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Second, there could be unmeasured variables that account for the associations between early age of cigarette smoking initiation and COPD risk, such as prenatal smoke exposure 26 and unmeasured aspects of cigarette smoking not accounted for by pack years, smoking duration, or current smoking status

For example, in Philadelphia, one study showed that low-income areas have 69% more tobacco retailers per person and more tobacco retailers within 500 and 1,000 feet of schools than high-income neighborhoods

Martinello says

This process led to recognition that one of the reasons the City was suffering was that many of its people had become afraid to use its streets and other public places

Disparities in screening and cancer stage at diagnosis likely reflect a combination of behavioral and structural barriers 7