Social Capital and Tobacco Retail Outlet Density: An Empirical Test of the Relationship

Abstract

Purpose:

To examine the relationship between tobacco outlet density and social capital.

Participants:

Parents of at least one teen (N = 2734) in a representative sample of US households with teens (ages 13-16).

Design:

Population-based, cross-sectional survey of a web panel of adolescent–parent pairs matched with spatial data for address to characterize household neighborhoods.

Setting:

US households identified by latitude and longitude with a 50-ft random shift.

Measures:

Perceived social capital (trust and informal social control as reported by parents), tobacco outlet density (retailers per land area in 1/2-mile buffer around each household), neighborhood demographics (derived from American Community Survey), and parent demographics.

Analysis:

Multivariable regression examined the relationship between tobacco outlet density and social capital controlling for household buffer and individual-level covariates, including correlates of social capital.

Results:

Tobacco outlet density was inversely correlated with perceived trust in neighbors (B = −1.12, P = .0004), but not social control (B = 0.11, P = .731).

Conclusion:

This study is the first we are aware of to find that social capital is related to tobacco outlet density. The results imply that individuals with low social capital may benefit from policies regulating tobacco outlet density and may benefit from policies that address neighborhood inequality by increasing social capital and reducing poverty.

Keywords

active living/built environment tobacco control social health low income community

Purpose

A variety of socioecological frameworks have focused public health research on the interaction between people’s choices, their environment, and health-related outcomes.^1

-4 One of the important innovations of moving from largely individual-focused models toward ecological models is the explicit inclusion of community and physical environmental conditions as mechanisms that influence the individual’s decision-making process.^5,6 From an ecological context, opportunity structures⁷ for smoking in an environment play significant roles in smoking uptake.^8,9 Much research has focused on limiting places where residents in a community can smoke.^10
-12 However, there is increasing interest in limiting places where residents purchase tobacco products, commonly measured as tobacco outlet density (TOD).^13,14 While the relationships between TOD and neighborhood-level economic disadvantage and the presence of vulnerable populations have been documented,¹⁵ the relationship between social capital and TOD has not been explored. However, an inverse relationship between alcohol outlet density and social capital¹⁶ would lead us to predict that TOD and social capital are similarly correlated.

Background

The growing body of evidence regarding the environmental influences of TOD on smoking indicates that the concentration of retail outlets in a community is an important opportunity structure for smoking that can be addressed through retail-related policy interventions.^17

-25 Studies in the United States, Canada, New Zealand, and Australia show that tobacco outlets are disproportionately located (ie, higher TOD) in economically disadvantaged and low social economic status (SES) communities.^23,26
-28 In the United States, in both national and local area studies, higher TOD is associated with both community-level economic deprivation (measured generally through income) and higher rates of minority population composition, although the literature suggests that socioeconomic status is important even in areas with high levels of minority populations.^29

-37 In addition, TOD is greater near schools with a higher percentage of minority students.³⁸ While the relationship between TOD and many community-level characteristics has been well established, we could not find studies regarding TOD that considered social capital or studies regarding social capital and smoking that controlled for TOD.

Social capital is a collective resource that occurs at the interpersonal, group, or community level and commonly characterizes the social ties and norms that shape social interactions,^39,40 such as norms of trust⁴¹ and reciprocity,⁴² informal social control,^43,44 and civic engagement.⁴⁵ Social capital is thought to have a protective influence on smoking and other health risk behaviors because it may give residents access to social and community-level support and financial resources that improve the chances of making healthy choices. In fact, higher social capital is associated with lower odds of smoking among adults^46,47 and adolescents.^48,49 However, the relationship between social capital and TOD is unclear. Community-level zoning and retail licensing ordinances affect the location and density of tobacco, alcohol, and other retailers and have been used to promote public health around these issues.^50

-55 Zoning and licensing decisions are often influenced by, or the result of, civic engagement and collective action.^54,56
-58 It has been observed that political activism and civic engagement are associated with, among other things, high levels of social capital in a community.^40,59 It has been argued that social capital within a community is a precondition to collective action and that social capital helps to foster collective action by creating, imposing, legitimating, and diffusing a shared understanding and worldview among a community.^60
-62 In the case of TOD, we theorize that neighborhoods with higher social capital are better positioned to regulate tobacco retailers via licensing or zoning restrictions. Additionally, these communities may have already placed zoning or licensing restrictions on alcohol retailers,⁵⁰ many of which sell tobacco,⁶³ which would also reduce TOD in their communities. Thus, we hypothesize that social capital and TOD are inversely related.

