U54 Pilot: Examining the Role of Neighborhood Environmental Risk and Relative Rurality in Tobacco and Nicotine Use Behaviors: Insights from the All of Us Research Program

Tobacco and nicotine product use remains a major public health concern in the United States, with an estimated 18. 7% of the population using at least one product. While cigarette smoking has long been linked to chronic disease, emerging evidence implicates newer products, such as e-cigarettes, in respiratory diseases. Despite a shift in product use trends, the persistent burden of tobacco-related harm, particularly among socioeconomically disadvantaged populations, necessitates a greater understanding of contextual risk factors. This study examines the influence of the Neighborhood Environment (NE), a key component of the Social Determinants of Health (SDoH), and geographic location on tobacco/nicotine use. Using data from the All of Us Research Program, which includes groups underrepresented in biomedical research, we assess how NE, and geographic factors (Index of Relative Rurality, IRR) shape product choice and patterns of exclusive or poly use. Our first aim explores associations among NE characteristics, IRR, and tobacco use prevalence. The second aim develops a composite Neighborhood Environment Risk (NER) score using Item Response Theory (IRT), enabling the synthesis of heterogeneous NE measures into a latent risk construct. This validated NER score will be used to examine differential risk by product type and population subgroup. Findings of this study will support one of the Center for Tobacco Products'' Behavior priorities by evaluating tobacco product use across populations, including those disproportionately affected by social determinants of health (SDoH). This study will inform targeted interventions and policy strategies to advance the evidence base necessary for precision public health and population-specific regulatory action.