 had ever tweeted about diabetes, with 3 diabetes tweets being the median since adopting Twitter. LHDs tweeting about diabetes were in jurisdictions with larger populations and had more staff and higher spending than LHDs not tweeting about diabetes. They were significantly more likely to employ a public information specialist and provide programs in diabetes-related areas. There was also a weak positive association between jurisdiction diabetes rate and the percentage of all tweets that were about diabetes (r = .16; P = .049). CONCLUSION: LHDs are beginning to use social media to educate and inform their constituents about diabetes. An understanding of the reach and effectiveness of social media could enable public health practitioners to use them more effectively.