Examining the Relationship Between Racial, Ethnic, and Economic Residential Segregation and Cigarette Smoking Among a Nationally Representative Sample of Young Adults

Introduction: Predominantly Black, Hispanic or Latino, and lower-income communities are overexposed to tobacco. This study investigated the relationship between cigarette smoking and racial/ethnic and economic segregation using the Index of Concentration at the Extremes (ICE). Aims and Methods: A nationally representative sample of 4091 (aged 18–34 years) was surveyed between September and October 2016. We calculated census-tract population estimates to form ICE measures for ethnicity, race, income, ethnicity and income, and race and income. Quintiles were determined, with Quintile 1 (Q1) representing the most Hispanic/Latino, Black, and lowest-income neighborhoods and Q5 representing the most non-Hispanic/Latino, White, and highest-income neighborhoods. State fixed effects logistic regression models, weighted for national representativeness, assessed the relationship between ICE measures and past 30-day cigarette use, controlling for individual smoking correlates (eg, income, race/ethnicity, tobacco use). Results: For racial/ethnic segregation alone, individuals in neighborhoods with the highest proportions of Hispanic/Latino versus non-Hispanic/ Latino (Q5 vs. Q1–Q4 range 1.47–1.79) and Black versus White residents had higher smoking risk (Q5 vs. Q1 [1.41] and Q2 [1.40]). For economic segregation, individuals in Q2 and Q3 neighborhoods had higher smoking risk than those in Q5 (Q5 vs. Q2 [1.60] and Q3 [1.73]), but smoking risk did not differ between Q1 and Q5. Conclusions: In this sample, living in areas with the most Hispanic/Latino and Black residents was associated with the highest smoking risk, while living in areas with highest-income residents was associated with lowest smoking risk, even controlling for individual factors. Understanding the impact of ethnic, racial, and economic segregation on smoking behaviors informs targeted interventions to reduce tobacco overexposure. Implications: The study’s findings highlight the association between neighborhood socioeconomic factors and cigarette smoking. Racial and ethnic segregation is associated with higher smoking rates. The combined influence of racial, ethnic, and economic factors adds intricacy to the association between segregation and the risk of smoking. This research is significant as it provides valuable insights for designing focused interventions aimed at mitigating tobacco overexposure in predominantly Black, Hispanic/Latino, and low-income neighborhoods.