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Mayorga NA, Redmond BY, Salwa A, Shepherd JM, Garey L, Asfar T, Zvolensky MJ. Evaluating the role of smoking abstinence expectancies in the relation between perceived ethnic discrimination and cigarette dependence among Latinx individuals who smoke. Addict Behav 2024; 148:107864. [PMID: 37778236 DOI: 10.1016/j.addbeh.2023.107864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
The experience of perceived ethnic discrimination is prevalent and has harmful effects across various behavioral health processes among Latinx persons. Yet, there is limited work on the association between perceived ethnic discrimination and smoking among this health disparities group. Building from initial work that has demonstrated a relationship between perceived ethnic discrimination and smoking abstinence expectancies, the present study sought to explore mechanisms by which perceived ethnic discrimination may be related to cigarette dependence. Specifically, we tested the indirect effect of perceived ethnic discrimination on cigarette dependence through smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences) among Latinx persons who smoke (N = 338; Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that abstinence expectancies related to harmful consequences was a statistically significant underlying factor between the experience of perceived discrimination and cigarette dependence (b = 0.39, SE = 0.16, CI95% = 0.08, 0.71, CSE = 0.14). Overall, the present study suggests that smoking abstinence expectancies pertaining to harmful consequences may be a point of intervention for Latinx persons seeking to reduce or quit smoking. Future research is needed to extend the generalizability of these findings by corroborating the mediational role of abstinence expectancies related to harmful consequences across Latinx persons of varying cigarette use severity levels over time.
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Affiliation(s)
- Nubia A Mayorga
- Department of Psychology, University of Houston, United States
| | | | - Aniqua Salwa
- Department of Psychology, University of Houston, United States
| | | | - Lorra Garey
- Department of Psychology, University of Houston, United States; HEALTH Institute, University of Houston, United States
| | - Taghrid Asfar
- Department of Public Health Science, University of Miami Miller School of Medicine, and Sylvester Comprehensive Cancer Center, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, United States; HEALTH Institute, University of Houston, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, United States.
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Santiago-Torres M, Kwon DM, Mull KE, Sullivan BM, Ahluwalia JS, Alexander AC, Nollen NL, Bricker JB. Efficacy of Web-Delivered Acceptance and Commitment Therapy (ACT) for Helping Black Adults Quit Smoking. J Racial Ethn Health Disparities 2023; 10:2816-2825. [PMID: 36414931 DOI: 10.1007/s40615-022-01458-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Digital smoking cessation interventions may reduce racial disparities in cessation because they are low cost, scalable, and can provide support at any place or time. Despite their promise, whether Black adults engage with and benefit from these tools is largely unknown. In a secondary analysis of a randomized trial, we explored the efficacy of an acceptance and commitment therapy (ACT)-based website (WebQuit) for smoking cessation compared to a US clinical practice guidelines-based website (Smokefree.gov) among Black adults. METHODS A total of 316 Black adult smokers were enrolled in the trial between May 2017 and September 2018 and received access to WebQuit or Smokefree for 12 months. Participants self-reported on 30-day and 7-day abstinence from cigarette smoking at 3, 6, and 12-months. Treatment engagement was objectively measured and compared between arms. Participants also reported on their willingness to accept cues to smoke without smoking. RESULTS WebQuit versus Smokefree participants engaged more with their website (higher number of logins, Incidence Rate Ratio (IRR) = 2.21; 95% CI: 1.70, 2.89). Complete-case 30-day point prevalence abstinence (PPA) at 12-months was 34% for WebQuit vs. 29% for Smokefree (OR = 1.22 95% CI: 0.73, 2.04). Increases in participants' willingness to accept cues to smoke mediated the intervention effect on abstinence from cigarette smoking at 12 months. CONCLUSIONS This study addressed the lack of research on the utilization and efficacy of digital interventions for helping Black adults quit smoking. WebQuit participants engaged more with their website and quit smoking at a somewhat higher rate relative to Smokefree participants, albeit nonsignificant. Findings suggest high acceptability of ACT-based digital interventions to enable Black adult smokers to engage and sustain behavior changes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01812278.
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Affiliation(s)
- Margarita Santiago-Torres
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA.
| | - Diana M Kwon
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kristin E Mull
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA
| | - Brianna M Sullivan
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Adam C Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Nicole L Nollen
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard Mail Stop 1008, Kansas City, KS, 66160, USA
| | - Jonathan B Bricker
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
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Jones-Patten A, Shin SS, Bounds DT, Nyamathi A. Discrimination, Mental Health, and Readiness to Quit Smoking. Clin Nurs Res 2023; 32:1081-1091. [PMID: 37365813 PMCID: PMC10504822 DOI: 10.1177/10547738231183210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
We conducted a cross-sectional study, examining the mediation effects of depression and anxiety on the association between discrimination and readiness to quit cigarette smoking among African American adult cigarette smokers experiencing homelessness. Using a convenience sample, participants were recruited from a homeless shelter in Southern California. Scores of discrimination, depressive, and anxiety symptoms, and readiness to quit smoking were analyzed using linear regression modeling. We enrolled 100 participants; 58 participants were male. In the final model, discrimination had no association with readiness to quit (b = 0.02; 95% CI [-0.04, 0.08]; p = 0.47). The indirect effects of depression (b = 0.04, [0.01, 0.07]; p = 0.02) and anxiety (b = 0.03; [0.01, 0.05]; p = 0.04) reached statistical significance; the direct effects of depression (b = -0.01; [-0.09, 0.04]; p = 0.70) and anxiety (b = -0.00; [-0.09, 0.06]; p = 0.86) did not. Future studies should explore these associations to enhance smoking cessation programs for this population.
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Agterberg S, Weinberger AH, Stanton CA, Shuter J. Perceived racial/ethnic discrimination and cigarette smoking behaviors among a sample of people with HIV. J Behav Med 2023; 46:801-811. [PMID: 36864228 DOI: 10.1007/s10865-023-00401-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/09/2023] [Indexed: 03/04/2023]
Abstract
This study was a secondary analysis of baseline data from a clinical trial of an intensive group-based smoking cessation treatment for people with HIV (PWH) who smoke. It examined the cross-sectional relationship between perceived ethnic discrimination (PED) and cigarette smoking variables (i.e., nicotine dependence, motivation to quit smoking, self-efficacy to quit smoking) among PWH and explored whether depressive symptoms mediated the relationship between PED and smoking variables. Participants (N = 442; Mage = 50.6; 52.8% Male; 56.3% Black, non-Hispanic; 6.3% White, non-Hispanic; 13.3% Hispanic; 87.7% unemployed; 81.6% single) completed measures of demographics, cigarette smoking, depressive symptoms, and PED. Greater PED was related to lower self-efficacy to quit smoking, greater perceived stress, and greater depressive symptoms. In addition, depressive symptoms mediated the relationship between PED and two cigarette smoking variables (i.e., nicotine dependence, self-efficacy to quit smoking). Findings highlight the need for smoking interventions to target PED, self-efficacy, and depressive symptoms to improve smoking cessation variables among PWH.
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Affiliation(s)
- Silvana Agterberg
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cassandra A Stanton
- Westat, Rockville, MD, USA
- Georgetown University Medical Center, Washington, DC, USA
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Liu T, Phan L, Chen-Sankey J, Ajith A, Hacker K, Jewett B, Choi K. Race, Concern About COVID-19 Discrimination, and Cigarette Smoking Behavior: Comparison Between US Asian and White Adults Who Use Commercial Tobacco. J Racial Ethn Health Disparities 2023; 10:1955-1961. [PMID: 35994174 PMCID: PMC9395842 DOI: 10.1007/s40615-022-01377-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
Anti-Asian discrimination incidents in the USA have resurged during the COVID-19 pandemic. It is unclear how concern about being discriminatorily treated due to the COVID-19 pandemic varies between Asian and Asian American (A&AsA) and White adults. We examined A&AsA vs. White differences in concern about COVID-19 discrimination and associations of this concern with changes in cigarette smoking behaviors before and during the pandemic. Data were from a US representative sample of A&AsA and White adults (≥ 21 years) who currently and formerly used commercial tobacco (n = 1052), collected through an online panel oversampling A&AsA adults in January-February 2021. Participants reported their concern, worry, and stress about COVID-19 discrimination and past-30-day cigarette consumption before and during the pandemic. We examined the association between race and overall concern about COVID-19 discrimination, and this concern's associations with changes in past-30-day cigarette smoking consumption, smoking continuation, and return to smoking using weighted multivariable logistic and linear regression models. Overall concern about COVID-19 discrimination was higher (adjusted mean = 1.7, standard error = 0.16) among A&AsA adults who currently and formerly used commercial tobacco than their White counterparts (adjusted mean = 0.60, standard error = 0.04; p < 0.01). Overall concern about COVID-19 discrimination was associated with increased past-30-day cigarette consumption by 26.5 cigarettes (95% confidence interval [CI] = 1.2-51.9) and 4.4 times (95% CI = 2.3-8.5) greater odds of return to smoking among adults who smoke cigarettes. A&AsA adults who currently and formerly used commercial tobacco disproportionately bore higher concern about COVID-19 discrimination, and in turn could lead to increased smoking behavior and related morbidity and mortality among A&AsA adults.
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Affiliation(s)
- Tina Liu
- Department of Stem Cell and Regenerative Biology, Harvard College, Cambridge, MA, USA
- National Institute on Minority Health and Health Disparities Division of Intramural Research, 9000 Rockville Pike, MD, 20892, Bethesda, USA
| | - Lilianna Phan
- National Institute on Minority Health and Health Disparities Division of Intramural Research, 9000 Rockville Pike, MD, 20892, Bethesda, USA.
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Aniruddh Ajith
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kiana Hacker
- National Institute on Minority Health and Health Disparities Division of Intramural Research, 9000 Rockville Pike, MD, 20892, Bethesda, USA
| | - Bambi Jewett
- National Institute on Minority Health and Health Disparities Division of Intramural Research, 9000 Rockville Pike, MD, 20892, Bethesda, USA
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities Division of Intramural Research, 9000 Rockville Pike, MD, 20892, Bethesda, USA
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Arrazola RA, Griffin T, Lunsford NB, Kittner D, Bammeke P, Courtney-Long EA, Armour BS. US Cigarette Smoking Disparities by Race and Ethnicity - Keep Going and Going! Prev Chronic Dis 2023; 20:E45. [PMID: 37262328 DOI: 10.5888/pcd20.220375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Although current cigarette smoking among US adults decreased from 42.4% in 1965 to 12.5% in 2020, prevalence is higher among certain racial and ethnic groups, including non-Hispanic American Indian and Alaska Native (AIAN) adults. METHODS We examined trends in current cigarette smoking prevalence, population estimates, and relative disparity among US adults (aged ≥18 y) between 2011 and 2020 by using data from the National Health Interview Survey. SAS-callable SUDAAN was used to obtain prevalence and population estimates, and relative disparity was calculated on the basis of findings in the literature. Trends were significant at P < .05. RESULTS From 2011 to 2020, linear decreases in prevalence and population estimates were observed for non-Hispanic White (20.6% to 13.3%; 32.1 million to 20.7 million), non-Hispanic Black (19.4% to 14.4%; 5.1 million to 4.0 million), and Hispanic (12.9% to 8.0%; 4.2 million to 3.3 million) adults. For non-Hispanic AIAN adults, prevalence remained around 27%, and a linear increase in the population estimate was observed from 400,000 to 510,000. Relative disparity did not change across racial and ethnic categories. CONCLUSION Linear decreases have occurred between 2011 and 2020 for non-Hispanic White, non-Hispanic Black, and Hispanic adults who smoke, but the number of non-Hispanic AIAN adults who currently smoke has increased by 110,000, and relative disparities persist. To reduce racial and ethnic disparities in smoking, understanding how factors at multiple socioecologic levels impact smoking and helping to inform paths to equitable reach and implementation of tobacco control interventions for all population groups are needed.
