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

Public Health. 2016 Jul;136:35-40. doi: 10.1016/j.puhe.2016.02.032. Epub 2016 Apr 10.


Objectives: 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 1000 persons per census tract. Comparisons of tobacco outlet density and sociodemographic variables were analysed via two-sample t-tests, and the direct effect of sociodemographic variables on tobacco outlet density for each area was analysed 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 < 0.001). Prince George's County has a 67.5% Black population and an average of 3.94 tobacco outlets per 1000 persons per tract. By contrast, Baltimore City has a 65.3% Black population and an average of 7.95 tobacco outlets per 1000 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 socio-economic status, even in primarily underrepresented racial and ethnic geopolitical areas, is linked to lower tobacco outlet density.

Keywords: Census tracts; Communities; Geopolitical areas; Income; Race; Tobacco outlets.

MeSH terms

  • African Americans / statistics & numerical data*
  • Commerce / statistics & numerical data*
  • Cross-Sectional Studies
  • Humans
  • Income / statistics & numerical data*
  • Maryland
  • Residence Characteristics / statistics & numerical data*
  • Tobacco Products / statistics & numerical data*