Objectives Multi-unit housing environments remain significant sources of secondhand smoke (SHS) exposure, especially for vulnerable populations in subsidized housing. In Philadelphia, the largest US housing authority to implement smoke-free policies, we measured baseline resident smoking-related behaviors and attitudes, and longitudinal exposures to airborne nicotine, during policy development and implementation. Methods In 4 communities, we collected data in 2013, 2014, and 2016, before and after introduction of comprehensive smoke-free policies, interviewing persons in 172 households, and monitoring air-borne nicotine in non-smoking homes and public areas. Average nicotine level differences across years were estimated with multi-level models. Results Fifty-six percent of respondents smoked. Only 37% of households were smoke-free, with another 41% restricting smoking by area or time of day. The number of locations with detectable nicotine did not differ before and after policy implementation, with approximately 20% of non-smoking homes and 70%–80% of public areas having detectable nicotine. However, public area nicotine levels were lower in 2016, after policy implementation, than in 2013 and 2014 (−0.19 μg/m3, p = .03). Conclusions Findings suggest that initial policy implementation was associated with reduced SHS exposure in Philadelphia. As HUD strengthens smoke-free policies, SHS monitoring can be useful to educate stakeholders and build support for policy enforcement.

BackgroundIn breast cancer, worse disease characteristics are associated with fewer social resources and black race. However, it is unknown whether social gradients have similar impact across race, and whether behaviors, including tobacco use, may explain a portion of the social gradient.MethodsWe modeled relationships between area-level social class, tobacco spending and tumor characteristics, using 50,062 white and black cases diagnosed from 1992–2003 in Maryland, a racially and economically diverse state on the east coast of the United States. Multi-level models estimated the effect of area-level social class and tobacco consumption on tumor grade, size, and stage at diagnosis.ResultsAdjusting for race, age and year of diagnosis, higher social class was associated with lower risk for tumors with histological grade 3 or 4 (O.R. 0.96, 95% C.I. 0.94,0.99), those diagnosed at SEER stage 2 or later (O.R. 0.89, 95% C.I. 0.86, 0.91), and tumor size >2 cm (O.R. 0.87, 95% C.I. 0.84, 0.90). Higher tobacco spending was associated with higher risk for higher grade (O.R. 1.01, 1.00, 1.03) and larger tumors (O.R. 1.03, 95% C.I. 1.01, 1.06), but was not statistically significantly related to later stage (O.R. 1.00, 95% C.I. 0.98, 1.02). Social class was less protective for black women, but tobacco effects were not race-specific.ConclusionsResults suggest that in one U.S. geographic area, there is a differential protection from social class for black and white women, supporting use of intersectionality theory in breast cancer disparities investigations. Area-level tobacco consumption may capture cases’ direct use and second hand smoke exposure, but also may identify neighborhoods with excess cancer-related behavioral or environmental exposures, beyond those measured by social class. Given the growing global burden of both tobacco addiction and aggressive breast cancer, similar investigations across diverse geographic areas are warranted.

INTRODUCTIONAlthough both active tobacco use and passive tobacco exposure are well-established as being risk factors for lung cancer, it is challenging to measure tobacco-related exposures at the population level, while considering other factors (gender, race, socioeconomic status) that may modify the relationship between tobacco and lung cancer. Moreover, research to date has focused primarily on relationships between tobacco and endpoints of lung cancer incidence or mortality. Tobacco’s role in disease progression, through association with important disease characteristics such as tumor histological type and grade, and stage of disease at diagnosis, has been less well examined.METHODSThis research examines associations between area-level tobacco use and social class, as well as individual gender, race and age, and three adverse disease characteristics (tumor type, grade and stage) among incident cases of lung cancer reported to the Maryland Cancer Registry in 2000. Cases were geocoded by residential address. Multi-level logistic regression models included Census block group-level estimates of per capita tobacco spending, from Consumer Expenditure Survey data, and a 4-item social class index, from Census estimates of rates of high school graduation, employment, white collar occupation, and per capita income.RESULTSAnalyses of 3223 cases found no significant differences by race, however, results differed by gender. Lower block-group social class and higher tobacco spending were associated with squamous and small cell histological types and poorly differentiated or undifferentiated tumor grade. However, for later stage at diagnosis (SEER stages 2–7), both higher social class and greater tobacco spending were protective, especially for women, suggesting women in high tobacco use communities may benefit from early detection.CONCLUSIONSResults support using area-level behavioral data as tools for identifying high risk communities suitable for more resource-intensive research or interventions. Findings also suggest that area-level social resources are consistent drivers of lung cancer disparities, and merit continued research attention.

There is substantial evidence linking adverse breast cancer characteristics, including more aggressive histology, larger tumor size, and advanced stage at diagnosis, to both African American race, and lower social class. However, it is not well known if social class affects black and white women similarly, and what behavioral or environmental factors may contribute to the social class gradient for each racial group. Using data from approximately 55,000 cases of breast cancer reported to the Maryland Cancer Registry between 1992-2003, we used multi-level random effects models to examine the relationship between case race, age, year of diagnosis, area-level social class indices (area-level rates of high school graduation, employment, white collar work, and income) and three characteristics associated with adverse cancer outcomes: SEER stage at diagnosis (stage 2-7 versus 1), large tumor size at diagnosis (>2 cm versus <=2 cm), and aggressive histological grade of tumor (grade 3 or 4, versus 1 or 2). We then examined the additional contribution to the model of an estimate of area-level smoking behavior, using estimates of area-level average per household tobacco spending. Finally, we examined whether effects of social class and tobacco use varied for white and black women. Results demonstrate that black women were more likely to be diagnosed with later stage cancers (O.R. =1.29, 95% C.I.= 1.22,1.35), larger tumors (O.R.= 1.45, 95% C.I.= 1.34, 1.56), and more aggressive tumor histology (O.R. 1.65, 95% C.I.= 1.56,1.74). Social class was protective for all three outcomes, but statistically significant interactions showed that this protective effect of social class was reduced for black women compared to white women. In addition, each $1000 increase in average household level of tobacco spending was significantly associated with aggressive grade (O.R.=1.01 per $1000) and larger tumor size (O.R. =1.03, 95% C.I.=1.01,1.06) but not significantly associated with late stage diagnosis. There were no statistically significant interactions of tobacco spending by race, indicating that the effect of tobacco spending are similar for black and white cases. Findings suggest that social class effects differ by race, and that intersectionality - the context-based understanding of multiple simultaneous social effects on health - may be an important approach to understanding excess breast cancer burden in women. This analysis also suggests that health risk behaviors, such as group-level tobacco use, may contribute additional risk, and should be further explored with more robust designs and data. Citation Format: Ann C. Klassen, Aaron Pankiewicz, Frank Curriero. Race-specific social gradients in breast cancer burden in Maryland: 1992-2003. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 129. doi:10.1158/1538-7445.AM2013-129