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Affiliation(s)
- René A Arrazola
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, S107-7, Atlanta, GA 30341
| | | | - Natasha Buchanan Lunsford
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deirdre Kittner
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Philip Bammeke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth A Courtney-Long
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian S Armour
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Cornelius ME, Loretan CG, Jamal A, Davis Lynn BC, Mayer M, Alcantara IC, Neff L. Tobacco Product Use Among Adults - United States, 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:475-483. [PMID: 37141154 PMCID: PMC10168602 DOI: 10.15585/mmwr.mm7218a1] [Citation(s) in RCA: 98] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Commercial cigarette smoking among U.S. adults has declined during the preceding 5 decades (1,2); however, tobacco product use remains the leading cause of preventable disease and death in the United States, and some populations continue to be disproportionately affected by tobacco use (1,2). To assess recent national estimates of commercial tobacco use among U.S. persons aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute analyzed 2021 National Health Interview Survey (NHIS) data. In 2021, an estimated 46 million U.S. adults (18.7%) reported currently using any tobacco product, including cigarettes (11.5%), e-cigarettes (4.5%), cigars (3.5%), smokeless tobacco (2.1%), and pipes (including hookah)* (0.9%).† Among those who used tobacco products, 77.5% reported using combustible products (cigarettes, cigars, or pipes), and 18.1% reported using two or more tobacco products.§ The prevalence of current use of any tobacco product use was higher among the following groups: men; persons aged <65 years; persons of non-Hispanic other races; non-Hispanic White (White) persons¶; residents of rural (nonmetropolitan) areas; financially disadvantaged (income-to-poverty ratio = 0-1.99); lesbian, gay, or bisexual (LGB) persons; those uninsured or enrolled in Medicaid; adults whose highest level of education was a general educational development (GED) certificate; who had a disability; and who had serious psychological distress. Continued surveillance of tobacco product use, implementation of evidence-based tobacco control strategies (e.g., hard-hitting media campaigns, smoke-free policies, and tobacco price increases), conducting linguistically and culturally appropriate educational campaigns, and FDA regulation of tobacco products will aid in reducing tobacco-related disease, death, and disparities among U.S. adults (3,4).
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Guerrero N, Yu X, Raphael J, O'Connor T. Racial Discrimination in Late Adolescence and Mental Health Outcomes Among Participants in the Panel Study of Income Dynamics. J Adolesc Health 2023:S1054-139X(23)00124-6. [PMID: 37140520 DOI: 10.1016/j.jadohealth.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To assess whether racial discrimination experienced at ages 18-21 years is associated with psychological distress and well-being, and investigate potential moderators of this relationship. METHODS We used panel data collected from 2005 to 2017 from 661 participants in the Transition into Adulthood Supplement of the Panel Study of Income Dynamics. The Everyday Discrimination Scale measured racial discrimination. The Kessler six and Mental Health Continuum Short Form assessed psychological distress and well-being, respectively. Generalized linear mixed modeling was used to model outcomes and test potential moderating variables. RESULTS Approximately 25% of participants experienced high levels of racial discrimination. In analyses of panel data, these participants had significantly worse psychological distress (odds ratio = 6.04, 95% confidence interval: 3.41, 8.67) and lower levels of emotional well-being (odds ratio = 4.61, 95% confidence interval: 1.87, 7.36) compared to those who did not. Race and ethnicity moderated the relationship. DISCUSSION Exposure to racial discrimination in late adolescence was associated with worse mental health outcomes. This study has important implications for interventions addressing the need for mental health support that is critical for adolescents who experience racial discrimination.
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Affiliation(s)
- Natalie Guerrero
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Xian Yu
- Center for Innovation in Quality, Effectiveness and Safety (IQuESt), Houston, Texas
| | - Jean Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Teresia O'Connor
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Zhou X, Li Y, Zhu T, Xu Y. Individuals with long-term illness, disability or infirmity are more likely to smoke than healthy controls: An instrumental variable analysis. Front Public Health 2023; 10:1015607. [PMID: 36726634 PMCID: PMC9885293 DOI: 10.3389/fpubh.2022.1015607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Despite the prevalence of smoking cessation programs and public health campaigns, individuals with long-term illness, disability, or infirmity have been found to smoke more often than those without such conditions, leading to worsening health. However, the available literature has mainly focused on the association between long-term illness and smoking, which might suffer from the possible bidirectional influence, while few studies have examined the potential causal effect of long-term illness on smoking. This gap in knowledge can be addressed using an instrumental variable analysis that uses a third variable as an instrument between the endogenous independent and dependent variables and allows the identification of the direction of causality under the discussed assumptions. Our study analyzes the UK General Household Survey in 2006, covering a nationally representative 13,585 households. We exploited the number of vehicles as the instrumental variable for long-term illness, disability, or infirmity as vehicle numbers may be related to illness based on the notion that these individuals are less likely to drive, but that vehicle number may have no relationship to the likelihood of smoking. Our results suggested that chronic illness status causes a significantly 28% higher probability of smoking. The findings have wide implications for public health policymakers to design a more accessible campaign around smoking and for psychologists and doctors to take targeted care for the welfare of individuals with long-term illnesses.
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Affiliation(s)
- Xingzuo Zhou
- Institute for Global Health, University College London, London, United Kingdom,*Correspondence: Xingzuo Zhou ✉
| | - Yiang Li
- Department of Sociology, University of Chicago, Chicago, IL, United States
| | - Tianning Zhu
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Yiran Xu
- Centre of Development Studies, University of Cambridge, Cambridge, United Kingdom
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Klymova S, Cavanaugh C. The Impact of Posttraumatic Stress Disorder, Ethnic Discrimination, and Nativity on Nicotine Dependence among Female Hispanic Survivors of Physical Intimate Partner Violence. Subst Use Misuse 2023; 58:676-684. [PMID: 36798007 DOI: 10.1080/10826084.2023.2177968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background: Nicotine dependence (ND) is an understudied public health problem among Hispanic women experiencing physical intimate partner violence (PIPV). Despite multiple calls for such studies, little is known about the associations of PTSD, ethnic discrimination, and nativity with ND among female Hispanic survivors of PIPV. Objectives: This study aimed to do the following: 1) replicate the PTSD-ND association in a sample of female Hispanic survivors of PIPV, and 2) examine the impact of ethnic discrimination and nativity on ND among 378 female Hispanic survivors of PIPV. We hypothesized that past-year PTSD and ethnic discrimination would be associated with greater odds of past-year ND (PY-ND) and being born outside the U.S. would be associated with lower odds of PY-ND. Data was used from 378 participants in the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 who were female, Hispanic, and experienced PIPV. Logistic regression was used to test the impacts of past-year PTSD, ethnic discrimination and nativity on PY-ND while controlling for past-year major depressive episode, age, and personal income. Results: Results supported our hypotheses. Specifically, past-year PTSD was associated with greater odds of PY-ND, AOR = 1.91, 95% CI [1.43-2.56], and past-year ethnic discrimination was associated with greater odds of PY-ND, AOR = 2.31, 95% CI [1.82-2.93], whereas being born outside the U.S. was associated with lower odds of PY-ND, AOR = 0.33, 95% CI [0.26-0.41]. Conclusions: Findings suggest the need for additional studies to understand how ethnic discrimination and nativity affect ND among Hispanic female survivors of PIPV.
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Jokela M, Fuller‐Rowell TE. Changing associations between socioeconomic status and self-reported discrimination from the 1990s to the 2010s in the United States. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2022; 57:760-765. [PMID: 35535557 PMCID: PMC9790514 DOI: 10.1002/ijop.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/11/2022] [Indexed: 12/30/2022]
Abstract
We examined whether prevalence of social class discrimination-and its association with psychological distress-has changed between 1990s and 2010s in the United States. Data were from the original Midlife in the United States (MIDUS) study with data collections in 1995-1996 (n = 2931) and 2004-2005 (n = 1708), and the new MIDUS Refresher sample from 2011 to 2014 (n = 2543). Socioeconomic status (SES) became more strongly associated with self-rated discrimination over time, with individuals with the lowest SES experiencing more discrimination (B = 0.75, p < .001) and those with the highest SES less discrimination (B = 0.36, p < .001) over time: at baseline, the difference in self-rated discrimination between the highest and lowest SES groups was 15.3% versus 10.8% (4.7% point difference). This difference increased to 20.0% versus 7.4% in the last study wave (12.6% point difference). Association between self-reported discrimination and psychological distress strengthened over time, but the associations between socioeconomic indicators and distress did not change. The results suggest that people with low SES had higher risk of encountering unfair and disrespectful treatment in the 2010s compared to the 1990s.
