Profound health disparities are concentrated among individuals with low education and the unemployed, uninsured, and those living in poverty. Tobacco use is a major contributor to disparities with individuals from lower socioeconomic strata having much lower rates of quitting smoking. Unfortunately, the search for effective tobacco control policies and interventions to reduce disparities is severely hampered by a lack of research on why quitting is so difficult among disadvantaged populations. Although there has been an explosion of studies examining the genetics of cessation, there has been little research on the impact of the environment, despite the fact that environment accounts for h...

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Profound health disparities are concentrated among individuals with low education and the unemployed, uninsured, and those living in poverty. Tobacco use is a major contributor to disparities with individuals from lower socioeconomic strata having much lower rates of quitting smoking. Unfortunately, the search for effective tobacco control policies and interventions to reduce disparities is severely hampered by a lack of research on why quitting is so difficult among disadvantaged populations. Although there has been an explosion of studies examining the genetics of cessation, there has been little research on the impact of the environment, despite the fact that environment accounts for half of smoking persistence. Individuals from lower socioeconomic strata are exposed to significantly worse social (e.g., less neighborhood trust, more tolerance of crime) and physical environments (e.g., more tobacco outlets, bars, and abandoned homes; less access to health care), and these environments are likely to impact quitting. This study will examine the influence of the social and physical environment on smoking cessation and associated mechanisms among 300 diverse smokers. Real-time assessments of thoughts, feelings, craving, and smoking lapses will be paired with detailed spatial mapping of an individual’s environment throughout the course of a day (e.g., residential, work, and travel patterns indicating location and type of tobacco outlets; neighborhood poverty, education, and employment; residential stability; racial/ethnic makeup, crime, etc.). The study entails a novel combination of multi-level, state-of-the-science assessments to address key recommendations from major reports on both reducing tobacco use among the underserved and addressing health disparities; and, has important implications for tobacco control policies and interventions (e.g., land use policy, community and individual level interventions) designed to eliminate tobacco-related disparities.

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