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Original research
Tobacco retailer density and its association with birth outcomes in the USA: 2000–2016
  1. Chris D Baggett1,2,
  2. David B Richardson3,
  3. Tzy-Mey Kuo2,
  4. Jacqueline E Rudolph4,
  5. Amanda Y Kong5,6,
  6. Kurt M Ribisl2,7,
  7. Shelley D Golden2,7
  1. 1Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  2. 2Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, North Carolina, USA
  3. 3UCI Susan & Henry Samueli College of Health Sciences, Irvine, California, USA
  4. 4Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  6. 6TSET Health Promotion Research Center, The University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
  7. 7Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Chris D Baggett, Epidemiology, University of North Carolina at Chapel Hill, Carrboro, NC 27599, USA; cbaggett{at}email.unc.edu

Abstract

Introduction Significant progress has been made in reducing maternal exposure to tobacco smoke and subsequent adverse birth outcomes, however, reductions may require strategies that reduce the availability of tobacco retailers. In this study, we investigated the relationship between tobacco retailer density and birth outcomes across the USA and predicted the potential impact of a tobacco retailer density cap on these outcomes.

Methods Annual US county (n=3105), rates of preterm birth, low birth weight, small-for-gestational age, all-cause infant mortality and sudden infant death syndrome (SIDS) were calculated using National Vital Statistics System data. Tobacco retailers were identified from the National Establishment Time-Series Database. We used Poisson regression to estimate the effect of capping retailer density at 1.4 retailers per 1000 population, controlling for county demographics and air pollution, using propensity score weighting.

Results Tobacco retailer density was positively associated with most adverse birth outcomes. We estimate that a nationwide cap on tobacco retailer density, implemented in 2016, would have resulted in a reduction of 4275 (95% CI 2210 to 6392) preterm births, 6096 (95% CI 4421 to 7806) small-for-gestational-age births, 3483 (95% CI 2615 to 4378) low birthweight births, 538 (95% CI 345 to 733) all-cause infant deaths and 107 (95% CI 55 to 158) SIDS deaths in that year.

Conclusion Higher rates of adverse birth outcomes were seen in counties with high tobacco retailer density compared with those with low density. These results provide further support for regulating tobacco retail density to reduce adverse health outcomes associated with tobacco use.

  • End game
  • Environment
  • Health Services
  • Smoking Caused Disease

Data availability statement

Data may be obtained from a third party and are not publicly available. National Vital Statistics System data are publicly available: https://www.cdc.gov/nchs/nvss/index.htm. Due to contractual obligations, the National Establishment Times Series data are not accessible to the public. Access may be granted upon obtaining appropriate approval and adhering to usage agreements.

https://doi.org/10.1136/tc-2024-058779

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. National Vital Statistics System data are publicly available: https://www.cdc.gov/nchs/nvss/index.htm. Due to contractual obligations, the National Establishment Times Series data are not accessible to the public. Access may be granted upon obtaining appropriate approval and adhering to usage agreements.

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    Footnotes

    • X @AmandaYKong

    • Contributors The authors confirm contribution to the paper as follows: study conception and design: CB, DBR, JER, T-MK and SDG; data collection: CDB, JER, T-MK, SDG, AYK and KMR; analysis and interpretation of results: CDB, DBR, JER, T-MK, SDG, AYK and KMR; draft manuscript preparation: CDB, DBR, JER, T-MK, SDG, AYK and KMR; guarantor: CDB.

    • Funding This work was supported by the National Cancer Institute of the National Institutes of Health (P30CA225520) and the Oklahoma Tobacco Settlement Endowment Trust (STCST00400_FY24). Work was also supported by the Cancer Information and Population Health Resource at the UNC Lineberger Comprehensive Cancer Center, with funding provided by the University Cancer Research Fund via the state of North Carolina.

    • Disclaimer The funders had no role in any aspect of the study design, data analysis and interpretation, writing of the manuscript, or decision to publish.

    • Competing interests KMR and AYK serve as paid expert consultants in litigation against the tobacco industry.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.