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Affiliation(s)
- Markus Jokela
- Department of Psychology and Logopedics, MedicumUniversity of HelsinkiHelsinkiFinland
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Jones DM, Masyn KE, Spears CA. Discrimination, psychological functioning, and substance use among U.S. young adults aged 18-28, 2017. Exp Clin Psychopharmacol 2022; 30:884-896. [PMID: 34398638 PMCID: PMC9134875 DOI: 10.1037/pha0000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to test whether (a) discrimination is associated with past 30-day/current alcohol, cigarette, e-cigarette, alcohol, marijuana, and other illicit drug use among Black and White U.S. adults aged 18-28, (b) psychological distress (PD) and positive well-being (PW) are mediators of the discrimination-substance use relationships, and (c) the associations are moderated by race and sex. Using data from a 2017 U.S. nationally representative survey we conducted multiple-group moderated mediation analyses among 2,192 young adults aged 18-28 (508 Black males, 594 Black females, 533 White males, 557 White females). Black males had higher discrimination, Whites had higher PW, and females had higher PD scores. Discrimination was positively associated with PD and negatively associated with PW. Among all groups, discrimination was positively associated with other illicit drug (direct and indirect), and marijuana use through PD. Indirect effects were stronger among White males for other illicit drugs and Black males for marijuana. The indirect effect of discrimination and alcohol use through PW was positive for Black females and negative for all other groups examined. Among Black males only, discrimination was positively associated with cigarette and alcohol use through PD (positive) and cigarette smoking through PW (negative). This study highlights the negative influence of perceived discrimination on current licit and illicit substance use among Black and White young adults. Our results suggest that this relationship may be partially mediated by PD and PW, especially among Black male young adults. Future discrimination and substance use studies should consider potential mediation effects of poor mental health and differences by race and sex. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Dina M. Jones
- Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
| | - Katherine E. Masyn
- Department of Population Health Sciences, School of Public Health, Georgia State University
| | - Claire Adams Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University
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Zimmerman GM, Trovato D, Miller-Smith A. Discrimination in Context: Examining Neighborhood-Level Variation in the Incidence and Adverse Effects of Perceived Racial and Ethnic Discrimination Among Chicago Youth. RACE AND SOCIAL PROBLEMS 2022; 15:1-24. [PMID: 35601816 PMCID: PMC9106986 DOI: 10.1007/s12552-022-09367-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
A growing body of research links interpersonal racial and ethnic discrimination to adverse youth outcomes. Yet, studies examining the relevance of neighborhood context for discrimination are sparse. This study examines neighborhood-level variation in the incidence and impact of perceived racial and ethnic discrimination on depressive symptoms, suicidal behavior, violent behavior, and substance use. Hierarchical regression models on a sample of 1333 African American and Hispanic youth (52.44% female; x̄ = 13.03 years, SD = 3.25 at wave 1) residing in 238 Chicago neighborhoods from the Project on Human Development in Chicago Neighborhoods indicated little to no neighborhood-level variation in the incidence and impact of discrimination. Findings suggest that the experience of discrimination among youth of color is ubiquitous.
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Affiliation(s)
- Gregory M. Zimmerman
- School of Criminology and Criminal Justice, Northeastern University, 360 Huntington Avenue, Boston, MA 02115 USA
| | - Daniel Trovato
- School of Criminology and Criminal Justice, Northeastern University, 360 Huntington Avenue, Boston, MA 02115 USA
| | - Ayanna Miller-Smith
- School of Criminology and Criminal Justice, Northeastern University, 360 Huntington Avenue, Boston, MA 02115 USA
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14
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Social Determinants of Health in Oncology: Towards a More Personalized and Equitable Delivery of Cancer Care. Am J Clin Oncol 2022; 45:273-278. [PMID: 35532746 DOI: 10.1097/coc.0000000000000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Social determinants of health (SDOH) are defined as the set of modifiable social and physical risk factors that affect health. It is known that SDOH directly influence the population's overall health, but their effects on patients with cancer are considerably less elucidated. Here, we review the literature describing the effects of SDOH outlined by the Healthy People 2020 framework on patients diagnosed with cancer. We have found that while some SDOH are well-defined in cancer patients, evidence surrounding several variables is scarce. In addition, we have found that many SDOH are associated with disparities at the screening stage, indicating that upstream interventions are necessary before addressing the clinical outcomes themselves. Further investigation is warranted to understand how SDOH affect screenings and outcomes in multiple disciplines of oncology and types of cancers as well as explore how SDOH affect the treatments sought by these vulnerable patients.
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15
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Santiago-Torres M, Mull KE, Sullivan BM, Kwon D, Nollen NL, Zvolensky MJ, Bricker JB. Efficacy and utilization of an acceptance and commitment therapy-based smartphone application for smoking cessation among Black adults: secondary analysis of the iCanQuit randomized trial. Addiction 2022; 117:760-771. [PMID: 34890104 PMCID: PMC9798432 DOI: 10.1111/add.15721] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Black adults who smoke are less likely to seek treatment and to succeed in quitting compared with other racial groups. The lack of efficacious and engaging trials for smoking cessation further contributes to this disparity. This study explored whether an acceptance and commitment therapy (ACT)-based smartphone application (iCanQuit) was more efficacious for smoking cessation than a United States Clinical Practice Guidelines (USCPG)-based smartphone application (QuitGuide) among Black adults. DESIGN Secondary analysis of a two-arm randomized trial with 12-month follow-up. SETTING United States (US). PARTICIPANTS A total of 554 Black adults who smoke daily were recruited from 34 US states and enrolled between May 2017 and September 2018. INTERVENTIONS Participants were randomized to receive iCanQuit (n = 274) or QuitGuide (n = 280) for 12 months. MEASUREMENTS Smoking cessation outcomes were measured at 3, 6, and 12 months. The primary outcome was self-reported complete-case 30-day point prevalence abstinence (PPA) at 12 months. Secondary outcomes were 7-day PPA, missing-as-smoking imputation, multiple imputation, prolonged abstinence, and cessation of all tobacco products at 12 months. Study retention, treatment engagement, and change in ACT-based processes were also compared between arms. FINDINGS Study retention was 89% at 12 months and did not differ by arm (P > 0.05). The complete-case 30-day PPA was 28% for iCanQuit versus 20% for QuitGuide at 12 months (odds ratio [OR] = 1.60; 95% confidence interval [CI] = 1.03, 2.46). Similar associations were observed for the missing-as-smoking imputation, although non-significant (25% iCanQuit vs 18% QuitGuide; OR = 1.50; 95% CI = 0.98, 2.30). iCanQuit vs QuitGuide participants were significantly more engaged with iCanQuit application as measured by the number of logins from baseline to 6 months (incidence rate ratio = 3.26; 95% CI = 2.58, 4.13). Increased acceptance of cues to smoke mediated the effect of treatment on cessation (indirect effect: OR = 0.20; 95% CI = 0.05, 0.29). CONCLUSIONS Among Black adults, an acceptance and commitment therapy-based smartphone application appeared to be more efficacious and engaging for smoking cessation than the United States Clinical Practice Guidelines-based QuitGuide application.
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Affiliation(s)
- Margarita Santiago-Torres
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kristin E. Mull
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brianna M. Sullivan
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Diana Kwon
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Department of Psychology, University of Washington, Seattle, WA, USA
| | - Nicolle L. Nollen
- Department of Preventive Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA,HEALTH Institutive, University of Houston, Houston, TX, USA,MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Jonathan B. Bricker
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Department of Psychology, University of Washington, Seattle, WA, USA
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16
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Singhal A, Jackson JW. Perceived racial discrimination partially mediates racial-ethnic disparities in dental utilization and oral health. J Public Health Dent 2022; 82 Suppl 1:63-72. [PMID: 35726459 PMCID: PMC9233570 DOI: 10.1111/jphd.12515] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
Objectives Perceived racial discrimination has been associated with poor health outcomes, yet its impact on oral health disparities is not understood. We examine the role of perceived racial discrimination in healthcare settings in explaining racial‐ethnic disparities in dental visits and tooth loss. Methods We used behavioral risk factor surveillance system (BRFSS) data for 2014 from four diverse states (AZ, MN, MS and NM) that included “reactions to race” module. Using Poisson regression to estimate risk ratios, we employed inverse odds ratio(IOR)‐weighted estimation for mediation analyses to estimate the role of perceived discrimination, after equalizing other confounders and risk factors. Results We found that among those with similar risk factors, those who experienced racial discrimination were 15% less likely to visit a dentist, and 12% more likely to have tooth loss than those who were treated same as other races. Both Hispanics and non‐Hispanic Blacks were 26% less likely to visit a dentist (for Hispanics, RR = 0.74, 95%CI: 0.69–0.78; for non‐Hispanic Blacks, RR = 0.74, 95%CI: 0.70–0.79), and non‐Hispanic Blacks were 36% more likely to have tooth loss relative to non‐Hispanic Whites with similar risk factors (RR = 1.36, 95%CI: 1.28–1.45). Perceived discrimination appears to contribute to racial‐ethnic disparities in dental utilization among Hispanics, and disparities in tooth loss among non‐Hispanic Blacks, relative to non‐Hispanic Whites. Conclusions Perceived racial discrimination partially explains the racial‐ethnic disparities in dental utilization and tooth loss among those who otherwise share the same risk factors for these outcomes. Addressing discrimination and systemic racism can reduce the racial‐ethnic disparities in oral health.
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Affiliation(s)
- Astha Singhal
- Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - John W Jackson
- Epidemiology, Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, USA
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Alexander AC, Waring JJ, Olurotimi O, Kurien J, Noble B, Businelle MS, Ra CK, Ehlke SJ, Boozary LK, Cohn AM, Kendzor DE. The relations between discrimination, stressful life events, and substance use among adults experiencing homelessness. Stress Health 2022; 38:79-89. [PMID: 34137166 PMCID: PMC9629914 DOI: 10.1002/smi.3073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/03/2023]
Abstract
The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30-days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self-reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30-days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30-days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30-days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.
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Affiliation(s)
- Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joseph J.C. Waring
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Oluwakemi Olurotimi
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Jasmin Kurien
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Bishop Noble
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chaelin K. Ra
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Laili K. Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, Norman, OK
| | - Amy M. Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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18
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Bayard S, Fasano G, Tamimi RM, Oh PS. Leveraging Electronic Health Records to Address Breast Cancer Disparities. CURRENT BREAST CANCER REPORTS 2022; 14:199-204. [PMID: 36091940 PMCID: PMC9440449 DOI: 10.1007/s12609-022-00457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
Purpose of Review Breast cancer is the most commonly diagnosed cancer in women, and the leading cause of cancer death. However, racial and ethnic minority groups, as well as rural and underserved populations, face disparities that limit their access to specialty care for breast cancer. To address these disparities, health care providers can leverage an electronic health record (EHR). Recent Findings Few studies have evaluated the potential benefits of using EHRs to address breast cancer disparities, and none of them outlines a standard approach for this effort. However, these studies outline that EHRs can be used to identify and notify patients at risk for breast cancer. These systems can also automate referrals and scheduling for screening and genetic testing, as well as recruit eligible patients for clinical trials. EHRs can also provide educational materials to reduce risks associated with modifiable risk factors, such as physical activity, obesity, and smoking. These systems can also support telemedicine visits and centralize inter-institutional communication to improve treatment adherence and the quality of care. Summary EHRs have tremendous potential to increase accessibility and communication for patients with breast cancer by augmenting patient engagement, improving communication between patients and providers, and strengthening communication among providers. These efforts can reduce breast cancer disparities by increasing breast cancer screening, improving treatment adherence, expanding access to specialty care, and promoting risk-reducing habits among racial and ethnic minority groups and other underserved populations.
