Date of Degree

9-2015

Document Type

Dissertation

Degree Name

D.P.H.

Program

Public Health

Advisor(s)

Lorna E. Thorpe

Subject Categories

Epidemiology

Keywords

Multiunit housing; Secondhand smoke; Tobacco; Tobacco retailers

Abstract

Background: Despite decades of smoking prevalence declines and more recent smoke-free indoor and outdoor air laws, smoking causes 400,000 preventable deaths and secondhand smoke (SHS) exposure leads to 40,000 deaths from respiratory and cardiovascular disease among non-smokers annually. Built and social environment factors linked to smoking include tobacco retailer density and neighborhood poverty. Housing environments including multiunit housing are linked to SHS exposure and adverse health outcomes.

Objectives: To investigate possible associations of different environmental factors with smoking, SHS exposure, and SHS-related health outcomes.

Methods: Many data sources were used: New York City Community Health Survey, Department of Consumer Affairs, American Community Survey, Primary Land Use Tax Lot Output, and Health and Nutrition Examination Survey data. Ecological and multilevel models examined tobacco retailer density and neighborhood poverty associations with smoking prevalence and behavior, assessing for moderation by neighborhood poverty and housing environments. Logistic regression assessed associations between housing type and elevated SHS exposure as well as possible mediation of the housing-health outcome associations by SHS exposure.

Results: Ecological analyses demonstrated a potential differential effect of economic strata on tobacco retailer density and neighborhood smoking and multilevel analyses found positive associations between neighborhood poverty and smoking behavior. Logistic regression found no adjusted associations between multiunit housing and SHS exposure, nor did SHS exposure mediate the housing and health outcome associations.

Conclusions: Environmental factors contributed to smoking prevalence and behavior in NYC, while associations between housing, SHS and SHS-related health outcomes in non-smoking adults require more investigation.

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