Collections > Electronic Theses and Dissertations > An Examination of Community and Consumer Tobacco and Food Retail Environments
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Community and consumer tobacco and food environments may contribute to neighborhoods that either support or limit health promoting choices. Tobacco use and dietary intake behaviors consolidate early in life and track over time; yet tobacco and food environments are often studied independently. The three studies in this dissertation examine the intersection of tobacco and food environments at the community and consumer levels. Studies One and Two examine the availability of tobacco outlets and fast food restaurants surrounding public schools (n=18,379) in a national sample of 97 counties within 40 states. Study One used spatial point pattern analysis to examine whether tobacco outlets and fast food restaurants cluster around schools. Significant clustering of tobacco outlets occurred as close as 200 m from all schools. Significant clustering of fast food restaurants occurred as close as 200 m from schools in cities and suburbs, and within 600 m of schools in rural areas. Study Two used generalized linear mixed models to examine whether tobacco outlet and fast food restaurant availability within 800 m of schools was associated with student socioeconomic status and race/ethnicity. The odds of having both a tobacco outlet and fast food restaurant nearby increased by 5% for every 10% increase in the percentage of Hispanic students (IRR 1.05, 95% CI 1.03, 1.07) and by 3% for every 10% increase in low income students (IRR 1.03, 95% CI 1.01, 1.05). Study Three examined the consumer tobacco and food environment within rural, small food stores and used the Diffusion of Innovation (DOI) to investigate retailer (n=55) perceptions of the availability, display and promotion of tobacco products and healthy foods. Retailers with greater perceived relative advantage were more willing to sell and display more healthy foods and beverages, but DOI constructs were not associated with willingness to reduce tobacco products and marketing. The three studies in this dissertation have implications for using land use planning, zoning and licensing ordinances to improve the retail tobacco and food environments at both the community and consumer level.