ChristianaCare Researchers Show That Where You Live Can Affect Your Smoking Habits

In the first study of its kind, researchers at ChristianaCare’s Institute for Research on Equity and Community Health (iREACH) have unearthed new insights about the impact of smoking on Delaware’s communities of color – and potential new solutions.

Published in the peer-reviewed journal Cities & Health, the study involved the use of geospatial analyses. It showed disproportionately higher counts of convenience store tobacco retailers located in medium- and high-density residential zones – in predominantly African American and LatinX neighborhoods – within the city of Wilmington relative to the surrounding county.

By linking anonymized data from patient electronic health records and U.S. Census Bureau data, the researchers found that approximately 80% of Wilmington smokers and 60% of Wilmington youth lived in these residential zones. The findings highlight the potential to more equitably reduce tobacco retailer exposure through a residentially focused zoning approach.

“We know that communities of color are just as interested in quitting smoking and make just as many quit attempts as any other community,” said Scott Siegel, Ph.D., MHCDS, director of population health research at ChristianaCare and lead author of the study.

“But living in neighborhoods where they are surrounded by tobacco marketing, smoking cues and easy access to cigarettes undermines their efforts to quit and creates barriers to their ability to achieve their personal health goals.”

The study analyzed New Castle County, which has a population of about 559,000 residents, and represents 57% of Delaware’s population. In Wilmington, the state’s largest city, there were 10 times the proportion of tobacco retailers located in residential zones versus other municipal and non-municipal areas.

In addition, the largest share of tobacco retailers in Wilmington was located in medium- and high-density residential zones, whereas in low-density residential zones, the share was as low as zero.

The researchers propose that public officials consider the use of zoning policy to decrease the number of corner stores and retailers that sell tobacco products in vulnerable communities.

Since high-density residential neighborhoods often lack easy access to healthy foods, corner stores serve a vital role in providing goods and services, Siegel said.

He and the other researchers propose engaging with these store owners by helping them partner with healthy and affordable food programs that can generate new forms of revenue to help offset reduced tobacco sales. Similar efforts have been successful in other areas, such as Philadelphia, Pennsylvania through the Healthy Corner Store Initiative and in San Francisco, California through the Tobacco-Free Project.

“As part of our reimagining New Castle County, this report will help us address key health inequities in our working-class neighborhoods,” said Matt Meyer, executive of New Castle County in Delaware.

“This study presents us with hard facts when it comes to developing future public policy. I am thankful to the hard work of Dr. Siegel and iREACH at ChristianaCare and I look forward to more of their work.”

The study was conducted by iREACH, which is composed of experts in epidemiology, biostatistics, program evaluation and data management. Researchers at iREACH partner closely with ChristianaCare’s population health, community health, health equity and virtual health programs to transform health care.

“By investing our resources in research that impacts the social determinants of health, we are able to come up with innovative solutions to some of today’s toughest clinical challenges,” said LeRoi Hicks, M.D., MPH, physician leader of iREACH and chief medical officer of ChristianaCare’s Wilmington Hospital.

“This study is a shining example of the type of research that iREACH is committed to conducting.”