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Original Investigation |

Association Between Distance From Home to Tobacco Outlet and Smoking Cessation and Relapse ONLINE FIRST

Anna Pulakka, PhD1; Jaana I. Halonen, PhD2; Ichiro Kawachi, MD, PhD3; Jaana Pentti, BSc2; Sari Stenholm, PhD1,4; Markus Jokela, PhD5; Ilkka Kaate, MSc6; Markku Koskenvuo, MD, PhD7; Jussi Vahtera, MD, PhD1,8; Mika Kivimäki, PhD2,7,9
[+] Author Affiliations
1Department of Public Health, University of Turku, Turku, Finland
2Finnish Institute of Occupational Health, Helsinki, Finland
3Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
4School of Health Sciences, University of Tampere, Tampere, Finland
5Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
6Department of Geography and Geology, University of Turku, Turku, Finland
7Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
8Turku University Hospital, Turku, Finland
9Department of Epidemiology and Public Health, University College London Medical School, London, England
JAMA Intern Med. Published online August 15, 2016. doi:10.1001/jamainternmed.2016.4535
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Importance  Reduced availability of tobacco outlets is hypothesized to reduce smoking, but longitudinal evidence on this issue is scarce.

Objective  To examine whether changes in distance from home to tobacco outlet are associated with changes in smoking behaviors.

Design, Setting, and Participants  The data from 2 prospective cohort studies included geocoded residential addresses, addresses of tobacco outlets, and responses to smoking surveys in 2008 and 2012 (the Finnish Public Sector [FPS] study, n = 53 755) or 2003 and 2012 (the Health and Social Support [HeSSup] study, n = 11 924). All participants were smokers or ex-smokers at baseline. We used logistic regression in between-individual analyses and conditional logistic regression in case-crossover design analyses to examine change in walking distance from home to the nearest tobacco outlet as a predictor of quitting smoking in smokers and smoking relapse in ex-smokers. Study-specific estimates were pooled using fixed-effect meta-analysis.

Exposures  Walking distance from home to the nearest tobacco outlet.

Main Outcomes and Measures  Quitting smoking and smoking relapse as indicated by self-reported current and previous smoking at baseline and follow-up.

Results  Overall, 20 729 men and women (age range 18-75 years) were recruited. Of the 6259 and 2090 baseline current smokers, 1744 (28%) and 818 (39%) quit, and of the 8959 and 3421 baseline ex-smokers, 617 (7%) and 205 (6%) relapsed in the FPS and HeSSup studies, respectively. Among the baseline smokers, a 500-m increase in distance from home to the nearest tobacco outlet was associated with a 16% increase in odds of quitting smoking in the between-individual analysis (pooled odds ratio, 1.16; 95% CI, 1.05-1.28) and 57% increase in within-individual analysis (pooled odds ratio, 1.57; 95% CI, 1.32-1.86), after adjusting for changes in self-reported marital and working status, substantial worsening of financial situation, illness in the family, and own health status. Increase in distance to the nearest tobacco outlet was not associated with smoking relapse among the ex-smokers.

Conclusions and Relevance  These data suggest that increase in distance from home to the nearest tobacco outlet may increase quitting among smokers. No effect of change in distance on relapse in ex-smokers was observed.

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Figure 1.
Selection of Study Participants

Finnish Public Sector (FPS) participants who responded to the survey both in 2008 or 2009 and 2012 or 2013 (n = 53 755, 79% of the eligible 2008/2009 respondents) and the Health and Social Support (HeSSup) participants who responded both in 2003 and 2012 (n = 11 924, 63% of the eligible 2003 participants) were included. Current and ex-smokers were included only and those who reported never smoking at baseline were excluded. In addition, those with missing data on smoking in either survey, not residing in mainland Finland, or with unsuccessful geocoding of residential address were excluded. The analytic sample was therefore 15 218 FPS and 5511 HeSSup participants.

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Figure 2.
Odds of Quitting Smoking in Relation to Increasing Distance From Home to the Nearest Tobacco Outlet

Values are odds ratios (95% CI) per 500-m increase in distance to the nearest tobacco outlet between baseline and follow-up presented separately for the FPS and the HeSSup studies, with pooled results marked as diamond. Maximum value for distance is set at 1000 m. Odds ratios are adjusted for age and education at baseline. FPS indicates the Finnish Public Sector study; HeSSup, the Health and Social Support study; OR, odds ratio.

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