Is There a Relationship Between the Concentration of Same-Sex Couples and Tobacco Retailer Density?
BACKGROUND
Tobacco use is markedly higher among lesbian, gay, and bisexual populations than heterosexuals. Higher density of tobacco retailers is found in neighborhoods with lower income and more racial/ethnic minorities. Same-sex couples tend to live in similar neighborhoods, but the association of this demographic with tobacco retailer density has not been examined.


METHODS
For a national sample of 97 US counties, we calculated the number of tobacco retailers per 1000 persons and rates of same-sex couples per 1000 households in each census tract (n = 17 941). Using spatial regression, we examined the association of these variables in sex-stratified models, including neighborhood demographics and other environmental characteristics to examine confounding.


RESULTS
Results from spatial regression show that higher rates of both female and male same-sex couples were associated with a higher density of tobacco retailers. However the magnitude of this association was small. For female couples, the association was not significant after controlling for area-level characteristics, such as percent black, percent Hispanic, median household income, the presence of interstate highways, and urbanicity, which are neighborhood correlates of higher tobacco retailer density. For male couples, the association persisted after control for these characteristics.


CONCLUSIONS
Same-sex couples reside in areas with higher tobacco retailer density, and for men, this association was not explained by neighborhood confounders, such as racial/ethnic composition and income. While lesbian, gay, and bisexual disparities in tobacco use may be influenced by neighborhood environment, the magnitude of the association suggests other explanations of these disparities remain important areas of research.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; jose.lee@unc.edu.
Joseph G L
JG
Lee
Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, NC;
William K
WK
Pan
Stanford Prevention Research Center, Stanford School of Medicine, Palo Alto, CA;
Lisa
L
Henriksen
Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Adam O
AO
Goldstein
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Kurt M
KM
Ribisl
D000328:Adult; D001727:Bisexuality; D005260:Female; D006716:Homosexuality; D018452:Homosexuality, Female; D006801:Humans; D007182:Income; D008297:Male; D008393:Marriage; D012111:Residence Characteristics; D058012:Small Business / Q000191:economics*; D012907:Smoking / Q000191:economics / Q000453:epidemiology; D062789:Tobacco Products / Q000191:economics*; D014481:United States / Q000453:epidemiology; D055815:Young Adult