Black, White, or Green? The Effects of Racial Composition and Socioeconomic Status on Neighborhood-Level Tobacco Outlet Density in Maryland

Despite declines in tobacco use, disparities in tobacco-related health outcomes continue to affect disadvantaged populations such as Blacks and low-income individuals. Efforts have been made to reduce tobacco use, but it is important to consider the influence of tobacco outlet density. The research of the relationship between sociodemographics and tobacco outlet density is limited, but studies have reported associations that warrant deeper investigation. This study utilized the contextual-ecological heterogeneity of Maryland to elucidate the relationship between race and socioeconomic status to refine the basic epidemiological foundation of determinants of tobacco outlet density. Data included Census Tract-level sociodemographic data from the 2011-2015 American Community Survey, Maryland roadway data, and 2016-2017 Maryland tobacco outlet addresses. Tobacco outlet density was measured as both the number of tobacco outlets per 1,000 persons per Census Tract and the number of tobacco outlets per 10km of roadway. Two-sample t-tests were conducted to compare mean descriptives across jurisdictions, and spatial lag regression models were conducted to determine the direct association of sociodemographics and place with tobacco outlet density. Aim I investigated the relationship between socioeconomic status and tobacco outlet density in predominantly White Maryland counties. The results of the study supported the hypothesis, showing that predominantly-White counties with higher socioeconomic status had lower tobacco outlet density than predominantly-White counties with lower socioeconomic status. Aim II examined the relationship between racial composition and tobacco outlet density while controlling for socioeconomic status and urbanicity in Maryland counties. The results did not support the hypothesis, as predominantly-White counties had lower tobacco outlet density than predominantly-Black counties, despite both having similar socioeconomic status. Aim III was a descriptive epidemiological study of the relationship between sociodemographics and tobacco outlet density in Maryland. The results of the findings were consistent with findings from past statewide and nationwide tobacco outlet density studies, showing that Black population percentage was directly related to tobacco outlet density, White population percentage was inversely related to tobacco outlet density, and that socioeconomic status was inversely related to tobacco outlet density. The overall findings support the existence of racial and socioeconomic gradients that must be acknowledged in tobacco control policies