Evaluating the impact of tobacco retailer density on smoking among patients with serious mental illness and diabetes in New York State

Abstract

ABSTRACT

Background: The present study investigated the relationships between serious mental illness, diabetes, smoking, and additional contextual effect of tobacco retailer density in New York. Methods: We utilized a cross-sectional study design using data from the Patient Characteristics Survey (2017), the New York State Behavioral Risk Factor Surveillance System (2017) and Population density of tobacco retail outlets data (2017) to answer 5 hypothesis questions. Results: In the present study, the relationships between serious mental illness (SMI), smoking, diabetes, and population density of tobacco retail outlets (as environment factor) were examined among a population comorbid with SMI and diabetes. Results suggest that the population density of tobacco retail outlets was associated with an increased risk for smoking among people who have comorbid SMI and diabetes. The density of tobacco retail outlets was positively associated with smoking [OR=1.04, 95%CI: 1.03, 1.07] after adjusting for sex, race, education, employment, insurance coverage, and obesity. Public health implication: The results of this study will have several public health implications, including the importance of screening diabetes and smoking status among those who have a serious mental illness, emphasizing smoking prevention and cessation in clinical care and self-care for those who have co-morbid SMI and DM, and policy intervention to reduce density of tobacco retail outlets as part of a comprehensive approach to reduce the harm of smoking. Funding should be allocated towards more interventions that focus on how to quit smoking and manage diabetes - especially in counties and zip code areas with a high tobacco retailer density.

Conclusion: This study lends to a more comprehensive understanding of the relationship between tobacco outlet exposure and tobacco use among SMI adult with diabetes living in NYS. High tobacco outlet density in each county or 3-digit zip code areas may have a hazardous influence on tobacco use, as well as on beliefs about tobacco use among SMI adult with diabetes. Future longitudinal studies, however, will be required to better disentangle the theoretical frameworks and relationships between tobacco retailer accessibility, tobacco consumption, and the resulting clinical outcomes and financial burdens among the SMI population.