Although it is plausible that social capital mediates or moderates the relationship between neighborhood characteristics and TOD, the current study cannot determine this (see Figure 1). Understanding the relationship between social capital and TOD will better elucidate how to garner support for retail policy interventions. Additionally, there is a need to understand how upstream or downstream factors may intersect, as the tobacco industry is attempting refocus of tobacco control efforts on upstream solutions.⁶⁴

Figure 1.

Possible relationships of social capital to tobacco outlet density.

Methods

Design

We report cross-sectional data from an Internet panel that uses address-based sampling to create a representative sample of US households (GfK, Inc, Chicago, IL, USA; April 2011 to December 2012). One parent and one age-eligible teenager (aged 13-16 years) per household completed surveys about environmental and social influences on tobacco, following procedures approved by a university medical institutional review board. Further details about the methods have been reported elsewhere.^14,65

Sample

This paper focuses on parent respondents exclusively, who were asked about community social capital, household smoking, attitudes toward the tobacco industry, adolescent behavior, demographics, and other variables.

Measures

Measures were obtained from adult respondents to the Internet panel (parent variables) and from lists of known tobacco outlets and the American Community Survey (environmental variables).

Parent variables

Variable of interest

Perceptions of trust in others and informal social control are commonly used to measure community levels of social capital.⁶⁶ Respondents were asked a series of standard questions about living in, and the safety of, their community and about their neighbor’s willingness to intervene when trouble occurs, rating their agreement on a 5-point scale. We combined these items to form a trust measure and informal social control measure similar to other social capital measures.^43,67,68 We confirmed these measures using a factor analysis, with promax rotation. Our analysis indicated a 2-factor solution (eigenvalue factor 1 = 2.53 and eigenvalue factor 2 = 2.26) and the variables loaded on conceptually distinct (trust and informal social control) constructs.

The 2 measures were created by averaging across 3 items (all of which were on a 5-point scale). For trust, these items were, “People in this neighborhood can be trusted,” “Living in this neighborhood gives me a secure feeling,” and “People around here are willing to help their neighbors.” In addition, participants were asked, “How would you rate your neighborhood as a place to raise children?” (Cronbach α = .89, mean = 3.92, standard deviation [SD] = .82).

Informal social control items were, “How likely is it that one of your neighbors would do something if your kids were getting into trouble?” “How likely is it that one of your neighbors would do something if someone was trying to sell drugs to one of your children?” and “How likely is it that one of your neighbors would do something if there was a fight in front of your house?” (Cronbach α = .90, mean = 3.94, SD = 1.00).

Control variables

Education of the responding parent was recoded into less than high school, high school, some college and bachelor’s degree, or higher. Respondents were asked about household income, which was recoded into the following categories, <$30 000, $30 000 to $49 999, $50 000 to $74 999, $75 000 to $99 000, and ≥$100 000. Race/ethnicity was coded as non-Hispanic white, non-Hispanic black, other non-Hispanic, and Hispanic. Home ownership was recoded into does or does not own a home. Marital status was also included

Environmental variables

Outcome variable

The outcome variable is TOD. The knowledge networks web panel provided household addresses with a 100-ft random shift in order to link survey data with environmental data about tobacco outlets. Participants’ neighborhoods were defined by a 1/2-mile buffer around each household address. Only 3.2% of participants’ home neighborhoods overlapped with another participant’s home neighborhood. A list of likely tobacco outlets was created by purchasing addresses from 2 independent sources, Reference USA and Dun & Bradstreet, for outlets with a primary and/or secondary North American Industry Classification System business code for store types that represent 98% of tobacco sales in the United States.¹⁴ The purchased lists were cleaned to remove duplicates and retail chains known not to sell tobacco, merged and again checked for duplication. Using ArcGIS v10.1, likely tobacco outlets within home neighborhoods were mapped (mapping rate = 99.7%). Tobacco outlet density was measured for each home by counting outlets within each buffer and dividing by the land area (square miles) (mean = 4.10, SD = 9.98).¹⁴

Household neighborhood control variables

Household neighborhood control variables were derived from previous research indicating that TOD is higher in communities with larger minority composition in the United States and around schools with a higher percentage of minority students.^29

