1. Froelich, Warren

Article Content

Tobacco and vape shops that peddle e-cigarettes and similar devices have been sprouting like wild mushrooms in recent years, often replacing more traditional means of burning and inhaling nicotine, like cigarettes.

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Now, a study focusing on one Los Angeles region suggests these establishments have taken root largely in the poorest and most ethnically dense neighborhoods, threatening to erode many years of effort to reduce lung disease and cancer resulting from tobacco use.


"Electronic nicotine delivery systems or ENDS have flooded the marketplace and have enticed younger persons, women, and even traditional smokers," said Kimlin Ashing, PhD, a population and behavioral scientist at City of Hope in Duarte, Calif., who presented results of this study at the AACR 2020 Virtual Annual Meeting held in April. "We cannot afford to lose the gains we have made in the fight against tobacco use; thus, this is a public health crisis."


This latest regional study supports other national reports showing that vape and smoke shops tend to concentrate in poorer communities with a larger proportion of ethnic minorities. Combined, experts say they provide evidence for regulatory changes needed to restrain the sale of e-cigarettes and similar vaping devices, particularly among teens and young adults.


"Our appreciation of tobacco control may have to evolve with the times," said Jarushka Naidoo, MBBCh, Assistant Professor of Oncology and attending physician at the Sidney Kimmel Cancer Center at Johns Hopkins University, who did not participate in this study.


Study Details

In 2015, a Reuters/Ipsos poll calculated that about 10 percent of U.S. adults vape, with a large chunk of those between 18 to 24 years. A report that year from the U.S. Centers for Disease Control and Prevention (CDC) found that e-cigarette use among U.S. high school students skyrocketed from 1.5 percent in 2011 to 16 percent in 2015, an increase of more than 900 percent. According to the 2019 National Youth Tobacco Survey, more than 5 million youth reported having used e-cigarettes in the past 30 days, with nearly 1 million reporting daily use.


The study presented at the AACR meeting focused on the San Gabriel Valley (also known as Los Angeles Service Planning Area or SPA3), a region with a population of roughly 2 million people or about one-fifth of Los Angeles County. Median household income here ranges from $47,000 to $160,000 with Hispanics (45%) and Asian-Americans (30%) underscoring the region's high concentration of ethnic minorities.


To explore the socioeconomic contexts of tobacco and vape shops in the San Gabriel Valley, the researchers identified all vape/smoke shops in the region, and then linked their locations to specific data that included age, racial/ethnic background, and annual household income. Population was based on the U.S. Census, while the locations of vape/smoke shops were gleaned from searches on Google, the Yellow Pages, and social media platforms.


The result was a color-coded geospatial map that allows the researcher and others to better visualize the location of dedicated tobacco and vape retail in relation to community characteristics, including race/ethnicity and poverty/wealth.


In all, the study identified 196 vape/smoke shops in the region. Lower-income cities tended to have more tobacco and vape shops compared to very high-income cities. Poorer neighborhoods are often characterized by proximity to freeways, heavier traffic flow and population density, and more retail outlets selling both tobacco products and alcohol.


Interestingly, no dedicated tobacco shops were found in the three highest income communities. By contrast, some of the lowest income/minority-dense communities experienced the highest concentration of vape/smoke shops.


"We were surprised at the concentration of dedicated tobacco shops in underserved communities," Ashing said. "Some cities had two dedicated tobacco and vape shops in every square mile. And they were selling tobacco products at lower prices.


"Most of the results aligned with our hypotheses, but we did not expect to see a complete absence of dedicated tobacco shops in very wealthy communities. Therefore, affluent neighborhoods are less exposed to tobacco products as well as tobacco marketing and advertising."


Several questions remain that require further investigation, including the impact of current legal restraints that forbid the sale of vaping products to individuals younger than 21 years. Many suspect teens are sharing products through social contacts, thus steering clear of the law.


Also, researchers have yet to clearly establish a definitive link between e-cigarettes and lung cancer, though previous investigations have found a connection between e-cigarettes and lung inflammation. The jury is still out on lung cancer.


"There is no definitive verdict on electronic nicotine delivery systems and lung cancer specifically," said Ashing. "We actually have a study that is about to begin. With that study, we hope to answer that very question. We are examining the genotoxic effects of electronic nicotine delivery systems."


Warren Froelich is a contributing writer.


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