The influence of discrimination on smoking cessation among Latinos
Introduction
Latino health has become a major focus of public health attention. Latinos comprise 16.3% of the total U.S. population, which represents a 43% increase since 2000, and individuals of Mexican origin represent 63% of the U.S. Latino population (Ennis et al., 2011). Discrimination is a common experience among Latinos (Lopez et al., 2010, Pérez et al., 2008), with over 60% of Latinos reporting that discrimination is a major problem (Lopez et al., 2010). For example, Hosoda et al. (2012) reported that individuals with a Mexican-Spanish accent were rated as less suitable for employment than those with an American English accent. Thus, discrimination may be particularly problematic for those who prefer to speak Spanish and/or those who are less proficient in English.
Discrimination is associated with a variety of negative health outcomes including higher rates of smoking (Lee and Ahn, 2012, Paradies, 2006) and greater nicotine dependence (Kendzor et al., 2014). For example, Purnell et al. (2012) reported that the prevalence of current smoking was significantly greater among individuals who perceived racial discrimination in healthcare and/or workplace settings versus those who did not. Although studies have largely focused on the link between racial/ethnic discrimination and smoking among Black adults (Borrell et al., 2010, Borrell et al., 2007, Corral and Landrine, 2012, Cuevas et al., 2014, Horton and Loukas, 2011, Landrine and Klonoff, 2000, Nguyen et al., 2012), research suggests that discrimination is similarly linked with smoking prevalence among Latinos (Albert et al., 2008, Lorenzo-Blanco and Cortina, 2012, Todorova et al., 2010). Although smoking prevalence is lower among Latinos than in the general U.S. population (12.5% vs. 19.3%; CDC, 2011), the leading causes of death among Latinos (i.e., cancer, cardiovascular disease) are related to smoking (Heron, 2012). Moreover, lung cancer, a primarily smoking-related disease, is the leading cause of cancer death among Latinos (USCS, 2013). Therefore, reducing tobacco use is essential to chronic disease prevention among Latinos.
Negative affect, low self-efficacy, and diminished perceptions of social status may function as key mechanisms linking discrimination with unhealthy behaviors and poor health (Chae et al., 2011, Cuevas et al., 2013, Gee et al., 2006, Lee and Ahn, 2012, Molina et al., 2013, Pascoe and Richman, 2009, Purnell et al., 2012, Torres et al., 2012). In a recent meta-analysis, Lee and Ahn reported that discrimination among Latinos was strongly associated with negative affect and unhealthy behavior, and that intrapersonal variables (e.g., self-efficacy, self-esteem) were associated with both discrimination and physical/mental health outcomes (Lee and Ahn, 2012). Molina et al. (2013) reported that discrimination was associated with poorer self-rated health through perceptions of diminished U.S. social status and negative affect. Further, numerous studies have demonstrated a link between smoking relapse and negative affect (Businelle et al., 2010, Cofta-Woerpel et al., 2011, Piasecki, 2006, Piper et al., 2011, Shiffman, 2005) and low self-efficacy (Baer et al., 1986, Gwaltney et al., 2005, Matheny and Weatherman, 1998, Shiffman, 2005). Thus, discrimination may have a negative influence on smoking cessation via increased negative affect, diminished self-efficacy, and low perceived social status.
Despite theoretical plausibility, studies have yet to evaluate the influence of discrimination experiences on smoking cessation. Previous studies of discrimination and smoking status among Latinos have focused on several conceptualizations of discrimination including everyday discrimination, lifetime racial/ethnic or language discrimination of any type, and discrimination in healthcare settings (Albert et al., 2008, Lorenzo-Blanco and Cortina, 2012, Todorova et al., 2010). Major experiences of discrimination, such as being fired from a job, could also have a significant impact on behaviors such as smoking and smoking cessation. Studies are needed to determine the prospective influence of everyday and major discrimination on smoking cessation outcomes among Latinos making a quit attempt. A focus on individuals of Mexican heritage is warranted given that this group comprises the largest proportion of a rapidly growing population and Spanish-speaking individuals may be particularly likely to experience discrimination. Thus, the primary goals of the current study were to: (1) characterize both everyday and major discrimination experiences among Spanish-speaking individuals of Mexican heritage making a smoking quit attempt, and (2) examine the influence of everyday and major discrimination experiences on smoking cessation in this population.
Section snippets
Methods
This research was approved by the Institutional Review Board of the University of Texas MD Anderson Cancer Center, and informed consent was obtained from all participants. Data were collected as part of a longitudinal study designed to examine neighborhood, individual, and acute intrapersonal and contextual determinants of smoking cessation among Spanish-speaking individuals of Mexican heritage making a quit attempt. Participants were tracked from 2 weeks prior to their quit date through 26
Participant characteristics
Of the 199 Spanish-speaking smokers of Mexican heritage recruited in the parent study, 9 were excluded from all analyses because they were missing data on both discrimination measures (n = 3) or on any of the covariates (n = 6). Thus, the overall sample size was reduced to 190 participants. At 26-weeks post-quit, 15.8% (n = 30) of participants had achieved 7-day point prevalence abstinence and 7.4% (n = 14) had achieved continuous abstinence. See Table 1 for participant characteristics.
Everyday discrimination experiences
Thirteen
Discussion
Latinos in the current study who experienced greater lifetime exposure to major discrimination events were less likely to achieve abstinence than individuals who experienced less discrimination. In contrast, everyday discrimination was not associated with smoking cessation. More than half of participants reported that they had experienced at least one major discrimination event, with the most common events being job-related. Race/ethnicity/nationality was the most commonly perceived reason for
Role of funding source
Funding for this study was provided by the National Center on Minority Health and Health Disparities grant P60MD000503 (to DWW). Data analysis and manuscript preparation were additionally supported through American Cancer Society grants MRSGT-10-104-01-CPHPS (to DEK) and MRSGT-12-114-01-CPPB (to MSB), National Cancer Institute grant K01CA157689 (to YC), National Cancer Institute diversity supplement grant U54CA153505 (to MAC), the University of Texas MD Anderson Cancer Center Duncan Family
Contributors
DEK conducted all statistical analyses and was the primary author of the manuscript. MSB, LRR, YC, JIV, CAM, PMC, CYL, CEA, VCF, and MAC contributed to study conceptualization and manuscript preparation/revision. DWW was the principle investigator on the parent project and he contributed to study conceptualization, interpretation of the statistical analyses, and manuscript preparation/revision.
Conflict of interest
The authors have no conflicts of interest to disclose.
Acknowledgments
We would like to acknowledge the financial support of the National Center on Minority Health and Health Disparities, the American Cancer Society, the National Cancer Institute, and the University of Texas MD Anderson Cancer Center (including the Duncan Family Institute for Cancer Prevention and Risk Assessment). We are grateful for the contributions of all study team members including Shanna Barnett, Erica Cantu, Gloria Cortez, Ellen Cromley, Patricia Figueroa, Araceli Flores, Jeannie Flores,
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2022, Addictive BehaviorsCitation Excerpt :Importantly, lower median household income and higher proportion of Hispanic residents in the census tract is associated with greater local availability of tobacco products (Siahpush, Jones, Singh, Timsina, & Martin, 2010). Another study showed that multiple major discrimination events such as not being hired for a job or being fired is associated with lower smoking abstinence among Latino smokers (Kendzor, Businelle, & Reitzel, 2014). Adult smokers with well-established indicators of low SES such as unemployment, income below the poverty level, low educational level and no health insurance are less likely to quit smoking relative to their peers with higher SES (National Center for Chronic Disease Prevention and Health Promotion, 2014; Businelle, Kendzor, & Reitzel, 2010; Kendzor, Businelle, & Costello, 2010; Leventhal, Bello, Galstyan, Higgins, & Barrington-Trimis, 2019; Reid, Hammond, Boudreau, Fong, & Siahpush, 2010).
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2019, Social Science and MedicineCitation Excerpt :Psychosocial mechanisms may also link skin color to tobacco use and poor cessation outcomes. Blacks with darker skin color are predisposed to experience discrimination and unfair treatment (Uzogara and Jackson, 2016), and previous studies have shown that experiencing discrimination is associated with smoking (Chen and Yang, 2014; Parker et al., 2017), greater nicotine dependence (Kendzor et al., 2014b), and difficulty quitting smoking (Alexander et al., 2019; Kendzor et al., 2014a). Secondarily, because Blacks with darker skin color report high levels of discrimination, they may also be more likely to believe that people are intentionally harmful and inherently dishonest and believe that society is uncontrollable and harmful (Brondolo et al., 2011; McClendon et al., 2019).