Direct and Indirect Effects of Tobacco Outlet Density on Tobacco Use Among African American Young Adults

Background: No policies to date regulate tobacco outlet density in residential neighborhoods. This is problematic because exposure to tobacco outlets at the neighborhood level potentially has both direct and indirect effects on tobacco use. Mediating mechanisms that explain the relationship between tobacco outlet exposure and tobacco use are understudied. Aim: To assess the mediating role of perceived harmfulness and disapproval of cigarette use in the relationship between tobacco outlet exposure (i.e., density and proximity to outlets) and past month tobacco use among African American young adults living in Baltimore City, Maryland.  Methods: Path analyses and geospatial methods were used to evaluate the mediating role of perceived harmfulness and disapproval of cigarette use in the relationship between tobacco outlet exposure and past month tobacco use among 230African American young adults living in Baltimore City from 2007 through 2009. Tobacco outlet density and proximity were assessed at the neighborhood level (e.g., within a quarter mile of participants’ homes). Tobacco outlets were classified based on whether or not they were licensed to sell tobacco only (TO outlets) or tobacco and alcohol (TA outlets).  Results: Among men, the relationship between tobacco outlet density (both TO and TA outlets) and past month tobacco use was fully mediated by disapproval of cigarette use. For example, men living in neighborhoods with at least one TA outlet per quarter mile were more likely to approve of cigarette use, which was in turn associated with an increased likelihood of tobacco use, and this indirect path was significant (probit coefficient for the indirect path 0.275; 95% bootstrap confidence interval 0.006, 0.761). Perceived harmfulness of cigarette use was not a significant mediator in this relationship.  Among women, tobacco outlet density did not directly or indirectly effect tobacco use.  Furthermore, the relationship between proximity to the nearest tobacco outlet was not mediated by either disapproval or perceived harmfulness of cigarette use for men or women. Conclusion: Tobacco outlet density, relative to proximity is the more salient correlate of tobacco use and the effects of tobacco outlet density on tobacco use vary by gender. This study provides a more complete conceptual framework of the relationship between tobacco outlet exposure and tobacco use by elucidating mediating factors. Furthermore, these results call attention to potential gender differences in the relationship between tobacco outlet density and tobacco use. This study has implications for policies aimed at reducing tobacco outlet density in residential areas, as well as preventive interventions aimed at addressing perceived norms about tobacco use.

"Funding Sources: NIDA Grants T32DA007292 (P.I. Debra Furr-Holden, 
PhD) and R37-DA011796 (P.I. Nicholas Ialongo, PhD)."