WMJ Vol 123 Issue 5: The Legacy of Redlining and the Geography of Tobacco Retailers in Wisconsin
ABSTRACT
Introduction: Housing discrimination as one of the main mechanisms for reinforcing racial segregation has persisted historically in the United States through a process known as “redlining.” In recent years, researchers across different disciplines have utilized the iconic “residential security maps” created by the Home Owners’ Loan Corporation (HOLC) in the 1930s to analyze the structural roots of racial disparities. HOLC maps designated grading of “best” to “still desirable” to “definitely declining” and “hazardous“ to urban areas where percentage of African American and foreigners were among the reordered measures.
Objective: Given that sales and marketing of tobacco products also present a historical connection to structural racism in the US, this study examines how historical redlining relates to current geographies of tobacco retailers in Wisconsin.
Methods: Analyses were conducted for 4 cities in Wisconsin with available HOLC maps. We used negative binomial models to account for spatial heterogeneity and overdispersion of retailers, and we controlled for present-day sociodemographic characteristics.
Results: Findings indicated that the hierarchy of HOLC grades are reflected in the present-day retailer density, and areas historically graded as “less desirable” have a higher present-day density of tobacco retailers. The result of the statistical model shows that poverty and percentage minority are also significant factors in distribution of tobacco retailers.
Conclusions: These results highlight that to address the structural roots of health disparities, we need intervention strategies that employ a comprehensive look at the historical legacies of discrimination.
Intended Audience
The intended audience for this continuing education activity is healthcare professionals caring for the people of Wisconsin and beyond.
Learning Objectives
As a result of participating in this journal-based activity, healthcare team members will be able to:
- Explain the historical context of redlining and its connection to health disparities
- Evaluate the relationships between the tobacco products retailer density and residential patterns, percentage of minorities, and prevalence of poverty.
- Discuss interventions that can be implemented by healthcare teams to target disparate exposure to tobacco products
FACULTY DISCLOSURE
It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE). In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.
For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.
| Name of Individual | Individual's Role in Activity | Financial Relationship Disclosure | Discussion of Unlabeled/Unapproved Uses of Drugs/Devices |
| Marianna Shershneva, MD, PhD | Accreditation Specialist | No relevant relationships with ineligible companies to disclose | No |
| James Eberhard, MFA | Accreditation Specialist | No relevant relationships with ineligible companies to disclose | No |
| Sima Namin, PhD | Author | No relevant relationships with ineligible companies to disclose | No |
| Yuhong Zhou, PhD, MS, ME | Author | No relevant relationships with ineligible companies to disclose | No |
| Chima Anyanwu, MA | Author | No relevant relationships with ineligible companies to disclose | No |
| Shannon Walker, PhD, MEd | Author | No relevant relationships with ineligible companies to disclose | No |
| Kirsten Beyer, PhD, MPH, MS | Author | No relevant relationships with ineligible companies to disclose | No |
| Elizabeth M Petty, MD | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Amy Schultz, PhD, MS | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Robert Treat | Editor | No relevant relationships with ineligible companies to disclose | No |
| Sue Wenker, PT, PhD, MS, FNAP | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Jessica Leiberg, DNP, ACNP | Reviewer | No relevant relationships with ineligible companies to disclose | No |
| Jennifer Esch, PharmD, MBA, BCPS | Reviewer | No relevant relationships with ineligible companies to disclose | No |
*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients. The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.
Accreditation Statement
| Accreditation Logos | Accreditation Statements |
![]() | In support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal. The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. |
Credit Designation Statements | |
American Medical Association (AMA) The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. | |
American Nurses Credentialing Center (ANCC) The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 ANCC contact hour. | |
![]() | American Academy of Physician Assistants (AAPA) The University of Wisconsin–Madison ICEP has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until 12/02/2025. PAs should only claim credit commensurate with the extent of their participation. |
Accreditation Council for Pharmacy Education (ACPE) The University of Wisconsin–Madison ICEP designates this knowledge-based activity for 1.0 hours or 0.1 CEUs. Credit can be earned by successfully completing the activity. Credit will be provided to NABP CPE Monitor within 60 days after the activity completion. | |
Continuing Education Units The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour. | |
Available Credit
- 0.75 AAPA Category 1 CME
- 0.75 ACPE Contact Hours - Pharmacist
- 0.75 AMA PRA Category 1 Credit™
- 0.75 ANCC Contact Hours
- 0.75 University of Wisconsin–Madison Continuing Education Hours
- 0.75 Approved for AMA PRA Category 1 Credit™
Accessibility
If you need anything to participate in this program, please contact [email protected].
Required Hardware/software
Free, current version of Chrome, Firefox, Safari, or Edge. Some older browsers and Microsoft Internet Explorer could produce error messages or not display the content correctly.
Free, current version of Adobe Acrobat Reader or other .pdf reader.

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