Background
Social features of neighborhood environments may influence smoking by creating a stressful environment or by buffering stress through social cohesion. However, the association of the overall neighborhood social environment (NSE) with smoking, and the association of specific neighborhood social factors with change in smoking behavior over time, has rarely been examined.
Methods
This study included 5,856 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 neighborhood surveys). Generalized 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 standard deviation increase in baseline NSE composite score was associated with 13% lower prevalence of smoking at baseline (adjusted prevalence ratio (aPR): 0.87 (95% confidence interval: 0.78, 0.98). Neighborhood safety and aesthetic quality were similarly associated with lower smoking prevalence (aPR: 0.87 (0.78, 0.97) and aPR: 0.87 (0.77, 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 neighborhood social context influences whether older adults smoke, but does not promote smoking cessation or reduction over time.