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Tobacco use is a leading cause of cancer death, and both tobacco products and secondhand smoke contain many carcinogenic chemicals that damage human DNA. Tobacco use and secondhand smoke exposure are well-established risk factors for several types of cancer including lung, larynx, mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon, rectum and cervix, as well as acute myeloid leukemia, according to the National Cancer Institute. They are also linked to the development of other chronic diseases including asthma, emphysema and heart disease. Although the overall incidence of smoking has declined significantly in the U.S. over the last two decades, pregnant women and children are still particularly vulnerable to smoke exposure.

VCU Massey Cancer Center researchers Bernard Fuemmeler, Ph.D., M.P.H., and David Wheeler, M.P.H., Ph.D., received a $2.1 million R01 grant from the National Cancer Institute to examine the impact of tobacco retail outlets (TROs) and neighborhoods on maternal smoking during pregnancy as well as secondhand smoke exposure among children.

“Presumably, reducing tobacco retail outlet density should lead to lower levels of adult smoking, which should also reduce maternal smoking during pregnancy and secondhand smoke exposure in children,” said Fuemmeler, who is the associate director for cancer prevention and control and the Gordon D. Ginder, M.D., Chair in Cancer Research at Massey as well as professor of health behavior and policy at the VCU School of Medicine. “However, there is scant evidence that tobacco retail outlet density is related to smoking behaviors, and there is no evidence showing that reducing TRO density will extend to vulnerable subgroups and those passively exposed like pregnant women and children.”

Using clinical and epidemiological data gathered through the Newborn Epigenetics Study (NEST), a federally-funded birth cohort study, in combination with census data and geospatial analysis, the investigators will explore the extent to which neighborhood characteristics and TROs influence smoke exposure in pregnant women and children and any associated health care costs. The researchers will look at biomarkers of smoke exposure in 1,000 women during their pregnancy as well as 400 children aged 4-10 delivered by those same women.

“By better understanding the link that tobacco retail outlets have with smoke exposure and the related health care costs associated with such exposure, we will be better positioned to make data-driven policies that aim to modify the TRO landscape,” said Wheeler, who is a member of the Cancer Prevention and Control research program at Massey and an associate professor of biostatistics at the VCU School of Medicine. “Successful completion of this project will provide evidence supporting continued efforts to expand policies reducing TRO density and retain them where they are being enacted.”

Many cities and states in the U.S. have already enacted or proposed certain regulations to curb TRO density, including laws that ban tobacco sales within a certain distance of youth-populated areas, laws that prohibit tobacco from being sold in pharmacies and laws that mandate a minimum distance between which TROs can operate from one another, among others policies.

Collaborating on this four-year study are investigators from North Carolina State University and Duke Cancer Institute.

Written by: Blake Belden