Neighborhood Socioeconomic Deprivation and Geographic Heterogeneity of Tobacco Environment in Missouri

Abstract

Abstract Purpose: To examine neighborhood characteristics associated with geographic distribution of tobacco sale outlets in Missouri. Methods: We obtained the addresses of tobacco outlets in Missouri from the Missouri Department of Mental Health. We geocoded these addresses and computed the outlet density by 5-digit ZIP codes. Using the data from the 2008–2012 American Community Survey, we developed a ZIP Code Tabulation Area (ZCTA)-level socioeconomic deprivation (SED) index. We analyzed the relationships of tobacco outlet density with neighborhood SED index and five separate socioeconomic indicators (%population with less than high school, %population unemployed, %households below the poverty, % population under the poverty, and %African Americans). Results: There were more than 5,000 tobacco retailers within Missouri in January, 2014. The number of tobacco retailers ranged from 0 to 56 (median = 2) per ZIP code, while tobacco outlet density ranged from 0 to 29 per 1,000 persons age 18+ (median: 1.18). Tobacco outlet density was significantly correlated with neighborhood SED (rho = 0.21, P < 0.001). The consistency of quartiles of both variables was also statistically significant (weighted Kappa = 0.11, P < 0.001). Logistic regression analysis indicated that neighborhood SED was associated with more than 3 times higher odds of denser tobacco outlets (>median density) (the most vs. least deprived quartile: odd ratio = 3.24, 95% confidence interval = 2.26–4.65). Similar results were also found for each of the five individual socioeconomic indicators. Conclusion: Geographic distribution of tobacco retailing outlets was strongly associated with neighborhood SED environment. Neighborhoods with greater SED condition were also more likely to have a higher density of tobacco retailing outlets in Missouri. Our finding implies that higher accessibility to tobacco retailing outlets might play an important role in geographic SED disparity in smoking. Future studies should examine the degree to which neighborhood SED effect on smoking behaviors is mediated by higher accessibility to tobacco retailing outlets. This insight can help policy-makers develop appropriate geographic priority to effectively allocate tobacco control programs to reduce cigarette smoking in Missouri.