-32 Studies of the locations of TOD in the United States, Canada, New Zealand, and Australia show higher TOD in economically disadvantaged and low SES communities.^{18,23,26

-30} As a result, models for TOD should include these covariates in order to see whether there was an effect of social capital beyond the effect of SES

Intercensal estimates (Geolytics Inc, Somerville, NJ, USA) for census tracts were used to characterize 1/2-mile service area buffers around households in terms of 3 community characteristics: percentage in poverty, percentage non-Hispanic black, and percentage Hispanic. We used data from the American Community Survey 2012⁶⁹ to compute these covariates. We used the percentage of the population living under poverty within the buffer zone as a proxy for community-level SES. Because TOD is associated positively with economic deprivation,^30,33 and the presence of minority populations,^30,33 we also controlled for the percentage of the population that was living in poverty, non-Hispanic black and Hispanic. In addition, respondents’ home address was categorized as being a metropolitan statistical area or not.

Analysis

A multivariate linear regression completed using Stata/MP13.0 was used to examine the relationship between social capital and TOD. All analyses were weighted to reflect a nationally representative sample of households using respondent’s age, gender, race, home ownership, and living in a metropolitan area and household income using pweights in Stata.

Results

Participants

Most parent respondents (82%) were female, 70.9% were non-Hispanic white, and 9.2% were non-Hispanic black. Most parents had some college or more (Table 1). The percentage of households with at least one smoker was 15%.

Table 1.

Parental Demographics and Household Neighborhood Characteristics, Unweighted and Weighted.^a

	Unweighted	Weighted
	Mean (SD)/%	Mean (SD)/%
Tobacco outlet density	4.1 (10)
Parent-reported variables
Social capital
Perceptions of trust	3.9 (0.8)	3.9 (0.8)
Social control	3.9 (1.0)	3.9 (1.0)
Parental/household demographics
Female	82.2%	56.8%
Over 45	47.1%	42.4%
Race
Non-Hispanic white	70.9%	61.4%
Non-Hispanic black	9.2%	12.1%
Non-Hispanic other	7.2%	6.9%
Hispanic	12.7%	19.7%
Income
29 999 or lower	19.5%	19.6%
$30 00-$49 999	18.6%	15.5%
$50 000-$74 999	20.7%	19.7%
$75 000-$99 999	18.4%	20.9%
$100 000 or higher	22.9%	24.3%
Education
Less than high school/GED	3.9%	7.6%
High school/GED	15.8%	31.6%
Some college	40.1%	32.0%
Bachelor’s or higher	40.3%	28.8%
Own home	77.4%	73.7%
Neighborhood demographics
Percent below poverty	12.8% (10.0)
Percent non-Hispanic black	10.4% (10.3)
Percent Hispanic	14.7% (20.2)
Live in metropolitan statistical area	85%	83.9%
N	2772

Abbreviations: GED, general equivalency diploma; SD, standard deviation.

^aTobacco outlet density measure retailers per square mile in a household-centered 1/2-mile buffer.

Table 1 also describes the characteristics of the household-centered neighborhoods. The average TOD near households with teens (ages 13-16) was 4.1 tobacco retailers per square mile and this variable was highly skewed (SD = 10). The average percentage of households in poverty was 12.8% (SD = 10.0), while the average for the percentage of non-Hispanic blacks and Hispanics living in the neighborhood was 10.4% (SD = 10.3) and 14.7% (SD = 20.2), respectively. The majority of households were located in a metropolitan statistical area.

Social Capital and TOD

As parent perceptions of trust increased, neighborhood TOD decreased (B = −1.12, standard error [SE] = 0.37, P = .0004; Table 2), even after controlling for respondents’ age, sex, race, income, education, home ownership, and residing in a metropolitan area. Contrary to expectation, we found no relationship between perceptions of social control and TOD. Among the parent-reported covariates, only owning a home was associated with lower TOD (B = −2.5, SE = 1.01, P = .013).

Table 2.

Correlation Between Social Capital and Neighborhood Tobacco Outlet Density Controlling for Household Neighborhood Characteristics and Individual-Level Characteristics.^a

	B (SE)	P Value
Parent-reported variables
Social capital
Perceptions of trust	−1.12 (0.37)	.0004
Social control	0.11 (0.32)	.731
Individual-level control variables
Age 45+	0.41 (0.57)	.474
Female	−1.26 (0.66)	.054
Race (reference white)
African American	0.84 (1.93)	.662
Hispanic	1.7 (0.98)	.084
Other	−0.26 (0.7)	.705
Income (reference 100 000+)
Less than $30 000	−1.38 (1.31)	.293
$30 000-$49 999	−1.04 (1.08)	.334
$50 000-$74 999	0.04 (0.84)	.961
$75 000-$99 999	0 (0.82)	.995
Education (reference bachelor’s degree or higher)
Less than high school	−1.91 (1.18)	.103
High school	−0.48 (0.74)	.517
Some college	−0.93 (0.55)	.088
Married	−0.98 (0.8)	.224
Own home	−2.5 (1.01)	.013
Household/neighborhood control variables
Percent under poverty	12.89 (5.06)	.011
Percent non-Hispanic black	3.03 (3.53)	.392
Percent Hispanic	4.54 (2.34)	.019
Reside in an MSA	1.67 (0.54)	.002
Constant	7.87 (2.35)	.001

Abbreviations: MSA, metropolitan statistical area; SE, standard error.

^aN = 2734, R² = 0.1251.

Consistent with previous research, we found higher TOD near households in neighborhoods with a higher percentage of residents whose income was below the poverty level (B = 12.89, SE = 5.06, P = .011) and with higher percentage of Hispanic residents (B = 4.54, SE = 2.34, P = .019). However, there was no relationship between the percentage of African Americans in the household neighborhoods and TOD (B = 3.03, SE = 3.53, P = .392). Not surprisingly, households in metropolitan statistical areas had higher TOD (B = 1.67, SE = 0.54, P = .002).

Discussion

This is the first study that we are aware of to examine whether social capital and TOD are related. Results indicate that respondents’ perceptions of trust were inversely correlated with TOD in the respondents’ home neighborhoods. It has been argued that social capital, in particular, trust, is essential to, and a precursor for, collective action.^60,61 The fact that higher levels of trust were associated with lower TOD lends credence to our logical model, arguing that zoning regulations around tobacco retail outlets are often influenced through collective action and civic engagement at the community level. Low social capital is an indication of the lack of trust and community ties, which would make the regulation of the retail environment difficult. Informal social control was not correlated with TOD. However, because informal social control has to do with norms surrounding children, it may be that this type of social capital would be associated with regulations, or support for regulations, aimed at youth consumption, such as Tobacco 21 campaigns (campaigns for policies raising the age at which purchases can be made to 21 years of age or older).⁷⁰ This may mean that in the logic models relating social capital and TOD, social control may have a more direct relationship to policies restricting tobacco purchasing opportunities (such as Tobacco 21 policies) or engaging in tobacco-related behavior.

The percentage of residents in poverty and the percentage of Hispanics in a neighborhood were positively correlated with TOD after controlling for social capital, which suggests that some associations of neighborhood demographics and TOD are independent of social capital. The positive relationship we found between percentage of residents in poverty confirms that individuals in economically deprived areas are disproportionately exposed to tobacco retailers.^{18,23,26

-30} A previous national-level study found a relationship between the proportion of African American and Hispanic in US census tracts and TOD³⁰; however, in our model, which examined smaller spatial units, only the relationship between percentage Hispanics and TOD was significant. Longitudinal research is needed to test whether social capital moderates or mediates associations of neighborhood demography with TOD. Future research should also consider whether civic engagement or collective action is correlated with TOD.

In the United States, exposure to tobacco outlets is correlated with a significant number of individual-level behaviors, such as current smoking,^{19,20,22,23,24} and more recent research found that neighborhoods with a higher concentration of tobacco/smoke shops have higher crime rates.⁷¹ The current research suggests that the relationship between TOD and these outcomes needs to be reassessed in light of the relationship between TOD and social capital. It has been suggested that social capital flattens the social gradient.⁷² If social capital is correlated with neighborhood TOD, then it is possible that social capital is a moderatoring variable and the previously observed relationship between TOD, neighborhood SES, neighborhood minority composition, and smoking may shift once social capital is included in the model.

Adolescent smoking is positively correlated with different measures of TOD in this US sample¹⁴ and in other studies.^73,74 In a post hoc analysis from the current data, household smoking was not related to TOD or social capital measures when other household neighborhood and individual characteristics were controlled. This could be due to the sample size and the larger number of variables we included in the final model. Future research with larger longitudinal population-based surveys should consider whether social capital is independently related to tobacco use by adolescents and adults, when TOD is included in the model.

Because the percentage of residents in poverty and the percentage of Hispanics in a neighborhood were positively correlated with TOD after controlling for social capital, we conducted 2 post hoc analyses analyzing the association of our social capital variables with (a) the percentage of the population living in poverty and (b) the percentage of Hispanics, in the respondents’ neighborhood (1/2-mile service area buffers around households). We found that perception of trust (B = −0.2, P ≤ .001) was negatively correlated with the percentage of the population in the neighborhood living in poverty (controlling for individual-level demographic variables and the percentage of non-Hispanic African Americans and Latinos in the neighborhood). Additionally, we found that neither perceptions of trust (B = −0.01, P = .322) nor social control (B = .00, P = .929) were significantly correlated with the percentage of Hispanics within a neighborhood (controlling for individual-level demographic variables and the percentage of the population living in poverty). These findings, combined with our main findings, suggest that creating opportunities for neighborhood connections, engagement, and mobilization in communities that are targeted by the tobacco industry, particularly poor communities, is one way to foster an environment where social capital can develop.^75

-78 This could work for low-income communities, particularly if daycare and other resources were provided in these spaces. Additionally, other forms of social capital building can occur in African American and Latino communities through the development of preexisting, community assets such as religious and church organizations^79
-81 or community health workers (including promotores).^82,83 The development of social capital and community institutions may foster political engagement in communities targeted by the tobacco industry and allow for mobilization around retail-related policy interventions. Alternately, mobilization itself around tobacco-related retail policies may foster social capital since neighborhood mobilization can foster social capital.⁷⁵

Strengths of this study are data from a nationally representative sample of US households, with information about home address to define household-centered buffers as neighborhoods. Another strength is the geolocation data for likely tobacco retailers derived from 2 independent data sources. The primary weaknesses are the cross-sectional design and a measure of social capital derived from self-reported perceptions without parallel measures from environmental data which are sometimes included in social capital models.^42,84,85 Additionally, while several measures of social capital were collected (trust and social control), political engagement was not collected. Further research should include these measures in order to determine whether political engagement is related to TOD. Although our definition of area surrounding homes is similar to other studies,⁸⁶ it does not reflect the ways that individuals move through the larger communities in which they spend work and leisure time. It is possible that other definitions of community might elicit different findings. Future research should consider alternate operational definitions of community based either on qualitative or survey research.

So What?

What is already known on this topic?

Tobacco outlet density (TOD) is greater in economically disadvantaged neighborhoods and in neighborhoods with higher proportions of racial/ethnic minority populations.

What does this article add?

This study is the first to examine social capital as a predictor of TOD. In a representative of US households with teens (ages 13-16), parent-reported higher measures of social capital (trust, but not social control) were related to lower TOD near homes.

What are the implications for health promotion practice or research?

In order to reduce place-based inequities in tobacco TOD, interventions that improve social capital could complement local policies to restrict retail environment for tobacco.

Conclusion and Public Health Implications

Our study shows a significant inverse correlation between social capital and TOD. While the tobacco industry is attempting to undermine tobacco control by refocusing efforts on upstream solutions,⁶⁴ our research indicates that while community-level factors such as poverty, TOD, and social capital affect smoking behaviors, communities with high proportions of minorities, low SES, or low social capital need the application of density reducing tobacco control policies (such as limitations on retailer licensing or zoning ordinances) in order to reduce their disproportionate exposure to the tobacco retail environment.

Footnotes

Authors’ Note

A.S.J., M.G., and L.H. all worked to design the initial models for this paper. A.S.J. and M.G. completed the analyses and wrote the first draft together. All authors participated in the iterative process of refining the data analysis and provided feedback throughout the process on both conceptual and statistical issues related to the analysis. A.S.J. and M.G. wrote the first draft and share equal responsibility for the content as first authors. L.H. made critical revisions.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Henriksen’s effort was supported by grants U01-CA154281 R01-CA067850, and Dr Sanders-Jackson’s effort was supported by T32-HL007034, while she was a postdoctoral fellow at the Stanford Prevention Research Center. The funders had no input on the design, analysis, interpretation of results or decision to submit for publication.

ORCID iD

Mariaelena Gonzalez, PhD

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