Study finds correlation between number of tobacco retailers and prevalence of tobacco use in Virginia counties


A new study from Hong Xue and colleagues shows that the county-level association between tobacco retailers and adult smokers can be largely explained by several social determinants of health, including mental and physical health. 

Hong Xue photo
Hong Xue, Associate Professor in the Department of Health Administration and Policy

Smoking-related costs in the United States account for more than 12% of health care spending, making the United States one of the top countries to have health issues caused by smoking. Many public health practitioners and researchers, including Associate Professor Hong Xue in the Department of Health Administration and Policy, have identified the importance of evidence-based policies and regulations to reduce tobacco use, including regulating the tobacco industry. 

Xue’s most recent study found that a higher number of tobacco retailers in a Virginia county is associated with a higher prevalence of adult smoking in that county. The analysis done by the interdisciplinary research team found that the higher number of smokers in a county is largely explained by social determinants of health, including socioeconomic status, environmental factors, risk conditions or behaviors, and population health, more than the amount of tobacco retailers. 

“Tobacco retailers are more prevalent in areas where the population has low income and a lower quality of physical and mental health, responding to the higher demand of tobacco products in these areas. A higher supply in turn promotes greater demand. This is a dynamic enforcing feedback loop that policies and regulations need to intervene. Also, it’s not only the store selling tobacco that is attracting more smokers, but other aspects of life that are leading people to smoke,” said Xue, who was the principal investigator. “Thus, efforts to reduce tobacco use and consequent negative health effects should explore the impact of improving regional social determinants of health.” 

This is the first study that identified the spatial relationship between tobacco retail outlets and smoking prevalence in Virginia and revealed the importance of social determinants in tobacco control. 

“This study helps disentangle the complicated relationship between tobacco retailers and adults who smoke and provides actionable evidence to local, state, and federal regulators for effective tobacco prevention and control,” said Xue. “Reducing the number of tobacco retailers might not be sufficient. Policy or program intervention may wish to focus on the social factors, such as reducing the rate of violent crime or addressing issues related to mental distress and physical inactivity.” 

Digging deeper into the social determinants of health, the study found that mental distress and physical inactivity are the most important determinants of smoking at the population level. Additionally, results showed that risky environmental conditions related to low income, such as food insecurity and violent crime, were closely associated with county-level smoking prevalence. 

The study, “The association between tobacco retailer outlet density and prevalence of cigarette smoking in Virginia” was funded by the Virginia Foundation for Healthy Youth and published in Nicotine & Tobacco Research in August 2022.  

The research team included three other researchers associated with Mason: Shuo-yu Lin, a Health Administration and Policy doctoral student; Weiyu Zhou, a doctoral student in the Department of Statistics; Ruixin Yang, Associate Professor in the Department of Geography and Geoinformation Science, as well as J. Randy Koch from the Department of Psychology and the Center for the Study of Tobacco Products and Andrew J. Barnes from the Department of Health Behavior and Policy, both at Virginia Commonwealth University.