Black, white, or green? The effects of racial composition and socioeconomic status on neighborhood-level tobacco outlet density

Race has been shown to be a social construct, but its effects on health disparities and resource inequalities is substantial due to systems of oppression like segregation. Tobacco outlet density studies have reported a direct relationship between Black population percentage and tobacco outlet density, as well as inverse relationships between socioeconomic status and tobacco outlet density. It remains unclear whether socioeconomic status or race has a larger effect than the other. This study compared predominantly-Black and predominantly-White Maryland areas with similar socioeconomic status to examine the role of both race and socioeconomic status on tobacco outlet availability and tobacco outlet access. Influenced by past studies, the hypothesis was that there would be no difference in tobacco outlet availability and access in areas with similar socioeconomic status despite different majority racial concentrations. This study geocoded Maryland tobacco outlet addresses with 2011–2015 American Community Survey sociodemographic data. Two-sample t-tests were conducted comparing the mean values of sociodemographic variables and tobacco outlet density per Census Tract, and spatial lag based regression models were conducted to analyze the direct association between covariables and tobacco outlet density while accounting for spatial dependence between and within jurisdictions. Results showed that predominantly-White jurisdictions had lower tobacco outlet availability and access than predominantly-Black jurisdictions, despite similar socioeconomic status. Spatial lag model results showed that median household income and vacant houses had consistent associations with tobacco outlet density across most of the jurisdictions analyzed, and place-based spatial lag models showed direct associations between predominantly-Black jurisdictions and tobacco outlet availability and access.