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Cross-sectional and longitudinal associations of neighbourhood social environment and smoking behaviour: the multiethnic study of atherosclerosis
  1. Stephanie L Mayne1,
  2. Amy H Auchincloss1,
  3. Kari A Moore1,
  4. Yvonne L Michael1,
  5. Loni Philip Tabb1,
  6. Sandra E Echeverria2,
  7. Ana V Diez Roux1
  1. 1Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
  2. 2Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
  1. Correspondence to Dr Amy H Auchincloss, Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, 3215 Market Street, 5th floor, Philadelphia, PA 19104, USA; aha27{at}


Background Social features of neighbourhood environments may influence smoking by creating a stressful environment or by buffering stress through social cohesion. However, the association of the overall neighbourhood social environment (NSE) with smoking, and the association of specific neighbourhood social factors with change in smoking behaviour over time, has rarely been examined.

Methods This study included 5856 adults aged 45–84 years from the Multi-Ethnic Study of Atherosclerosis (2000–2012, average follow-up: 7.8 years). Outcomes included current smoking status and smoking intensity (average number of cigarettes smoked per day among baseline smokers). NSE was assessed as a composite score composed of aesthetic quality, safety and social cohesion scales (derived from neighbourhood surveys). Generalised linear mixed models evaluated the association of baseline NSE (composite score and individual scales) with current smoking (modified Poisson models) and smoking intensity (negative binomial models) cross-sectionally and longitudinally.

Results Each SD increase in baseline NSE composite score was associated with 13% lower prevalence of smoking at baseline (adjusted prevalence ratio (aPR) 0.87 (95% CI 0.78 to 0.98). Neighbourhood safety and aesthetic quality were similarly associated with lower smoking prevalence (aPR 0.87 (0.78 to 0.97) and aPR 0.87 (0.77 to 0.99), respectively) but the association with social cohesion was weaker or null. No significant associations were observed for smoking intensity among baseline smokers. Baseline NSE was not associated with changes in smoking risk or intensity over time.

Conclusions Results suggest that neighbourhood social context influences whether older adults smoke, but does not promote smoking cessation or reduction over time.

  • Neighborhood/place

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  • Contributors SLM designed the study, analysed the data, interpreted results and drafted the article. KAM assisted with analysing data. AVDR acquired the data. All authors provided guidance on study design and interpretation of results, critically revised drafts of the manuscript and approved the final version for publication.

  • Funding This research was partially supported by US Department of Health and Human Services. National Institutes of Health (NIH), P60 MD002249-05 (National Institute of Minority Health and Health Disparities) and R01 HL071759 (National Heart, Lung, and Blood Institute (NHLBI)). Funding for the MESA parent study came from NIH NHLBI contracts: HHSN268201500003I, N01-HC-95159 through 95169, UL1-TR-000040 and UL1-TR-001079.

  • Competing interests None declared.

  • Ethics approval Drexel University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The Multi-Ethnic Study of Atherosclerosis (MESA) has hundreds of investigators, many active scientific working groups (on renal disease, eye disease and other topics) and dozens of ongoing analytic projects. The authors are always looking for outside investigators interested in using the data to answer their research questions. To help interested parties navigate the data and topics and find fruitful collaborations, they encourage you to contact the Coordinating Center or a MESA investigator. Here is a link to the website for more details: