Where There's Smoke: Cigarette Use, Social Acceptability, and Spatial Approaches to Multilevel Modeling

Heather A. O'Connell, Rice University

I contribute to the longstanding body of literature on how context is related to health and other 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 the examination of one manifestation of the social acceptability hypothesis. Both contributions help provide a clearer picture of the associations between county-level characteristics and the individual-level odds of smoking during pregnancy. For this analysis I use restricted-use natality data from the Vital Statistics, and county-level data from the 2005-9 ACS. I combine multilevel and spatial modeling techniques to analyze the contextual associations with maternal smoking. The results suggest that spatial modeling is still critical in a multilevel framework. In addition, I argue that processes related to social acceptability and spatial diffusion underlie the relationships linking racial/ethnic minority concentration to lower overall odds of smoking.