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Inequities in tobacco retailer sales to minors by neighbourhood racial/ethnic composition, poverty and segregation, USA, 2015
  1. Joseph G L Lee1,
  2. Hope Landrine2,
  3. Essie Torres1,
  4. Kyle R Gregory3
  1. 1Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
  2. 2Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
  3. 3Georgia State University Tobacco Center of Regulatory Science, Atlanta, Georgia, USA
  1. Correspondence to Dr Joseph G L Lee, Department of Health Education and Promotion, 3104 Carol Belk Building, Mail Stop 529, Greenville, NC 27858, USA; leejose14{at}


Objective Tobacco retailers are an important source of tobacco products for minors. Previous research shows racial discrimination in sales to minors, but no national study has examined neighbourhood correlates of retailer under-age sales.

Methods We accessed publicly available results of 2015 US Food and Drug Administration (FDA) inspections of tobacco retailers (n=108 614). In this cross-sectional study, we used multilevel logistic regression to predict the likelihood of retailer sale to a minor based on tract characteristics. We assessed the proportion of residents identifying as American Indian, Asian, Black, Latino and White; Isolation Index scores for each racial/ethnic group; the proportion of people less than age 65 living in poverty; and the proportion of residents age 10–17 in relation to retailer inspection results.

Results The proportion of American Indian residents, Black residents, Latino residents and residents less than age 65 under the poverty line in a neighbourhood are independently, positively associated with the likelihood that a retailer in that neighbourhood will fail an under-age buy inspection. The proportion of White residents and residents age 10–17 are independently, negatively associated with the likelihood of sale of tobacco products to a minor. Isolation Index scores show a similar pattern. In multivariable models holding neighbourhood characteristics constant, higher proportions of Black (+), Latino (+) and age 10–17 (−) residents remained significant predictors of the likelihood of under-age sale.

Discussion Regulatory agencies should consider oversampling retailers in areas with higher likelihood of sales to minors for inspection. Interventions with tobacco retailers to reduce inequities in youth access should be implemented.

  • Disparities
  • Prevention
  • Advertising and Promotion

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  • Twitter Follow Joseph Lee at @Joseph_GL_Lee

  • Contributors JGLL conceptualised the study, conducted the analyses and wrote the first draft. All authors provided critical feedback on the conceptualisation of the study, interpreted the results, edited the manuscript and approved the final draft.

  • Funding Research reported in this publication was supported with trainee support by grant number P50DA036128 from the US NIH/National Institute on Drug Abuse and Food and Drug Administration (FDA) Center for Tobacco Products (KRG). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests JGLL has a royalty interest in a store audit/compliance and mapping system, Counter Tools (, owned by the University of North Carolina at Chapel Hill. The tools and audit mapping system were not used in this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data used in this study are available from the first author.