Counter Tobacco: Laying the Groundwork for Tobacco Retailer Licensing in North Carolina

Background: Tobacco use, primarily of cigarettes, is the leading preventable cause of death in the United States (Danaei et al., 2009; Mokdad, Marks, Stroup, & Gerberding, 2004; US Department of Health and Human Services, 2004). In North Carolina, 12,200 of our state's citizens die every year from tobacco use, and the state spends $769 million in tobacco-related Medicaid costs. Additionally, despite widespread prevention efforts, cigarette-smoking rates remain high among youth (Everett et al., 1999). Exposure and access to tobacco is also an area reflective of striking disparities along racial, socio-economic, and age lines. It is therefore imperative that North Carolina take progressive steps to decrease youth cigarette use. One way in which states and localities are reducing tobacco use is by creating tobacco control policies that act at the point-of-sale (POS). POS policies are those that are directed at the location and event of purchase of tobacco products. One POS policy that has been used in the majority of states, but not in North Carolina, is tobacco retailer licensing. Tobacco retailer licensing laws can effectively decrease access and smoking rates, illegal sales of tobacco products and resulting tax revenue losses, and the burden of enforcement costs on the state when fees from licensing fund enforcement efforts. Methods: As a group of Capstone students from the Department of Health Behavior at the UNC Gillings School of Global Public Health, we produced four deliverables to lay the groundwork for tobacco retailer licensing in North Carolina. These deliverables are presented in the following order: 1) Tobacco retailer maps of Chapel Hill and Durham County 2) Policy brief 3) Social marketing materials, and 4) Manuscript. To assess the locations of tobacco retailers in two local communities, team members collected Geographic Information Systems (GIS) data on every tobacco retailer in Chapel Hill and Durham County. From these data, team members created maps of tobacco retailers in Chapel Hill and Durham County and examined spatial patterns based on available data, such as census information on racial composition and income of census blocks. To create a policy brief that advocates of POS policies could use to communicate with policy makers, a review of the scientific, legal, and advocacy materials on licensing tobacco retailers was conducted. To inform and inspire advocacy among potential allies around tobacco retailer licensing, the team created social marketing materials that were message-tested with Durham and Chapel Hill residents as well as community leaders, and revised materials with this input to create final versions. Finally, the team drafted a manuscript to document existing published evidence of POS tobacco marketing, youth tobacco use, and youth purchase of tobacco at tobacco retail outlets near schools. Results: We increased the North Carolina tobacco advocacy community and the general public's knowledge about tobacco retailer licensing. The data collected and materials produced were presented to members of the Orange County Health Department, the North Carolina Tobacco Prevention and Control Branch, the North Carolina Alliance for Health, and community leaders from Durham and Chapel Hill as testimony for the need for tobacco retailer licensing in these areas. Finally, all of the materials will be made available on the Counter Tobacco website for advocates to continue to use. Discussion: Working with the tobacco control advocacy and policy-making communities provided the Capstone team with the opportunity to continually refine the priorities and deliverables of our project. These experiences provided a solid foundation of policy advocacy and social marketing skills for Capstone team members. The Capstone team's activities and materials will advance POS policies in North Carolina and across the country.Master of Public Healt

A two-tiered model for simulating the ecological and evolutionary dynamics of rapidly evolving viruses, with an application to influenza

Understanding the epidemiological and evolutionary dynamics of rapidly evolving pathogens is one of the most challenging problems facing disease ecologists today. To date, many mathematical and individual-based models have provided key insights into the factors that may regulate these dynamics. However, in many of these models, abstractions have been made to the simulated sequences that limit an effective interface with empirical data. This is especially the case for rapidly evolving viruses in which de novo mutations result in antigenically novel variants. With this focus, we present a simple two-tiered ‘phylodynamic’ model whose purpose is to simulate, along with case data, sequence data that will allow for a more quantitative interface with observed sequence data. The model differs from previous approaches in that it separates the simulation of the epidemiological dynamics (tier 1) from the molecular evolution of the virus's dominant antigenic protein (tier 2). This separation of phenotypic dynamics from genetic dynamics results in a modular model that is computationally simpler and allows sequences to be simulated with specifications such as sequence length, nucleotide composition and molecular constraints. To illustrate its use, we apply the model to influenza A (H3N2) dynamics in humans, influenza B dynamics in humans and influenza A (H3N8) dynamics in equine hosts. In all three of these illustrative examples, we show that the model can simulate sequences that are quantitatively similar in pattern to those empirically observed. Future work should focus on statistical estimation of model parameters for these examples as well as the possibility of applying this model, or variants thereof, to other host–virus systems