Elsevier

Drug and Alcohol Dependence

Volume 136, 1 March 2014, Pages 143-148
Drug and Alcohol Dependence

The influence of discrimination on smoking cessation among Latinos

https://doi.org/10.1016/j.drugalcdep.2014.01.003Get rights and content

Abstract

Background

Although studies have shown a cross-sectional link between discrimination and smoking, the prospective influence of discrimination on smoking cessation has yet to be evaluated. Thus, the purpose of the current study was to determine the influence of everyday and major discrimination on smoking cessation among Latinos making a quit attempt.

Methods

Participants were 190 Spanish speaking smokers of Mexican Heritage recruited from the Houston, TX metropolitan area who participated in the study between 2009 and 2012. Logistic regression analyses were conducted to evaluate the associations of everyday and major discrimination with smoking abstinence at 26 weeks post-quit.

Results

Most participants reported at least some everyday discrimination (64.4%), and at least one major discrimination event (56%) in their lifetimes. Race/ethnicity/nationality was the most commonly perceived reason for both everyday and major discrimination. Everyday discrimination was not associated with post-quit smoking status. However, experiencing a greater number of major discrimination events was associated with a reduced likelihood of achieving 7-day point prevalence smoking abstinence, OR = .51, p = .004, and continuous smoking abstinence, OR = .29, p = .018, at 26 weeks post-quit.

Conclusions

Findings highlight the high frequency of exposure to discrimination among Latinos, and demonstrate the negative impact of major discrimination events on a smoking cessation attempt. Efforts are needed to attenuate the detrimental effects of major discrimination events on smoking cessation outcomes.

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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