Elsevier

Social Science & Medicine

Volume 140, September 2015, Pages 18-26
Social Science & Medicine

Where there's smoke: Cigarette use, social acceptability, and spatial approaches to multilevel modeling

https://doi.org/10.1016/j.socscimed.2015.06.025Get rights and content

Highlights

  • I extend conceptual links between place and space to advance multilevel modeling.

  • Additional spatial statistics improve our use of spatial modeling in this context.

  • Consistent with social acceptability, spatial diffusion typifies maternal smoking.

  • The role of racial/ethnic composition in smoking is explained by spatial diffusion.

  • Incorporating space is central to enhancing theory on contextual linkages.

Abstract

I contribute to understandings of how context is related to individual outcomes by assessing the added value of combining multilevel and spatial modeling techniques. This methodological approach leads to substantive contributions to the smoking literature, including improved clarity on the central contextual factors and the examination of one manifestation of the social acceptability hypothesis. For this analysis I use restricted-use natality data from the Vital Statistics, and county-level data from the 2005–9 ACS. Critically, the results suggest that spatial considerations are still relevant in a multilevel framework. In addition, I argue that spatial processes help explain the relationships linking racial/ethnic minority concentration to lower overall odds of smoking.

Section snippets

The role of context in maternal smoking: space for advancement

Increasing focus on how the surrounding environment affects individuals has led scholars to examine the impact of local factors on health outcomes and behaviors (see e.g., Boardman, 2004, Kimbro and Denney, 2013, Yang and Matthews, 2010; Morenoff, 2003; Taylor et al., 1997). The primary contextual factors examined in many multilevel studies are those associated with economic advantage and disadvantage (see e.g., Brooks-Gunn et al., 1997, Clarke et al., 2014). The role of local socioeconomic

The elusive link between social acceptability and smoking

The topic of social acceptability has entered into a range of health research. Centrally, scholars have discussed it within the context of multiple dimensions of smoking (e.g., Afifi et al., 2013, Albers et al., 2004, Alesci et al., 2003, Botvin et al., 1992, Daly et al., 1993, Thomson et al., 2005). Research suggests that the smoking behavior of young women is strongly related to the smoking behavior of peers and how acceptable peers find smoking to be (Daly et al., 1993). Beyond smoking,

Incorporating space into multilevel models: methodological and conceptual considerations

Multilevel modeling approaches have become increasingly popular. However, in our excitement to take advantage of the benefits of hierarchical linear modeling and its generalized forms (hence forth referenced simply as “HLM”), researchers have all too often forgotten that HLM is prey to the same statistical concerns as are standard regression analyses. This includes, but is not limited to, concerns regarding the spatial independence of our residuals when analyzing geographically contiguous units

Data

The individual-level data for this project come from restricted natality data with county identifiers that was supplied by the National Center for Health Statistics (2007). These data were linked to 2005–2009 American Community Survey (ACS) county estimates (US Census Bureau, 2010). These data, including sample restrictions and the contextual unit of analysis, are ideal for this project because they have been used in recent research to demonstrate contextual associations with maternal smoking (

Results

Contextual factors are clearly related to the individual-level odds of smoking, suggesting a role of place in shaping health outcomes. Focusing on the level-2 associations, the baseline model for Texas suggests that county SES, non-Hispanic black, and Hispanic population concentration are related to a woman's odds of smoking while pregnant (see Table 2). Counties with higher values on the SES scale have lower average odds of smoking during pregnancy. Similarly, a woman's odds – regardless of

Discussion

Place and space are closely linked concepts that overlap and relate in many ways (see Gieryn, 2000, Lobao, 2004; Logan, 2012). Although often difficult to distinguish, both are necessary for explaining how social processes unfold. The incorporation of aspects of space and place has proliferated within the social sciences, but we are less comfortable with addressing issues related to where they intersect. For example, how does space affect our understanding of associations attributed to place?

Acknowledgments

This research was supported by center Grant #R24 HD047873 and training Grant #T32 HD07014 awarded to the Center for Demography and Ecology at the University of Wisconsin at Madison. Additional support was received through the Kinder Institute for Urban Research at Rice University. I would also like to specifically thank Carla Shoff, Justin Denney, and Katherine Curtis for their support while producing this work.

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