Inequalities in tobacco outlet density by race, ethnicity and socioeconomic status, 2012, USA: results from the ASPiRE Study

Abstract

BACKGROUND Evidence of racial/ethnic inequalities in tobacco outlet density is limited by: (1) reliance on studies from single counties or states, (2) limited attention to spatial dependence, and (3) an unclear theory-based relationship between neighborhood composition and tobacco outlet density. METHODS In 97 counties from the contiguous US, we calculated the 2012 density of likely tobacco outlets (N=90,407), defined as tobacco outlets per 1,000 population in census tracts (n=17,667). We used two spatial regression techniques, (1) a spatial errors approach in GeoDa software and (2) fitting a covariance function to the errors using a distance matrix of all tract centroids. We examined density as a function of race, ethnicity, income, and two indicators identified from city planning literature to indicate neighborhood stability (vacant housing, renter-occupied housing). RESULTS The average density was 1.3 tobacco outlets per 1,000 persons. Both spatial regression approaches yielded similar results. In unadjusted models, tobacco outlet density was positively associated with the proportion of Black residents and negatively associated with the proportion of Asian residents, White residents and median household income. There was no association with the proportion of Hispanic residents. Indicators of neighborhood stability explained the disproportionate density associated with Black residential composition, but inequalities by income persisted in multivariable models. CONCLUSIONS Data from a large sample of US counties and results from two techniques to address spatial dependence strengthen evidence of inequalities in tobacco outlet density by race and income. Further research is needed to understand the underlying mechanisms in order to strengthen interventions.

Neighbourhood characteristics and health outcomes: evaluating the association between socioeconomic status, tobacco store density and health outcomes in Baltimore City

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Tobacco outlet density and tobacco knowledge, beliefs, purchasing behaviours and price among adolescents in Scotland

“…The ubiquity of tobacco outlets in Scotland, may make identification of their effects difficult, especially in urban areas. The density of Scottish tobacco outlets found in this study of 1.9 per 1,000 people was considerably higher than that of 1.3 per 1,000 found, for example, in the USA (Lee et al, 2017) This analysis focussed upon outlets near adolescent's homes. However, measures of exposure to tobacco outlets around home and schools may underestimate adolescents' exposures (Lipperman-Kreda et al, 2015).…”

Neighborhood Disadvantage and Tobacco Retail Outlet and Vape Shop Outlet Rates

“…To overcome the limitation noted above, different spatial regression techniques have been developed to account for geographic clustering in the data [13,14]. These spatial regression techniques include calculation of the spatial autocorrelation in the residuals resulting from autocorrelation of the dependent variable (e.g., spatial lag), spatial autocorrelation in the error term due to spatially autocorrelated predictors not included in the models (e.g., spatial error), and conducting Lagrange multiplier tests to determine whether a spatial model or standard ordinary least squares modeling approach was most appropriate [5].…”