Tobacco outlet density and smoking prevalence: Does racial concentration matter?

The abuse of tobacco products is cause for international concern. The World Health Organization (WHO) estimates that tobacco use is the fourth most common risk factor for disease worldwide and the second leading cause of death in the world. Although the dangers of smoking have been well publicized in many industrial countries, current smoking patterns suggest that by the year 2025 smoking-related disease will account for approximately ten million deaths each year. The United States is one such industrial country where the detrimental effects of tobacco use have created a public health crisis, claiming the lives of over 440,000 Americans on an annual basis. Of particular concern is the growing epidemic of diseases caused by tobacco use among African Americans. But an important question eluding public policy officials is whether tobacco companies are increasing their presence in disadvantaged, racially diverse communities to increase sales of their product. Addressing this concern, this study is among the first to examine the effect of race on the geographic association between tobacco outlet density and cigarette smoking prevalence. End-of-year 2002 data were derived from licenses of 4745 tobacco-selling retail outlets operating in the State of Iowa, which is located in the midwestern part of the USA. The 2000 US census and the 2002 Iowa Behavioral Risk Factor Surveillance System were used to inform race and smoking prevalence variables. Results of hierarchical regression analysis indicated that the relationship between tobacco outlet density and smoking prevalence was greater in Iowa counties with a higher percentage of African Americans. Implications for tobacco-control policies and directions for future research are discussed.