The inequitable distribution of tobacco outlet density: the role of income in two Black Mid-Atlantic geopolitical areas

Abstract

Introduction Studies have shown that communities with higher concentrations of low-income racial and ethnic minorities correlate with a greater presence of tobacco outlets. Community-level income has consistently been among the strongest predictors of tobacco outlet density. This study analyzes two Maryland geopolitical areas with similar racial concentrations yet differing income levels in an attempt to disentangle the race-income relationship with tobacco outlet density. Study Design In this cross-sectional examination of tobacco outlet and census tract-level sociodemographic data, Baltimore City, Maryland and Prince George's County, Maryland were geocoded to determine tobacco outlet density. Methods Tobacco outlet density was defined as the mean number of tobacco outlets per 1,000 persons per census tract. Comparisons of tobacco outlet density and sociodemographic variables were analyzed via two-sample t-tests, and the direct effect of sociodemographic variables on tobacco outlet density for each area was analyzed via spatial lag regressions. Results Prince George's County, the area with the higher income level ($77,190 vs. $43,571), has a significantly lower tobacco outlet density than Baltimore City (p < .001). Prince George's County has a 67.5% Black population and an average of 3.94 tobacco outlets per 1,000 persons per tract. By contrast, Baltimore City has a 65.3% Black population and an average of 7.95 tobacco outlets per 1,000 persons per tract. Spatial lag regression model results indicate an inverse relationship between income and tobacco outlet density in Baltimore City and Prince George's County (β = -0.03, p < 0.01 β -0.01, p = 0.02, respectively), and a significant interaction term indicating a greater magnitude in the relationship between income and tobacco outlet density in Baltimore City (β = -0.05, p < 0.01). Conclusion Results suggest that higher socioeconomic status, even in primarily underrepresented racial and ethnic geopolitical areas, is linked to lower tobacco outlet density.

Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks’ Diminished Return

“…The differential effect of SES on smoking by race may be due in part to the policies and practices of the tobacco industry and access to smoking cessation services that disproportionately affect racial minorities. At least some of this pattern may be due to factors such as predatory marketing [ 84 ], flavoring [ 85 ], and the density of tobacco retailers [ 86 , 87 ]. Blacks may be also more sensitive to tobacco industry marketing than Whites [ 88 ].…”

Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research

“…Research suggests that racial and socioeconomic inequities persist in the residential proximity to, and density of, stores selling tobacco and alcohol. Many U.S.-based studies at the state, metropolitan area, and county levels have found that stores selling tobacco are disproportionately located in neighborhoods with higher percentages of minorities, particularly African Americans and Hispanics [ 52 , 53 , 54 ], and lower income [ 55 , 56 , 57 ]. Similar patterns of racial and economic inequity have been found for alcohol outlets [ 58 , 59 , 60 ].…”

<p>The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease</p>

“…Second, disadvantaged neighborhoods may have a clustering of risk factors that worsen COPD morbidity, such as tobacco smoke exposure, indoor and outdoor air quality, substandard housing, limited access to nutritious foods, and promotion of healthy diet. [44][45][46][47] For example, access to tobacco is greater in low-income neighborhoods, and high density of tobacco stores is associated with worse general Figure 3 Association of continuous ADI and COPD-related outcomes by rural status. The charts illustrate the interactions between continuous ADI and rural status on their associations with SGRQ, dyspnea, and 6-minute walk distance.…”

“…health outcomes. 44,45 In addition, neighborhood disadvantage may impact access to care, including transportation challenges 48 and fewer health care specialists. 49 Importantly, our results show that neighborhood factors, independent of individual SES factors, which have previously been linked to worse quality of life and functional status 50,51 are associated with COPD outcomes.…”