Density of tobacco retailers and its association with sociodemographic characteristics of communities across New York

Summary

Objective

To examine the association of community median income, race/ethnicity and age with the availability of tobacco products in New York State and six subareas.

Study design

Spatial regression analysis applied to licensed tobacco retailer and sociodemographic data in 2009 in New York.

Methods

This study assessed the association between tobacco retailer density and four demographic correlates (percentage African American, percentage Hispanic, percentage aged <18 years and median household income) at the census tract level in New York in 2009. Associations were modelled for New York State and six subareas: Greater New York City/Long Island, New York minus Greater New York City/Long Island (rest of State), the Capital region (containing the city of Albany and surrounding areas), Erie County (containing the city of Buffalo), Monroe County (containing the city of Rochester) and Onondaga County (containing the city of Syracuse). In total, 19,420 licensed tobacco retailers were linked to 4795 residential census tracts.

Results

In New York State, residential census tracts with higher proportions of African Americans and Hispanics generally had a significantly higher density of tobacco retailers. Census tracts with a higher percentage of residents aged <18 years and higher median household income generally had a significantly lower density of tobacco retailers. However, these associations were not statistically significant in all areas studied.

Conclusions

Tobacco retailers tend to be more densely distributed in areas characterized by high minority or low-income populations, but these associations were not found in all areas. This may suggest that policy measures to reduce the density of tobacco retailers may be more effective at reducing disparities in tobacco availability and exposure to point-of-sale advertising in some areas than in others.

Introduction

The tobacco industry has long recognized the importance of the retail outlet in promoting tobacco use. Tobacco industry documents from as early as the 1970s highlight the industry's interest in retail advertising, promotion and product placement.¹ More recently, in 2008, the tobacco industry spent US$9.9 billion on product marketing, approximately 85% of which was devoted to reducing the price of tobacco to smokers or advertising tobacco at the point of sale.² In New York, where this study was conducted, 96% of shops that sell tobacco also contain tobacco advertising.³ Therefore, the more shops that sell tobacco in a community, the more tobacco advertising in that community.

Youth, in particular, are highly aware of tobacco advertisements in shops.⁴ Exposure to point-of-sale tobacco advertising is associated with the perception that smoking is prevalent among youth peers and that cigarettes are easy to obtain,5, 6 and can lead to an increased risk of smoking initiation6, 7, 8, 9, 10, 11 and progression to regular smoking.10, 11, 12, 13, 14 Economic studies have shown that higher cigarette prices lead to less smoking,¹⁵ and low-income and African American smokers may be particularly price sensitive.¹⁶ Living in an area with a high number of tobacco retailers will effectively lower the cost of obtaining and using tobacco, potentially resulting in greater use. As a result of these concerns, states and communities are considering laws to restrict the number, type and location of tobacco retailers, and the Institute of Medicine has recommended that ‘state governments should develop and, if feasible, implement and evaluate legal mechanisms for restructuring retail tobacco sales and restricting the number of tobacco outlets’ (p. 307).¹⁷

Higher tobacco retailer density has been documented in poor and minority neighbourhoods in Buffalo (NY),¹⁸ Omaha (NE),¹⁹ Polk County (IA),²⁰ Bergen and Salem Counties (NJ),²¹ and New Jersey.²² A study using national data from the USA estimated higher tobacco outlet density in urban vs rural areas, and in association with larger proportions of Blacks, Hispanics and women with low levels of education.²³ The present study estimated the relationship between the density of tobacco retailers and the race/ethnicity, age and income characteristics of the communities in which those retailers are located using data from 2009 in New York State. As New York is a large and diverse state, spatial regression models were estimated for New York State as a whole and six distinct subareas to better understand if the relationship between tobacco retailer density and community demographic characteristics was similar across the various areas of New York State, or whether there were meaningful differences between areas. The results have implications for the effectiveness of policy interventions that limit the number, type and location of tobacco retailers in reducing disparities in tobacco availability and point-of-sale tobacco advertising exposure among disadvantaged population groups.