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Affiliation(s)
- Solange Bayard
- Division of Pediatric Surgery, Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
| | - Genevieve Fasano
- Division of Pediatric Surgery, Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
| | - Rulla M. Tamimi
- Department of Population Health Sciences, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
| | - Pilyung Stephen Oh
- Division of Pediatric Surgery, Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
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19
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Forde AT, Sims M, Wang X, Barber S, Diez Roux AV. The role of perceived discrimination in predicting changes in health behaviours among African Americans in the Jackson Heart Study. J Epidemiol Community Health 2021; 75:1222-1231. [PMID: 34117112 PMCID: PMC8588298 DOI: 10.1136/jech-2020-215998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examined whether perceived discrimination was associated with health behaviours over time and whether associations of discrimination with behaviours varied by attribution of discrimination. METHODS Multinomial logistic regression was used to estimate ORs and CIs for the associations of discrimination (everyday, lifetime, stress from lifetime discrimination) with health behaviours (cigarette smoking, alcohol use) over time among 3050 African Americans in the Jackson Heart Study from visit 1 (2000-2004) to visit 3 (2009-2013). Smoking status was classified as persistent current, persistent former, persistent never, current to former and former/never to current smokers. Alcohol use status was classified as persistent heavy, persistent moderate/none, heavy to moderate/none and moderate/none to heavy alcohol users. RESULTS Higher everyday discrimination was associated with persistent current smoking (OR per SD higher discrimination 1.26, 95% CI 1.11,1.43) and with persistent former smoking (high vs low OR 1.32, 95% CI 1.02,1.70) relative to persistent never smoking. Similar findings were observed for lifetime discrimination and persistent current smoking (high vs low OR 1.85, 95% CI 1.15,2.95) and with persistent former smoking (high vs low OR 1.45, 95% CI 1.06,1.98). Participants reporting lifetime discrimination as very stressful compared with not stressful were more likely to be persistent former smokers (OR 1.44, 95% CI 1.04,1.99). Associations did not vary by discrimination attribution. CONCLUSION Discrimination did not predict changes in smoking status or alcohol use. Discrimination was associated with persistent current smoking status, which may provide a plausible mechanism through which discrimination impacts the health of African Americans.
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Affiliation(s)
- Allana T Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Xu Wang
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Sharrelle Barber
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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20
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Muralikrishnan M, Sabbah W. Is Racial Discrimination Associated with Number of Missing Teeth Among American Adults? J Racial Ethn Health Disparities 2021; 8:1293-1299. [PMID: 33051748 PMCID: PMC8452587 DOI: 10.1007/s40615-020-00891-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objectives of this study are to assess the association of racial discrimination with tooth loss among American adults and whether this relationship, if existed, explains ethnic differences in tooth loss. METHODS Data is from the Behavioural Risk Factor Surveillance System (BRFSS) 2014, a cross-sectional survey of a nationally representative sample of American adults. The survey included data on sociodemographic characteristics, behaviour, health insurance and number of missing teeth. The survey also included questions on whether a person was treated differently because of his/her race. Logistic regression analysis was conducted to assess the relationship between tooth loss and indicators of discrimination. We also examined the relation between ethnicity and indicators of discrimination. RESULTS The analysis included 4858 participants aged 18 to 44 years. Tooth loss (> one tooth) was reported by 26% of participants. Among those reporting discrimination at healthcare facility, there was 141% increase in tooth loss compared to those not reporting discrimination. Discrimination at work and emotional impact of discrimination were both significantly associated with tooth loss in the partially adjusted models. Accounting for discrimination slightly attenuated ethnic differences in too loss. Black Americans had significantly higher odds for reporting all types of discrimination used here. CONCLUSION This study demonstrated a potential role for discrimination in tooth loss among American adults. Discrimination could also explain part of ethnic inequalities in oral health.
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Affiliation(s)
- Malini Muralikrishnan
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London, SE5 9RS, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London, SE5 9RS, UK.
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21
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Sartor CE, Haeny AM, Ahuja M, Bucholz KK. Social class discrimination as a predictor of first cigarette use and transition to nicotine use disorder in Black and White youth. Soc Psychiatry Psychiatr Epidemiol 2021; 56:981-992. [PMID: 33386872 PMCID: PMC8453663 DOI: 10.1007/s00127-020-01984-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To characterize the association of social class discrimination with the timing of first cigarette use and progression to DSM-IV nicotine dependence (ND) in Black and White youth, examining variation by race, parent vs. youth experiences of discrimination, socioeconomic status (SES), and stage of smoking. METHODS Data were drawn from 1461 youth (55.2% Black, 44.8% White; 50.2% female) and mothers in a high-risk family study of alcohol use disorder and related conditions. Cox proportional hazard regression analyses were conducted, using youth's and mother's social class discrimination to predict first cigarette use and progression to ND, stratifying by race. Interactions between discrimination and SES indicators (parental education and household income) were tested. Adjusted models included psychiatric covariates. RESULTS In the adjusted first cigarette use models, neither youth's nor mother's social class discrimination was a significant predictor among Black youth, but mother's discrimination was associated with increased risk [HR = 1.53 (1.18-1.99)] among White youth. In the adjusted ND models, mother's discrimination was associated with reduced ND risk for Black youth in middle-income families [HR = 0.29 (CI 0.13-0.63)], but neither youth's nor mother's discrimination predicted transition to ND among White youth. CONCLUSIONS The observed race and smoking stage-specific effects suggest that social class discrimination is more impactful on early stages of smoking for White youth and later stages for Black youth. The robustness of links with mother's discrimination experiences further suggests the importance of considering family-level effects and the need to explore possible mechanisms, such as socialization processes.
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Affiliation(s)
- Carolyn E Sartor
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA.
- Department of Psychiatry, Washington University School of Medicine, 660 Euclid Avenue, St. Louis, MO, 63116, USA.
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
| | - Manik Ahuja
- Department of Health Services Management and Policy, East Tennessee State University, College of Public Health, J1276 Gilbreath Drive, Johnson City, TN, 37614, USA
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, 660 Euclid Avenue, St. Louis, MO, 63116, USA
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22
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Bello MS, Liautaud MM, De La Cerda JT, Pang RD, Ray LA, Ahluwalia JA, Leventhal AM. Association of frequency of perceived exposure to discrimination with tobacco withdrawal symptoms and smoking lapse behavior in African Americans. Addiction 2021; 116:914-925. [PMID: 32860477 PMCID: PMC7914272 DOI: 10.1111/add.15238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/23/2020] [Accepted: 08/24/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Frequent experiences of discrimination could increase vulnerability to tobacco withdrawal and smoking lapse in populations subject to tobacco-related health disparities. This laboratory study (2013-17) examined whether individual differences in perceived exposure to discrimination in one's daily life predicted tobacco withdrawal symptoms and smoking lapse behavior following acute tobacco deprivation in African American smokers. DESIGN Mixed design with the between-subjects continuous variable of perceived discrimination crossed with the within-subject variable of tobacco deprivation status (deprived versus non-deprived). SETTING Academic medical center in Los Angeles, CA, USA. PARTICIPANTS African American non-treatment seeking daily cigarette smokers (n = 607, ≥ 10 cig/day). MEASUREMENTS At a baseline visit, self-reported frequency of perceived exposure to discrimination in one's daily life was measured [everyday discrimination scale (EDDS)]. At two subsequent counterbalanced experimental visits (16-hour tobacco deprivation versus ad-libitum smoking), self-report assessments of various tobacco withdrawal symptom domains [Brief Questionnaire of Smoking Urges), Wisconsin Smoking Withdrawal Scale (WSWS), Profile of Mood States (POMS), Snaith-Hamilton Pleasure Scale (SHAPS) and Current Impulsivity Scale (CIS)) and a behavioral smoking lapse analogue task were measured. FINDINGS Adjusted models demonstrated that greater frequency of perceived exposure to discrimination was associated with larger deprivation-induced increases in acute urges to smoke to alleviate negative mood, several negative mood states and subjective cognitive functioning-effect sizes were small in magnitude (βs = 0.09-0.13; Ps < 0.02). Data were inconclusive for associations between perceived exposure to discrimination and deprivation-induced changes in cravings, urges to smoke for pleasure, positive mood reduction, other symptoms or smoking reinstatement behavior. CONCLUSIONS Frequency of perceived exposure to discrimination appears to be modestly associated with increased severity of some deprivation-induced tobacco withdrawal symptoms in African American smokers.
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Affiliation(s)
- Mariel S. Bello
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Madalyn M. Liautaud
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Julianne T. De La Cerda
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Raina D. Pang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lara A. Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Jasjit A. Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Adam M. Leventhal
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Cox SR, Daniel CL. Racial and Ethnic Disparities in Laryngeal Cancer Care. J Racial Ethn Health Disparities 2021; 9:800-811. [PMID: 33733426 DOI: 10.1007/s40615-021-01018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
There is a long history of racial and ethnic disparities in healthcare and they continue to persist in contemporary society. These disparities have the potential to negatively affect morbidity and mortality in racial and ethnic minorities diagnosed with laryngeal cancer. Diagnosis, medical treatment, and rehabilitation for laryngeal cancer have improved considerably, leading to improvements in overall survival rates and physical, social, and psychological functioning. Yet members of minority and underrepresented groups are at an increased risk for experiencing reduced access to quality care and delays between diagnosis and treatment, and as a result have lower survival rates. Increasing health providers' awareness of racial and ethnic disparities in laryngeal cancer is necessary to facilitate changes in patient and provider education, clinical practice, and health policies. The purpose of this review is to summarize current literature on disparities in laryngeal cancer diagnosis, treatment, and rehabilitation among Black and Hispanic patients. We present recent data from the Surveillance, Epidemiology, and End Results database to examine trends in laryngeal cancer and patient, provider, and health systems factors that may perpetuate these disparities. In addition, we offer interventions to address racism and other racial and ethnic biases in laryngeal cancer care and describe research and legislative actions that are needed to reduce disparities in this area.
