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The
Geography of Tobacco Related Disease in California
Principal
Investigator: Robert I. Lipton, Ph.D.
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.
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