Many factors at multiple levels may give rise to geographic health disparities in cancer and tobacco use. To develop appropriate interventions, it is useful to consider factors at multiple levels. Beginning at the outermost level, the political and economic environment includes key features of communities such as policies and laws, availability of health care services, and characteristics of people who live in the community. The second level focuses on features of the physical environment, including the built, occupational, and natural environments. The third level examines features of the social context, including interpersonal networks, cultural beliefs, and shared norms. The fourth level focuses on individual characteristics that influence tobacco use and cancer risk. Finally, the innermost level examines the influence of biology on tobacco and cancer outcomes. It is important to note that factors at one level are often closely linked with other levels. Hover over the levels to learn more about how they influence cancer and tobacco-related outcomes.







Although not the primary focus of efforts within the Geographic Health Equity Alliance, biological factors, including genetics, do contribute to cancer and tobacco-use risk.

Key Factors

> Medical Conditions
> Genetics

This includes key characteristics that influence risk such as age, race/ethnicity, income, education, and health behaviors (e.g., diet, physical activity, smoking, alcohol use).

Key Factors

> Health Behaviors
> Demographics
> Socio-Economic Status

This level focuses on interpersonal relationships, including networks of social connections, cultural factors, shared social norms about cancer and tobacco, and the positive benefits that arise from community social connections.

Key Factors

> Culture
> Social Capital
> Social Networks
> Social Norms

This level focuses on features of the built environment (roads, sidewalks, housing and retail characteristics), environmental exposures such as proximity to hazardous substances and advertising, exposures in work places, as well as travel distance to urban areas and health care facilities.

Key Factors

> Travel Distance
> Occupational Exposure
> Environmental Exposure
> Built Environment

This level includes features of communities such as state and local policies and laws, as well as characteristics of people who live in the community (income, education, housing). It also includes geographical features such as population density and rurality, as well as the number and distribution of health care providers and facilities.

Key Factors

> Access To Care
> Area-level Characteristics
> State & Local Politics
> Health Care Systems