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Affiliation(s)
- Steven R Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, 11530, USA.
| | - Carolann L Daniel
- School of Social Work, Adelphi University, Garden City, NY, 11530, USA
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Harlow AF, Lundberg D, Raifman JR, Tan ASL, Streed CG, Benjamin EJ, Stokes AC. Association of Coming Out as Lesbian, Gay, and Bisexual+ and Risk of Cigarette Smoking in a Nationally Representative Sample of Youth and Young Adults. JAMA Pediatr 2021; 175:56-63. [PMID: 33104174 PMCID: PMC7589064 DOI: 10.1001/jamapediatrics.2020.3565] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/23/2020] [Indexed: 01/05/2023]
Abstract
Importance Coming out as lesbian, gay, bisexual, or other identities besides heterosexual (LGB+) may represent a susceptible period for cigarette smoking initiation in youth and young adults. Objective To assess whether young people who change their sexual identity have higher risk of cigarette smoking initiation and current smoking compared with those with consistent sexual identities. Design, Setting, and Participants This cohort study used data from the nationally representative Population Assessment of Tobacco and Health study (wave 1, 2013-2014; wave 2, 2014-2015; wave 3, 2015-2016; wave 4, 2016-2018). Youth and young adults aged 14 to 29 years who were never smokers at wave 1 were included in this study. Analysis began October 2018 and ended June 2020. Exposures Consistent sexual identity (consistently heterosexual, consistently LGB+) vs changing sexual identity (coming out as LGB+, other LGB+ patterns) based on 4 waves of sexual identity data. Identities were further classified by distinguishing between bisexual and lesbian, gay, and other nonheterosexual identities. Main Outcomes and Measures Smoking initiation and current cigarette smoking at wave 4. Results Among 7843 individuals who never smoked at wave 1, 6991 (90.7%) reported a consistent sexual identity, and 852 (9.3%) changed sexual identity across waves. The mean (SE) baseline age of participants who reported consistent heterosexuality was 20.1 (0.8) years; consistently LGB+, 20.0 (3.7) years; coming out as LGB+, 18.0 (2.9) years, and other LGB+ pattern, 20.3 (3.8) years. A total of 14.1% (weighted) initiated smoking, and 6.3% were current smokers at wave 4. Compared with consistently heterosexual identities, coming out as LGB+ (23% vs 13%; odds ratio [OR], 1.72; 95% CI, 1.34-2.20), consistently LGB+ identities (17% vs 13%; OR, 1.45; 95% CI, 1.03-2.04), and other LGB+ patterns (17% vs 13%; OR, 1.47; 95% CI, 1.04-2.08) were positively associated with smoking initiation by wave 4. Compared with consistently heterosexual identities, ORs for smoking initiation were 2.24 (28% vs 13%; 95% CI, 1.72-2.92) for coming out as bisexual, 1.99 (23% vs 13%; 95% CI, 1.20-3.29) for consistently LGB+ with change to/from bisexual, and 2.20 (23% vs 13%; 95% CI, 1.40-3.46) for other LGB+ patterns with change to/from bisexual identity. Current smoking estimates were similar to those for smoking initiation. Conclusions and Relevance Compared with consistently heterosexual identities, changing sexual identity over follow-up was associated with smoking initiation and current smoking. The risk associated with changing sexual identities was concentrated among participants coming out as bisexual or reporting other changes in their identity to/from being bisexual. More research is needed on mechanisms underlying the association between changing sexual identity and smoking initiation to inform tailored prevention programs and tobacco regulations.
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Affiliation(s)
- Alyssa F. Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Dielle Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Julia R. Raifman
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Andy S. L. Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia
| | - Carl G. Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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Calixte-Civil PF, Brandon TH. The Effect of Acute Interpersonal Racial Discrimination on Smoking Motivation and Behavior Among Black Smokers: an Experimental Study. J Racial Ethn Health Disparities 2020; 8:1511-1521. [PMID: 33215359 DOI: 10.1007/s40615-020-00914-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022]
Abstract
In comparison to White smokers, Black smokers are likely to report both more discrimination and less success in smoking cessation. No previous study has tested the causal relationship between an experience of racial discrimination and smoking variables associated with cessation. The goal of this study was to test the causal influence of interpersonal racial discrimination on smoking motivation (i.e., the urge to smoke cigarettes, cessation self-efficacy, and smoking behavior) using a controlled experimental design. We used a virtual ball-playing game to create a laboratory model of racial discrimination. A 2 × 2 between-subjects factorial design (inclusion/exclusion vs. ingroup/outgroup) was used to randomly assign participants to one of four groups: (1) included/ingroup, (2) included/outgroup, (3) excluded/ingroup (ostracism), and (4) excluded/outgroup (racial discrimination). Sixty-nine Black smokers were recruited from the community. Participants in the excluded conditions reported lower cessation self-efficacy than those in the included conditions. Participants in the outgroup conditions had reduced latency to smoke compared to those in the ingroup conditions. There were no main effects of social inclusion on cravings or latency to smoke and no statistically significant interactions for social inclusion × group membership. This laboratory simulation of racial discrimination shows a causal relationship between exclusion and low cessation self-efficacy, which contributes to a better understanding of influences upon smoking cessation attempts among Black smokers.
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Affiliation(s)
| | - Thomas H Brandon
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Health Outcomes and Behavior, Tobacco Research & Intervention Program, Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, FL, 33617, USA
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Webb Hooper M, Calixte-Civil P, Verzijl C, Brandon KO, Asfar T, Koru-Sengul T, Antoni MH, Lee DJ, Simmons VN, Brandon TH. Associations between Perceived Racial Discrimination and Tobacco Cessation among Diverse Treatment Seekers. Ethn Dis 2020; 30:411-420. [PMID: 32742143 PMCID: PMC7360180 DOI: 10.18865/ed.30.3.411] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives This study investigated a) racial/ethnic differences in past-year discrimination experiences and b) associations between discrimination and smoking abstinence. Design Prospective, longitudinal analysis of smoking status. Perceived past-year discrimination was assessed at baseline. ANCOVAs and intent-to-treat hierarchical logistic regressions were conducted. Setting Dual-site (Tampa, FL and Miami, FL) randomized controlled trial testing the effects of a group cessation intervention plus pharmacotherapy. Participants Treatment-seeking adult smokers (N=347; non-Hispanic White, non-Hispanic African American/Black, or Hispanic). Main Outcome Measures Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately post-intervention and at 6-month follow-up. Results After controlling for covariates, African Americans/Blacks reported greater perceived discrimination compared with non-Hispanic Whites (P=.02), and Hispanics (P=.06). Non-Hispanic Whites and Hispanics did not differ in perceived racial/ethnic discrimination experiences over the past year. Irrespective of race/ethnicity, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.97, CI: .95-.99) and at 6-months (AOR=.98, CI: .96-.99). Among African Americans/Blacks, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.95, CI: .92-.97) and at 6-months (AOR=.97, CI: .94-.99). Perceived discrimination was unrelated to 7-day ppa among Hispanics. Among non-Hispanic Whites, past-year perceived discrimination was inversely associated with post-intervention 7-day ppa (AOR=.95, CI: .91-.99), but not 6-months. Conclusions Perceived racial/ethnic discrimination was greater among African American/Black smokers compared with non-Hispanic Whites. Perceived discrimination was negatively associated with tobacco cessation in the full sample, and for African Americans at 6-months post-intervention. These data have implications for intervention delivery and health disparities.
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Affiliation(s)
- Monica Webb Hooper
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (former affiliation when study was conducted: Case Western Reserve University School of Medicine, Case Comprehensive Cancer Center, Cleveland, OH)
| | | | | | | | - Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Vani N. Simmons
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
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27
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van Binnendijk S, van Amsterdam JGC, Snijder MB, Schene AH, Derks EM, van den Brink W. Contribution of Alcohol and Nicotine Dependence to the Prevalence of Depressed Mood in Different Ethnic Groups in The Netherlands: The HELIUS Study. J Dual Diagn 2020; 16:271-284. [PMID: 32552497 DOI: 10.1080/15504263.2020.1772526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities.Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample (N = 22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan).Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group.Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.
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Affiliation(s)
- Simone van Binnendijk
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan G C van Amsterdam
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke B Snijder
- Department of Public Health, Academic Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Eske M Derks
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Translational Neurogenomics group, QIMR Berghofer, Brisbane, Australia
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Devlin A, Gonzalez E, Ramsey F, Esnaola N, Fisher S. The Effect of Discrimination on Likelihood of Participation in a Clinical Trial. J Racial Ethn Health Disparities 2020; 7:1124-1129. [PMID: 32157614 DOI: 10.1007/s40615-020-00735-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/13/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Despite efforts to increase minority enrollment in research, racial disparities still exist, and a belief persists that minorities are inherently less likely to enroll in medical research. This lingering view may impact the manner in which studies are presented to minority patients. This study aimed to assess racial differences in reported discrimination while seeking medical care and likelihood to participate in a medical research study. METHODS 844 residents were enrolled via convenience sampling, and asked to complete a survey designed to examine perceived discrimination while seeking healthcare and likelihood to participate (LoP) in a medical research study. RESULTS Participants who reported worse treatment than other races had lower mean LoP scores (53.7 ± 17.6) than participants who reported being treated the same as (61.1 ± 16.1) or better than (64.0 ± 15.0) other races (p < .001). There were no significant differences in mean LoP score by race/ethnicity. The interaction of race with discrimination had no significant effect on mean LoP (p = 0.8). There was a statistically significant association between race and discrimination (X2 = 11.32, p = 0.023), although the majority of participants reported no discrimination. CONCLUSION Patient experiences in the medical arena may have an impact on their willingness to join a medical study. An effective strategy to increase minority participation in research may be to work with investigators and staff on implicit bias with regard to minority patients. Further research should focus on the impact of research staff interactions on an individual's decision-making process.
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Affiliation(s)
- Amie Devlin
- Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
| | | | - Frederick Ramsey
- Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | | | - Susan Fisher
- Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
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Factors Affecting Painkillers, Sedatives/Hypnotics, Nicotine, and Unhealthy Alcohol Use Among Gay and Bisexual Men in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030851. [PMID: 32013262 PMCID: PMC7038077 DOI: 10.3390/ijerph17030851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/29/2023]
Abstract
Substance use has become a major health problem globally for sexual minorities. However, few studies have explored multi-dimensional factors associated with smoking, drinking, and prescription drug use. We aimed to investigate the factors affecting painkiller, sedative/hypnotic, nicotine and unhealthy alcohol use among gay and bisexual men in Taiwan. We recruited 500 gay or bisexual men and assessed their experiences of using painkillers, sedatives/hypnotics, nicotine, alcohol and multi-dimensional factors with self-reported questionnaires. Multivariate logistic regression with a forward stepwise model was used to verify the factors associated with substance use. Overall, 9.4%, 5.4%, and 13.8% of the participants reported using painkillers, sedatives/hypnotics, and nicotine, respectively, and 5.6% reported unhealthy alcohol use. Victims of traditional homophobic bullying in childhood and adolescence were more likely to report nicotine use, sedative/hypnotic use, and unhealthy alcohol use in early adulthood than non-victims. Missing classes or truancy at senior high school was associated with painkiller and sedative/hypnotic use in early adulthood. Traditional homophobic bullying and missing classes or truancy in childhood and adolescence predicted substance use in early adulthood among the gay and bisexual men in this study. Timely preventions and interventions for substance use are crucial for gay and bisexual men, especially for those who experience homophobic bullying and missing classes or truancy.
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30
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Wilkinson LL, Clay OJ, Hood AC, Plaisance EP, Kinnerson L, Beamon BD, Hector D. The Association of Emotional and Physical Reactions to Perceived Discrimination with Depressive Symptoms Among African American Men in the Southeast. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010322. [PMID: 31906523 PMCID: PMC6981499 DOI: 10.3390/ijerph17010322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 12/21/2022]
Abstract
This study examines the association of emotional and physical reactions to perceived discrimination with depressive symptoms among a sample of African American (AA) men in the southeastern United States. Analysis of the 2010 Behavioral Risk Factor Surveillance System (BRFSS) data set provides an examination of demographic, perceived discrimination context, and health status differences in depressive symptoms measured by the Patient Health Questionnaire—2 (PHQ-2). The analysis also assesses individual differences among AA men related to experiencing physical symptoms and feeling emotionally upset due to perceived discrimination. A focused examination investigates the role of adverse reactions to perceived discrimination in association with depressive symptomology. Findings illuminate the significance of experiences of and reactions to perceived discrimination in relationship with depressive symptomology among AA men living in the southeastern United States. Findings also demonstrate the need for additional research focusing on perceived discrimination experiences in relation to depressive symptoms experienced among the AA male subgroup. Continued investigation of within-group differences among AA men, with health promotional strategies to foster social-emotional support, will further the improvement in health and wellness for AA men.
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Affiliation(s)
- Larrell L. Wilkinson
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.P.P.); (L.K.); (B.D.B.); (D.H.)
- Correspondence: ; Tel.: +1-1205-975-1295
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Anthony C. Hood
- Department of Management, Information Systems & Quantitative Methods, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Eric P. Plaisance
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.P.P.); (L.K.); (B.D.B.); (D.H.)
| | - Lakesha Kinnerson
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.P.P.); (L.K.); (B.D.B.); (D.H.)
| | - Brandon D. Beamon
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.P.P.); (L.K.); (B.D.B.); (D.H.)
| | - Dominique Hector
- Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.P.P.); (L.K.); (B.D.B.); (D.H.)
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Stone AL, Elbers-Carlisle SK. Workplace Racial Discrimination, Negative Emotions Based on Treatment Due to Race, and Substance Use. Subst Use Misuse 2020; 55:1925-1934. [PMID: 32669029 DOI: 10.1080/10826084.2020.1781178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Experiencing racial discrimination may be associated with poor health outcomes including negative emotional states and substance use. The workplace is a setting where people may experience discriminatory treatment. Objectives: This study examined associations, between negative emotions due to treatment based on race (NE), workplace racial discrimination (WRD), and substance use outcomes (drinking and smoking), stratified by race. Methods: Data from the cross-sectional 2014 Behavioral Risk Factor Surveillance System (BRFSS), Minnesota and New Mexico sub-samples, were analyzed. This study excluded non-Hispanic white participants, resulting in a sample of n = 3098 adult, U.S. residents. Multivariable logistic regression models were utilized to examine the associations, and possible interactions, between WRD, NE, and substance use (alcohol and tobacco). Results: Prior to stratification, WRD was not associated with drinking or smoking after controlling for NE and other sociodemographic variables, however, NE was associated with heavy drinking. NE appeared to account for some of the observed bivariate associations between WRD and heavy drinking and daily smoking. Post-stratification, WRD was associated with heavy drinking for non-Hispanic other respondents, even after controlling for NE. For non-Hispanic black participants, NE was associated with smoking after controlling for WRD. A stratified interaction analysis of WRD*NE revealed that there was only an association between NE and heavy drinking for Hispanic participants who did not experience WRD. Conclusions: The relationship between WRD and substance use may be in part accounted for by NE. Further exploration is needed to more fully understand why associations exist for some race/ethnicity groups but not others.
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Affiliation(s)
- Andrea L Stone
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington, USA
| | - Shauna K Elbers-Carlisle
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington, USA
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Alcaraz KI, Wiedt TL, Daniels EC, Yabroff KR, Guerra CE, Wender RC. Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy. CA Cancer J Clin 2020; 70:31-46. [PMID: 31661164 DOI: 10.3322/caac.21586] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden. Reducing the burden of cancer and eliminating cancer-related disparities will require more focused and coordinated action across multiple sectors and in partnership with communities. This article, part of the American Cancer Society's Cancer Control Blueprint series, introduces a framework for understanding and addressing social determinants to advance cancer health equity and presents actionable recommendations for practice, research, and policy. The article aims to accelerate progress toward eliminating disparities in cancer and achieving health equity.
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Affiliation(s)
- Kassandra I Alcaraz
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Tracy L Wiedt
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Research, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard C Wender
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
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Wilson SM, Medenblik AM, Neal JM, Strauss JL, McNiel JM, Christian WE, Beckham JC, Calhoun PS. Lifetime Smoking Patterns and Preferences for Smoking Cessation Among Women Veterans Receiving Veterans Health Administration Care. QUALITATIVE HEALTH RESEARCH 2019; 29:2096-2107. [PMID: 31307290 PMCID: PMC6848747 DOI: 10.1177/1049732319857536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to identify common themes among women veterans who smoke or recently quit and had used smoking cessation treatment within the Veterans Health Administration (VHA). The study built upon previous research by utilizing in-depth interviews to encourage disclosure of potentially stigmatized topics. Twenty women veterans enrolled in VHA care engaged in a quality improvement project focused on improving smoking cessation services. Qualitative analysis of de-identified interviews used a combination of content analysis and thematic analysis within the sociopharmacological model of tobacco addiction. Findings revealed that participants' smoking was influenced by woman veteran identity and by several gender-related contextual factors, including military sexual trauma and gender discrimination. Findings also highlighted other contextual factors, such as personal autonomy, emotional smoking triggers, and chronic mental health concerns. Findings are interpreted within the context of cultural power imbalances, and recommendations are provided for VHA smoking cessation for women veterans.
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Affiliation(s)
- Sarah M Wilson
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alyssa M Medenblik
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julia M Neal
- Durham VA Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Jennifer L Strauss
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - J Murray McNiel
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Warren E Christian
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Patrick S Calhoun
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
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Alexander AC, Nollen NL, Ahluwalia JS, Hébert ET, Businelle MS, Kendzor DE. Darker skin color is associated with a lower likelihood of smoking cessation among males but not females. Soc Sci Med 2019; 240:112562. [PMID: 31586778 PMCID: PMC6921999 DOI: 10.1016/j.socscimed.2019.112562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/24/2019] [Accepted: 09/19/2019] [Indexed: 11/21/2022]
Abstract
Darker skin color is associated with discrimination and unfair treatment and may contribute to persisting health disparities. This study examined whether darker skin color was associated with smoking cessation and whether this association was moderated by sex and race. This study also explored whether biological and psychosocial factors, including nicotine and cotinine concentrations, discrimination, distrust, and neuroticism, mediated this association. The data for this study came from a prospective smoking cessation intervention that included 224 Black and 225 White adults from Kansas City, Missouri. Skin color was assessed using a DermaSpectrometer to measure melanin contained within the skin. Point prevalence smoking abstinence was biochemically-verified and assessed at weeks 4 and 26. Hierarchical logistic regression analyses were conducted to evaluate hypothesized relations between skin color and smoking cessation. Interactions between race and sex with skin color were also evaluated. While skin color was not associated with smoking cessation in the overall sample or among Blacks only, results indicated that sex moderated the effect of skin color on smoking cessation after adjusting for race and other covariates. Among males, darker skin color was associated with lower odds of achieving smoking abstinence at weeks 4 (OR = 0.60 [95% CI = 0.36, 0.99]) and 26 (OR = 0.52 [95% CI = 0.29, 0.91]). Skin color did not predict smoking cessation among females. Skin color was positively correlated with discrimination (r = 0.15, p = 0.02), cynicism/distrust (r = 0.14, p = 0.03) and neuroticism (r = 0.24, p < 0.01) among males only. However, these factors did not mediate the association between skin color and smoking cessation. Skin color may contribute to cessation-related health disparities among Black males, but more research is needed to understand the psychosocial and biological mechanisms through which skin color influences tobacco cessation.
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Affiliation(s)
- Adam C Alexander
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Nicole L Nollen
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Darla E Kendzor
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping. J Acquir Immune Defic Syndr 2019; 78:9-15. [PMID: 29373394 DOI: 10.1097/qai.0000000000001636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use. SETTING Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015. METHODS Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Mediation models for each form of discrimination (HIV, race and sexual orientation) adjusting for demographic variables and the other forms of discrimination were evaluated. RESULTS The indirect effect of HIV-related discrimination on likelihood of tobacco use through avoidance coping was significant, suggesting that avoidance coping mediates the association between HIV-related discrimination and tobacco use. However, the indirect effects of the other forms of discrimination were not significant. CONCLUSIONS Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.
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Everyday discrimination indirectly influences smoking cessation through post-quit self-efficacy. Drug Alcohol Depend 2019; 198:63-69. [PMID: 30878768 DOI: 10.1016/j.drugalcdep.2019.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although studies have shown an association between discrimination and current smoking, the influence of discrimination on smoking cessation is an understudied area in tobacco research. The current study evaluated the influence of everyday discrimination on smoking cessation and examined self-efficacy as a potential mediator of this association. METHODS Participants (N = 146), who were recruited from a safety-net hospital in Dallas County, Texas, from 2011 to 2013, completed a self-report measure of perceived discrimination one week before the scheduled quit attempt and self-efficacy for quitting was assessed one day after the scheduled quit date. Biochemically-verified 7-day point prevalence abstinence was assessed weekly, through the fourth week after the scheduled quit date. Structural equation modeling was used to evaluate the indirect effect of perceived discrimination on smoking cessation via self-efficacy for quitting. RESULTS Analyses indicated significant indirect effect of discrimination on smoking cessation through self-efficacy at Weeks 1 (B = .09, SE = .04, p = .02) and 4 (B = .07, SE = .03, p = .03). A higher frequency of discrimination was associated with lower self-efficacy one day after the scheduled quit date, and lower self-efficacy increased the likelihood of smoking one and four weeks after the scheduled quit attempt. CONCLUSIONS Findings suggest that perceptions of discrimination reduce the likelihood of smoking cessation via diminished self-efficacy. Future research is needed to identify intervention strategies to reduce the frequency of discrimination experiences and attenuate the negative impact of discrimination and low self-efficacy on smoking cessation.
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Is Weight Discrimination Associated With Physical Activity Among Middle Aged and Older Adults? J Prim Prev 2019; 40:279-295. [PMID: 30895424 DOI: 10.1007/s10935-019-00546-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Older adults (> 65) are less physically active than all other adult age groups. Although experiences of weight discrimination have been inversely associated with physical activity in several studies of middle-aged and older adults, the role of weight discrimination in this relationship has not been sufficiently explicated. Using data from the Health and Retirement Study (a longitudinal panel study of U.S. adults aged 50 and older), we hypothesized that, among middle aged and older adults, weight discrimination would (a) be inversely related to respondents' reported level of physical activity; and (b) partially mediate the relationship between BMI and physical activity. Using multiple logistic regression analysis, we found an inverse relationship between weight discrimination and vigorous physical activity (OR = 0.79; 95% CI [0.66, 0.94]), as well as between weight discrimination and moderate physical activity (OR = 0.76; 95% CI [0.62, 0.92]). Weight discrimination mediated 13% of the relationship between BMI and vigorous physical activity, as well as 9% of the relationship between BMI and moderate physical activity. Weight discrimination may thus pose a barrier to regular physical activity among middle aged and older adults. Future research and interventions should identify effective ways of mitigating barriers experienced because of weight discrimination in the promotion of physical activity among these age groups, as well as how we may effectively reduce the perpetration of weight discrimination in various settings.
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Vu M, Li J, Haardörfer R, Windle M, Berg CJ. Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework. BMC Public Health 2019; 19:108. [PMID: 30674293 PMCID: PMC6345035 DOI: 10.1186/s12889-019-6430-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Intersectionality theory focuses on how one’s human experiences are constituted by mutually reinforcing interactions between different aspects of one’s identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination. Methods Multivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use. Results Intersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22–5.03]), alcohol use (B = 1.65, CI = [0.56–2.73]), tobacco use (OR = 3.45, CI = [1.97–6.05]), and marijuana use (OR = 3.38, CI = [1.80–6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03–4.29] for depressive symptoms, B = 1.45 and CI = [0.58–2.32] for alcohol use, OR = 2.21 and CI = [1.32–3.70] for tobacco use, and OR = 3.01 and CI = [1.77–5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39–5.02]) and marijuana use (OR = 2.81, CI = [1.33–5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52–3.28]) and marijuana use (OR = 2.37, CI = [1.24–4.49]). Conclusions Our results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression).
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Affiliation(s)
- Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Jingjing Li
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.,Winship Cancer Institute, 1365 Clifton Rd, Atlanta, CA, 30322, USA
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Matsuzaka S, Knapp M. Anti-racism and substance use treatment: Addiction does not discriminate, but do we? J Ethn Subst Abuse 2019; 19:567-593. [DOI: 10.1080/15332640.2018.1548323] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sara Matsuzaka
- Fordham University Graduate School of Social Service, New York, New York
| | - Margaret Knapp
- Fordham University Graduate School of Social Service, New York, New York
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Ethnic Discrimination and Smoking-Related Outcomes among Former and Current Arab Male Smokers in Israel: The Buffering Effects of Social Support. J Immigr Minor Health 2019; 20:1094-1102. [PMID: 28786021 DOI: 10.1007/s10903-017-0638-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined the relationship between two forms of ethnic discrimination-interpersonal and institutional-and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n = 954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel.
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Unger JB. Perceived Discrimination as a Risk Factor for Use of Emerging Tobacco Products: More Similarities Than Differences Across Demographic Groups and Attributions for Discrimination. Subst Use Misuse 2018; 53:1638-1644. [PMID: 29338581 PMCID: PMC7392176 DOI: 10.1080/10826084.2017.1421226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Perceived discrimination has been associated with cigarette smoking and other substance use among members of disadvantaged minority groups. However, most studies have focused on a single minority group, have not considered the individual's attribution for the discrimination, and have not considered emerging tobacco products. OBJECTIVE This study examined the associations between perceived discrimination and use of six tobacco products (cigarettes, e-cigarettes, cigars, pipe tobacco, hookah, and smokeless tobacco) in a diverse sample of 1,068 adults in the United States. METHODS Participants were recruited on Amazon's Mechanical Turk and participated in an online survey. Logistic regression models were used to examine the association between perceived discrimination and use of each tobacco product. Interactions between discrimination and demographic characteristics, and between discrimination and perceived reasons for discrimination, were evaluated. RESULTS Controlling for age, sex, race/ethnicity, education, and socioeconomic status, perceived discrimination was a risk factor for current use of five of the six tobacco products. These associations were consistent across racial/ethnic groups and regardless of the individual's attribution for the reason for the discrimination. CONCLUSIONS Results indicate that perceived discrimination is a risk factor for the use of multiple tobacco products, and that this association is not limited to particular demographic groups or types of discrimination. Public health programs could potentially reduce tobacco-related disease by teaching healthier ways to cope with discrimination.
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Affiliation(s)
- Jennifer B Unger
- a Tobacco Center of Regulatory Science, Department of Preventive Medicine , University of Southern California, Keck School of Medicine , Los Angeles , California , USA
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Yang TC, Chen IC, Choi SW, Kurtulus A. Linking perceived discrimination during adolescence to health during mid-adulthood: Self-esteem and risk-behavior mechanisms. Soc Sci Med 2018; 232:434-443. [PMID: 30025883 DOI: 10.1016/j.socscimed.2018.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/06/2018] [Accepted: 06/17/2018] [Indexed: 12/01/2022]
Abstract
RATIONALE The literature on the effect of perceived discrimination on health has three gaps. First, the long-term relationship between perceived discrimination and health is underexplored. Second, the mechanisms through which perceived discrimination affects health remain unclear. Third, most studies focus on racial/ethnic discrimination, and other aspects of discrimination are overlooked. OBJECTIVE This study aims to fill these gaps by testing a research framework that links the discriminatory experience during adolescence to an individual's health during mid-adulthood via self-esteem and risk behaviors at early adulthood. METHOD Structural equation modeling is applied to the National Longitudinal Survey of Youth, 1979 Cohort (N = 6478). RESULTS The discriminatory experience during adolescence imposes an adverse impact on health during mid-adulthood even after accounting for other potential covariates, a detrimental effect lasting for over 30 years. In addition, while perceived discrimination reduces self-esteem at early adulthood, it affects only mental health during mid-adulthood, rather than general health. Finally, the discriminatory experience promotes risk behaviors at early adulthood and the risk behaviors subsequently compromise health during mid-adulthood. CONCLUSIONS Using a life course perspective, we find that the effect of perceived discrimination is more profound than the literature suggested and that risk behaviors may account for approximately 17% of the total effect of perceived discrimination on health. Our findings highlight the importance of early interventions in coping with perceived discrimination during adolescence.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New York, 1400 Washington Avenue, Arts and Sciences 351, Albany, NY 12222, USA.
| | - I-Chien Chen
- Department of Sociology, Michigan State University, 509 East Circle Drive, 317 Berkey Hall, East Lansing, MI 48824, USA
| | - Seung-Won Choi
- Department of Sociology, Michigan State University, 509 East Circle Drive, 317 Berkey Hall, East Lansing, MI 48824, USA
| | - Aysenur Kurtulus
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New York, 1400 Washington Avenue, Arts and Sciences 351, Albany, NY 12222, USA
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Liu Y, Jiang C, Li S, Gu Y, Zhou Y, An X, Zhao L, Pan G. Association of recent gay-related stressful events with depressive symptoms in Chinese men who have sex with men. BMC Psychiatry 2018; 18:217. [PMID: 29973174 PMCID: PMC6030786 DOI: 10.1186/s12888-018-1787-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/12/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To assess the association of different gay-related stressful events (GRSEs) with depressive symptoms in Chinese men who have sex with men (MSM). METHOD A total of 807 MSM were recruited using respondent-driven sampling from four cities in northeastern China. GRSEs were measured using the Gay Related Stressful Life Events Scale, and depressive symptoms were assessed using the Self-Rating Depression Scale (SDS). RESULTS A total of 26.0% of study participants experienced GRSEs in the past three months, and the average SDS score was lower than the previously reported national average for China. The study participants had significantly elevated risks of depression (SDS score ≥ 53) due to recent troubles with a boss (OR = 4.92, 95% CI = 1.87-12.97) or a workmate (OR = 3.68, 95% CI = 1.52-8.88), loss of a close friend (OR = 2.41, 95% CI = 1.39-4.18), argument with a close friend (OR = 2.07, 95% CI = 1.33-3.22), and being physically assaulted (OR = 2.08, 95% CI = 0.98-4.43). Arguments with family members or classmates had no significant effect on depression. Multiple logistic regression analysis showed that the number of GRSEs, a lower level of education, more advanced age, and HIV infection significantly increased the risk of depression. CONCLUSIONS There are large differences in the associations of different types of GRSEs with depressive symptoms. Reducing the stigmatization and discrimination toward MSM in all social environments and improving the capability of MSM to cope with different types of GRSEs may improve their emotional wellbeing.
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Affiliation(s)
- Yunyong Liu
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Xiaoheyan Road 44, Dadong District, Shenyang, 110042, People's Republic of China.
| | - Chao Jiang
- 0000 0000 9558 1426grid.411971.bDepartment of Psychiatry, Dalian Medical University, Dalian, People’s Republic of China
| | - Siyao Li
- 0000 0004 1757 9522grid.452816.cDepartment of Psychiatry, Liaoning Provincial People’s Hospital, Shenyang, People’s Republic of China
| | - Yuan Gu
- Shenyang Municipal Center for Disease Control and Prevention, Shenyang, People’s Republic of China
| | - Yan Zhou
- Dandong Municipal Center for Disease Control and Prevention, Dandong, People’s Republic of China
| | - Xiaoxia An
- Benxi Municipal Center for Disease Control and Prevention, Benxi, People’s Republic of China
| | - Li Zhao
- Anshan Municipal Center for Disease Control and Prevention, Anshan, People’s Republic of China
| | - Guowei Pan
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, People’s Republic of China
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Lo CC, Yang F, Ash-Houchen W, Cheng TC. Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization. Subst Use Misuse 2018; 53:1184-1193. [PMID: 29172859 DOI: 10.1080/10826084.2017.1400062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use. OBJECTIVES This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations. METHODS We used nationally representative data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents. RESULTS Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions. CONCLUSIONS We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen-and it is often minority Americans who lack access and trust. If minority Americans' health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.
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Affiliation(s)
- Celia C Lo
- a Department of Sociology and Social Work , Texas Woman's University , Denton , Texas , USA
| | - Fan Yang
- b Doctoral Student, School of Social Work , University of Alabama , Tuscaloosa , Alabama , USA
| | - William Ash-Houchen
- c Doctoral Student, Department of Sociology and Social Work , Texas Woman's University , Denton , Texas , USA
| | - Tyrone C Cheng
- d Department of Social Work and Child Advocacy , Montclair State University , Montclair , New Jersey , USA
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Rose SW, Mayo A, Ganz O, Perreras L, D'Silva J, Cohn A. Perceived racial/ethnic discrimination, marketing, and substance use among young adults. J Ethn Subst Abuse 2018; 18:558-577. [PMID: 29424638 DOI: 10.1080/15332640.2018.1425949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Perceived experiences of discrimination have been linked to negative health behaviors including tobacco, alcohol, and marijuana use across various racial/ethnic groups. Tobacco and alcohol marketing exposure have also been linked with substance use. This study examined the independent and interacting effects of perceived experiences of discrimination and exposure to alcohol and tobacco marketing, and receptivity to marijuana marketing on substance use in an online survey of a multiethnic sample of young adults in 6 metropolitan areas (n = 505). African Americans (mean (M) = 1.96, 9% 5CI [1.84, 2.09]) and Hispanics (M = 1.98, 95% CI [1.87, 2.09]) reported higher levels of perceived discrimination than Whites (M = 1.52, 95% CI [1.40, 1.64]), p < .001. African Americans had higher levels of exposure to tobacco and alcohol marketing; Hispanics reported higher levels of exposure to alcohol marketing and receptivity to marijuana promotion. Discrimination and marketing exposure were independently associated with higher odds of all 3 outcomes, controlling for covariates (AOR from 2.1 to 3.4 for discrimination; AOR from 1.4 to 13.8 for marketing). Models showed a significant interaction of discrimination and tobacco marketing on past 30-day cigarette use (F = 5.5; p = .02). Individuals with high levels of tobacco marketing exposure were likely to report high past 30-day cigarette use regardless of level of discrimination, while those with low exposure were only at increased risk of reporting cigarette use at higher levels of discrimination. Both perceived discrimination and marketing exposure play a role in substance use. Interventions should consider discrimination as a significant risk factor underlying vulnerability to substance use among young adults.
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Affiliation(s)
| | - Ashley Mayo
- Truth Initiative Schroeder Institute , Washington , DC
| | - Ollie Ganz
- Truth Initiative Schroeder Institute , Washington , DC.,George Washington University Milken Institute School of Public Health , Washington , DC
| | | | - Joanne D'Silva
- Truth Initiative Schroeder Institute , Washington , DC.,University of Maryland School of Public Health , College Park , Maryland
| | - Amy Cohn
- Battelle Memorial Institute , Arlington , Virginia.,Georgetown University Medical Center , Washington , DC
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Chyi T, Lu FJH, Wang ET, Hsu YW, Chang KH. Prediction of life stress on athletes' burnout: the dual role of perceived stress. PeerJ 2018; 6:e4213. [PMID: 29362691 PMCID: PMC5772382 DOI: 10.7717/peerj.4213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/10/2017] [Indexed: 11/20/2022] Open
Abstract
Although many studies adopted Smith's (1986) cognitive-affective model of athletic burnout in examining stress-burnout relationship, very few studies examined the mediating/moderating role of perceived stress on the stress-burnout relationship. We sampled 195 college student-athletes and assessed their life stress, perceived stress, and burnout. Correlation analyses found all study variables correlated. Two separate hierarchical regression analyses found that the "distress" component of perceived stress mediated athletes' two types of life stress-burnout relationship but "counter-stress" component of perceived stress-moderated athletes' general-life stress-burnout relationship. We concluded that interweaving relationships among athletes' life stress, perceived stress, and burnout are not straightforward. Future research should consider the nature of athletes life stress, and dual role of perceived stress in examining its' association with related psychological responses in athletic settings.
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Affiliation(s)
- Theresa Chyi
- Department of Exercise and Health Promotion, Chinese Culture University, Taipei City, Taiwan
| | - Frank Jing-Horng Lu
- Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei City, Taiwan
| | - Erica T.W. Wang
- Office of Physical Education and Sports Affairs, Feng Chia University, Taichung, Taiwan
| | - Ya-Wen Hsu
- Department of Physical Education, Health, and Recreation, National Chiayi University, Chiayi, Taiwan
| | - Ko-Hsin Chang
- Department of Physical Education, Chinese Culture University, Taipei City, Taiwan
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Irby-Shasanmi A, Leech TGJ. 'Because I Don't know': uncertainty and ambiguity in closed-ended reports of perceived discrimination in US health care. ETHNICITY & HEALTH 2017; 22:458-479. [PMID: 27741709 DOI: 10.1080/13557858.2016.1244659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective Surveys often ask respondents to assess discrimination in health care. Yet, patients' responses to one type of widely used measure of discrimination (single-item, personally mediated) tend to reveal prevalence rates lower than observational studies would suggest. This study examines the meaning behind respondents' closed-ended self-reports on this specific type of measure, paying special attention to the frameworks and references used within the medical setting. Design Twenty-nine respondents participated in this study. They were asked the widely used question: 'Within the past 12 months, when seeking health care do you feel your experiences were worse than, the same as, or better than people of other races?' We then conducted qualitative interviews focusing on their chosen response and past experiences. Descriptive analyses focus on both the quantitative and qualitative data, including a comparison of conveyed perceived discrimination according to the different sources of data. Results To identify discrimination, respondents drew upon observations of dynamics in the waiting room or the health providers' communication style. Our respondents were frequently ambivalent and uncertain about how their personal treatment in health care compared to people of other races. When participants were unable to make observable comparisons, they tended to assume equal treatment and report 'same as' in the close-ended reports. Conclusion Respondents' responses to single-item, closed-ended questions may be influenced by characteristics specific to the health care realm. An emphasis on privacy and assumptions about the health care field (both authority and benevolence of providers) may limit opportunities for comparison and result in assumptions of racial parity in treatment.
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Affiliation(s)
- Amy Irby-Shasanmi
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
| | - Tamara G J Leech
- a Department of Social and Behavioral Sciences , Indiana University Purdue University, Indianapolis (IUPUI) , Indianapolis , IN , USA
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Bowie JV, Parker LJ, Beadle-Holder M, Ezema A, Bruce MA, Thorpe RJ. The Influence of Religious Attendance on Smoking Among Black Men. Subst Use Misuse 2017; 52:581-586. [PMID: 28033482 PMCID: PMC10041884 DOI: 10.1080/10826084.2016.1245342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cigarette smoking poses a major public health problem that disproportionately affects Blacks and men. Religious attendance has been shown to be positively associated with health promotion and disease prevention among the Black population. In light of this evidence, this study examined if a similar relationship could be found for religious attendance and smoking in Black men. METHODS The National Survey of American Life (NSAL) study sampled 1,271 African American men and 562 Black Caribbean men. Multivariate logistic regression was used to determine the association between religious attendance and cigarette smoking. RESULTS After adjusting for age, marital status, household income, education, foreign born status, importance of prayer and major stress, men who reported attending religious services almost every day (odds ratio (OR) = 0.21, 95% confidence interval (CI) = 0.07, 0.62) and weekly (OR = 0.47, 95% CI = 0.29, 0.77) had lower odds of being a current smoker compared to men who reported never attending religious services. Conclusions/Importance: Findings suggest a health benefit in attending religious services on cigarette smoking among Black men in a nationally representative sample. In spite of lower church attendance in Black men in general, our results demonstrate that religious service attendance may still serve as a buffer against cigarette use. Given the emergent attention on faith-based health promotion among men, this conclusion is relevant and timely.
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Affiliation(s)
- Janice V Bowie
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Lauren J Parker
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Michelle Beadle-Holder
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,c Department of Sociology , University of Maryland , College Park , Maryland , USA
| | - Ashley Ezema
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Undergraduate Program in Public Health Studies, Johns Hopkins University , Baltimore , Maryland , USA
| | - Marino A Bruce
- e Center for Health of Minority Males, University of Mississippi Medical Center , Jackson , Mississippi , USA.,f Department of Sociology and Criminal Justice , Jackson State University , Jackson , Mississippi , USA
| | - Roland J Thorpe
- a Program for Research on Men's Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Undergraduate Program in Public Health Studies, Johns Hopkins University , Baltimore , Maryland , USA.,g Center for Biobehavioral Health Disparities Research, Duke University , Durham , North Carolina , USA
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Parker LJ, Hunte H, Ohmit A, Furr-Holden D, Thorpe RJ. The Effects of Discrimination Are Associated With Cigarette Smoking Among Black Males. Subst Use Misuse 2017; 52:383-391. [PMID: 27779434 PMCID: PMC6331212 DOI: 10.1080/10826084.2016.1228678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED Previous research has demonstrated that experiencing interpersonal discrimination is associated with cigarette smoking. Few studies have examined the relationship between the effects of physical and emotional discrimination and cigarette usage, and none have examined this relationship among Black men. The aim of this study was to examine the association between the effects of physical and emotional discrimination and cigarette smoking. METHODS Data from the Indiana Black Men's Health Study, a community-based sample of adult Black men, was used to conduct multivariate logistic regression to examine the relationship between the physical and emotional effects of discrimination and smoking, net of healthcare and workplace discrimination, age, education, household income, and being married. RESULTS After adjusting for having an emotional response to discrimination, health care and workplace discrimination, age, education, household income, and being married, males who had a physical response to discrimination (e.g., upset stomach or headache) had higher odds of cigarette use (odds ratio (OR): 1.95, 95% confidence interval (CI): 1.15-3.30) than men who did not have a physical response to discrimination. CONCLUSION Findings from the study suggest that Black males may use cigarette smoking as a means to mitigate the stress associated with experiences of discrimination. Future research is needed further to explore if and how Black males use cigarette smoking to cope with unfair treatment.
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Affiliation(s)
- Lauren J Parker
- a Program for Research on Men's Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Haslyn Hunte
- b School of Public Health, Social & Behavioral Sciences , West Virginia University , Morgantown , West Virginia , USA
| | - Anita Ohmit
- c Indiana Minority Health Coalition , Indianapolis , Indiana , USA
| | - Debra Furr-Holden
- d Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Roland J Thorpe
- a Program for Research on Men's Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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Stepanikova I, Oates GR. Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race. Am J Prev Med 2017; 52:S86-S94. [PMID: 27989297 PMCID: PMC5172593 DOI: 10.1016/j.amepre.2016.09.024] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study examined how perceived racial privilege and perceived racial discrimination in health care varied with race and socioeconomic status (SES). METHODS The sample consisted of white, black, and Native American respondents to the Behavioral Risk Factor Surveillance System (2005-2013) who had sought health care in the past 12 months. Multiple logistic regression models of perceived racial privilege and perceived discrimination were estimated. Analyses were performed in 2016. RESULTS Perceptions of racial privilege were less common among blacks and Native Americans compared with whites, while perceptions of racial discrimination were more common among these minorities. In whites, higher income and education contributed to increased perceptions of privileged treatment and decreased perceptions of discrimination. The pattern was reversed in blacks, who reported more discrimination and less privilege at higher income and education levels. Across racial groups, respondents who reported foregone medical care due to cost had higher risk of perceived racial discrimination. Health insurance contributed to less perceived racial discrimination and more perceived privilege only among whites. CONCLUSIONS SES is an important social determinant of perceived privilege and perceived discrimination in health care, but its role varies by indicator and racial group. Whites with low education or no health insurance, well-educated blacks, and individuals who face cost-related barriers to care are at increased risk of perceived discrimination. Policies and interventions to reduce these perceptions should target structural and systemic factors, including society-wide inequalities in income, education, and healthcare access, and should be tailored to account for racially specific healthcare experiences.
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Affiliation(s)
- Irena Stepanikova
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama; Research Centre for Toxic Compounds in the Environment, Masaryk University, Brno, Czech Republic;.
| | - Gabriela R Oates
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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