3158 - Tobacco Retail Access and Tobacco Cessation Among Head and Neck Cancer (HNC) Survivors

Background

Continued smoking after a HNC diagnosis is associated with poorer outcomes. Proximity to tobacco retail outlets is negatively associated with cessation in non-cancer patients (pts) but this has not been evaluated in cancer survivors. We evaluated the impact of tobacco retail access on cessation in HNC pts.

Methods

HNC pts (Princess Margaret Cancer Centre, Toronto, Canada) completed questionnaires at diagnosis and follow up (median 26 months apart) evaluating changes in tobacco use. Validated tobacco retail location data were obtained from Ontario Ministry of Health and pt home addresses were geocoded using ArcGIS 10.6.1, which calculated walking time/distance to nearest vendor and vendor density within 250 meters (m) and 500m from pts. Multivariable logistic regression and Cox proportional hazard models evaluated the impact of vendor availability on cessation and time to quitting after diagnosis respectively, adjusted for significant clinico-demographic and tobacco covariates.

Results

141/450 HNC pts smoked at diagnosis; quit rate after diagnosis was 48%. Mean distance and walking time to a vendor was 1.2 km (range 0-10) and 14 min (range 0-116). On average, there was 1 vendor (range 0-19) within 250m and 3 vendors (range 0-19) within 500m from pts; 33% and 56% of pts lived within 250m and 500m from at least one vendor, respectively. Greater distance (aOR 1.27 per 1000m [95% CI 1.01-1.59] p = 0.04) and increased walking time (aOR 1.02 per min [1.00-1.04] p = 0.04) to a vendor were associated with a higher quit rate at one year. Living near more vendors within 500m was associated with an increasing dose effect on reducing cessation rates at 1 year (aOR 0.90 per vendor [0.82-0.99] p = 0.03). Greater distance (aHR 1.18 per 1000m [1.01-1.38] p = 0.04) and increased walking time (aHR 1.01 per min [1.00-1.03] p = 0.04) to a vendor were also associated with quitting at any time. Living near more vendors within 500m had a trend towards reducing quit rates at any time (aHR 0.94 per vendor [0.88-1.00] p = 0.07).

Conclusions

Close proximity to tobacco retail outlets is associated with reduced cessation rates for HNC survivors. Reducing density of tobacco vendors is a cessation strategy that can positively impact HNC pt outcomes.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.