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The geography of tobacco related disease in California

Institution: Pacific Institute for Research and Evaluation
Investigator(s): Robert Lipton, BA, MA, MPH, Ph.D.
Award Cycle: 2002 (Cycle 11) Grant #: 11RT-0093 Award: $374,786
Subject Area: Epidemiology
Award Type: Research Project Awards
Abstracts

Initial Award Abstract
We are proposing to describe the spatial distribution of hospital admitted tobacco related disease (TRD) prevalence rates and smoking prevalence in California. Further, in the context of spatial analysis, we will examine how hospital related charges are related to hospital admitted TRD prevalence rate, tobacco sales outlet concentration and smoking prevalence throughout the state. In addition, we will seek to estimate to what extent specific zip codes have higher or lower than expected hospital-admitted TRD prevalence rates, outlet density, TRD related hospital charge information and smoking prevalence. It is expected that applying spatial analyses to TRD, smoking prevalence and health related charges will increase public health intervention and prevention efforts in California. This will be accomplished by systematically providing, (for three time points in a 10 year period) socio-demographic/economic information, in relation to health related charges, that accounts for underlying geographic relationships amongst zip codes in California.

We are assuming, based on a compelling research literature, that geographic areas have specific characteristics that, above and beyond individual affects, are related to TRD, outlet concentration, smoking prevalence and hospital charge information for a selected group of TRD (identified below). In this regard, we are asking the general question: “does place matter in regard to hospital-admitted TRD prevalence rates and smoking prevalence and hospital related charges?” We are interested in the confluence of factors that produce a certain level of TRD and smoking prevalence for a given area and a given TRD related cost/charge environment. Information that is obtained from this proposal will be used to develop further research programs that investigate tobacco related disease, charges and polices throughout the state.

Spatial analysis is important for describing the setting in which populations involve themselves with activities that increase or decrease risk of hospital-admitted TRD prevalence and smoking prevalence. Specific socio-demographic and ethnic/cultural factors may help construct a geographic place, along with specific physical features such as roads, dense housing, etc, that are related to a host of public health issues.

We propose a geographic analysis that retains socio-demographic complexity in the context of a more thoroughgoing treatment of the geographic setting in which TRD, smoking prevalence and TRD medical charges are assessed. Understanding how place effects health is essential from a public health treatment and intervention perspective. It is expected that applying spatial analyses in this setting will increase public health intervention and prevention efforts in California by systematically providing, socio-demographic/economic information that accounts for underlying geographic relationships (in this case, zip codes).

The purpose of this proposed project is to identify what places (zip codes) in California have the most tobacco related disease. In addition, we will seek to estimate differences in tobacco related disease across zip codes and to what extent specific zip codes have higher or lower than expected rates of TRD through time. Smoking prevalence and tobacco outlet density will be treated similarly to TRD. Further, differences in TRD charges will be described at the zip code level and related to variation in TRD, outlet density and smoking prevalence. To this end, data from the 1990 and 2000 census, hospital discharge data for the year 1990, 1995 & 2000, smoking outlet data from the tobacco retail database 1996 &2000 and survey information from the California Tobacco Survey (CTS) 1990, 1996,1999

There are two general goals of this research: 1) To improve targeting of public health intervention and prediction efforts by identifying zip codes in California where rates of TRD and smoking prevalence are relatively high. 2) To provide a baseline from which to develop more coherent public health interventions at the community level by assessing the relationships between TRD charges, TRD, smoking prevalence and outlet density.
Publications

The spacial distribution of lung cancer in California.
Periodical: TRDRP Annual Report to the State of California Legislature Index Medicus:
Authors: Lipton RI ABS
Yr: 2003 Vol: Nbr: Abs: Pg:

The geography of chronic obstructive pulmonary disease in California.
Periodical: Journal of Exposure Analysis and Environmental Epidemiology Index Medicus:
Authors: Lipton RI, Banerjee A, Dowling KC, Treno A ART
Yr: 0 Vol: Nbr: Abs: Pg: