Racial/ethnic differences in associations between neighborhood socioeconomic status, distress, and smoking among U.S. adults

In the eyes of the beholder: Race, place and health

Racial and ethnic health disparities are fundamentally connected to neighborhood quality. For example, as a result of historical systemic inequities, racial and ethnic minorities are more likely to live in neighborhoods with signs of physical disorder (e.g., graffiti, vandalism), and physically disordered environments have been noted to associate with increased risk for chronic illness. Degree of exposure to neighborhood disorder may alter peoples' perception of their neighborhoods, however, with those most exposed (e.g., historically marginalized racial/ethnic groups) perhaps perceiving less threat from signs of neighborhood disorder. The purpose of the present study was to examine the complex interrelationships between people and place by investigating whether exposure to neighborhood physical disorder relates to residents' (1) perceptions of neighborhood safety and (2) perceptions of their health, and (3) examining whether these links vary by race/ethnicity. Using 2016-2018 Health and Retirement Study (HRS) data, a representative sample of US adults aged 51 years and older (n = 9,080, mean age 68 years), we conducted a series of weighted linear regressions to examine the role of neighborhood disorder in relation to both perceived neighborhood safety and self-rated health. Results indicated that greater neighborhood physical disorder was statistically significantly related to feeling less safe among non-Hispanic Whites and Hispanics, but not non-Hispanic Blacks. Regarding self-rated health, neighborhood physical disorder was statistically significantly related to poorer health among all racial/ethnic groups. These findings suggest that, despite differential interpretation of neighborhood disorder as a threat to safety, this modifiable aspect of peoples' environment is related to poor health regardless of one's race/ethnicity.

Genetic Risk for Smoking: Disentangling Interplay Between Genes and Socioeconomic Status

This study aims to disentangle the contribution of genetic liability, educational attainment (EA), and their overlap and interaction in lifetime smoking. We conducted genome-wide association studies (GWASs) in UK Biobank (N = 394,718) to (i) capture variants for lifetime smoking, (ii) variants for EA, and (iii) variants that contribute to lifetime smoking independently from EA ('smoking-without-EA'). Based on the GWASs, three polygenic scores (PGSs) were created for individuals from the Netherlands Twin Register (NTR, N = 17,805) and the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2, N = 3090). We tested gene-environment (G × E) interactions between each PGS, neighborhood socioeconomic status (SES) and EA on lifetime smoking. To assess if the PGS effects were specific to smoking or had broader implications, we repeated the analyses with measures of mental health. After subtracting EA effects from the smoking GWAS, the SNP-based heritability decreased from 9.2 to 7.2%. The genetic correlation between smoking and SES characteristics was reduced, whereas overlap with smoking traits was less affected by subtracting EA. The PGSs for smoking, EA, and smoking-without-EA all predicted smoking. For mental health, only the PGS for EA was a reliable predictor. There were suggestions for G × E for some relationships, but there were no clear patterns per PGS type. This study showed that the genetic architecture of smoking has an EA component in addition to other, possibly more direct components. PGSs based on EA and smoking-without-EA had distinct predictive profiles. This study shows how disentangling different models of genetic liability and interplay can contribute to our understanding of the etiology of smoking.

Associations of positive and negative affect on health risk behaviors among Latinos

OBJECTIVE

Negative affect is widely emphasized in behavior modification interventions. However, positive affect is associated with smoking cessation, physical activity, and healthy dietary habits and may be an important treatment target. Few studies have examined the relationship between positive affect and health behaviors among Latinos, who disproportionately experience modifiable health risk behaviors. This study examined the independent associations of positive affect and negative affect on modifiable health risk behaviors among Latino adults.

METHOD

Data came from 432 persons who participated in one of two studies examining determinants of modifiable health risk behaviors among Latino adults. Primary outcomes were current smoking, at-risk drinking, insufficient physical activity, and insufficient fruit and vegetable consumption. Predictors were positive and negative affect as measured by the Positive and Negative Affect Schedule. Associations between positive and negative affect and health risk behaviors were examined using multiple logistic regression.

RESULTS

Positive affect was associated with lower odds of insufficient physical activity and insufficient fruit and vegetable consumption and lower odds of engaging in multiple health risk behaviors. Negative affect was associated with higher odds of at-risk drinking and current smoking.

CONCLUSIONS

Emphasis on increasing positive affect may be warranted for multiple health risk behavior interventions targeting Latinos. Intervention development efforts may also consider prioritizing positive affect for physical activity and dietary interventions, and negative affect for at-drinking and smoking cessation interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pre- and post-immigration factors associated with cigarette use among young adult recent Latinx immigrants during their initial year in the U.S

Background: Evidence indicates escalating rates of cigarette use among foreign-born Latinx as their time in the U.S increases. As such, it's important to understand shifts in pre- to post-immigration smoking patterns early in the immigration process and its associated factors.Objectives: To examine 1) cigarette use among recent Latinx immigrants (RLIs) during their initial year in the U.S.; 2) whether cigarette use after immigration is influenced by smoking patterns in immigrant's country of origin; and 3) associations between pre/post immigration sociocultural factors and changes in cigarette use after immigration.Methods: Baseline data were utilized from an on-going longitudinal study of 540 young adult (50% females) RLIs. Inclusion criteria was being between ages 18 and 34, residing in Miami-Dade County, Florida, and having immigrated from a Latin American country within the past yearResults: Approximately 31% of participants reported being smokers in their country of origin while 26% were current smokers (while residing in the U.S). Post-immigration cigarette use was substantially influenced by country of origin cigarette use (V = .68); 84% of pre-immigration smokers reported no change in smoking frequency, while 11% lowered and 6% increased their cigarette use post-immigration. Reduction in smoking after immigration was more likely among participants with higher pre-immigration social support (aOR = 1.87) and less likely among those residing in high-crime neighborhoods (aOR = .84).Conclusion: Interventions aimed to discourage cigarette use should begin early in the immigration process and account for RLIs' pre-immigration smoking patterns. Interpersonal supports and neighborhood contextual factors should be considered when developing smoking cessation programs with this population.

Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry

Background

Racial disparities in postoperative complications have been demonstrated in bariatric surgery, yet the relationship of race to complication severity is unknown.

Study Design

Adult laparoscopic primary bariatric procedures were queried from the 2015 and 2016 MBSAQIP registry. Adjusted logistic and multinomial regressions were used to examine the relationships between race and 30-day complications categorized by the Clavien-Dindo grading system.

Results

A total of 212,970 patients were included in the regression analyses. For Black patients, readmissions were higher (OR = 1.39, p < 0.0001) and the odds of a Grade 1, 3, 4, or 5 complication were increased compared with White patients (OR = 1.21, p < 0.0001; OR = 1.21, p < 0.0001; OR = 1.22, p = 0.01; and OR = 1.43, p = 0.04) respectively. The odds of a Grade 3 complication for Hispanic patients were higher compared with White patients (OR = 1.59, p < 0.0001).

Conclusion

Black patients have higher odds of readmission and multiple grades of complications (including death) compared with White patients. Hispanic patients have higher odds of a Grade 3 complication compared with White patients. No significant differences were found with other races. Specific causes of these disparities are beyond the limitations of the dataset and stand as a topic for future inquiry.

Profiles of Psychosocial Risk and Protective Factors and their Associations with Alcohol Use and Regular Smoking in Black Adults

INTRODUCTION

This study aimed to identify the clustering of substance use-related psychosocial risk and protective factors (subgroups) and the differential associations of those subgroups with current alcohol use and regular smoking among Black adults.

METHODS

Data were drawn from 4462 participants (29% Afro Caribbean, 71% African American; median age = 38; 63% female) in a nationally representative study of social, economic, and structural conditions and health in Black Americans. Latent classes, i.e., subgroups, were derived via latent profile analysis with 10 indicators representing social support and religious involvement (support); demands from family and religious community (demands); and socioeconomic and neighborhood factors and racial discrimination (adversity). Frequency of alcohol use and prevalence of regular smoking were compared across classes using regression analyses.

RESULTS

Four classes emerged: (1) high support, low demands and adversity; (2) high support and demands, low-moderate adversity; (3) low support and demands, low-moderate adversity; and (4) low support, high demands and adversity. Relative to Class 1, frequency of alcohol use and regular smoking prevalence were significantly higher only in Class 4.

CONCLUSIONS

Results indicate substantive variations in the clustering of substance use-related psychosocial risk and protective factors in Black adults. Furthermore, they suggest that neither the presence of high demands nor the absence of support alone differentiates likelihood of engaging in frequent alcohol use or regular smoking, but adverse experiences such as racial discrimination may be especially impactful.

Do inequalities add up? Intersectional inequalities in smoking by sexual orientation and education among U.S. adults

•

Among men, inequalities in cigarette smoking are primarily driven by socio-economic inequalities.

•

Among women, inequalities in cigarette smoking are primarily driven by sexual orientation inequalities.

Introduction

Inequalities in smoking by socio-economic status (SES) are well-known. A growing body of literature has demonstrated additional inequalities in smoking by sexual orientation. This study used an intersectional lens to examine smoking at the intersection of sexual orientation and education.

Methods

Data come from 28,362 adult participants in Wave 2 (2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study. We used educational level (less than high school education (HS); HS or more) and sexual orientation (heterosexual; sexual minority) to form four intersectional positions.

We estimated prevalence differences in smoking corresponding to joint, referent, and excess intersectional inequalities using weighted linear binomial regression models. Results were stratified by gender and adjusted for ethnicity and age.

Results

The adjusted joint inequality represented 7.6% points (p.p.) (95% CI: 2.5, 12.8) difference in smoking between the doubly advantaged (heterosexual with HS or more) and doubly disadvantaged (sexual minority with less than HS) positions. Joint inequality was decomposed into referent SES inequality (12.5 p.p. (95% CI: 10.5, 14.4)); referent sexual orientation inequality (9.7 p.p. (95% CI: 6.8, 12.6)); and a substantial negative excess intersectional inequality (−14.6 p.p. (95% CI: −20.8, −8.3)), attributed to an unexpectedly low prevalence of smoking among doubly disadvantaged persons. Similar overall patterns were found in the stratified analyses.

Conclusions

We found that “doubly-disadvantaged” group of low-educated sexual minority adults did not have the greatest burden of smoking; whereas, low-educated heterosexual adults had the highest smoking prevalence. Our findings support tailoring cessation interventions to disadvantaged groups’ different needs.

Neighborhood Cohesion, Disorder, and Physical Function in Older Adults: An Examination of Racial/Ethnic Differences

Objectives: This study examined the link between neighborhood social cohesion, disorder, and physical function in older adults, and identified potential racial/ethnic differences in these associations. Method: Data come from the National Health and Aging Trends Study (NHATS; N = 5,619). A series of linear regression models were used to predict physical function. Subgroup analyses and neighborhood/race interactions were used to examine differences. Results: Neighborhood disorder was associated with poorer physical function (p < .05), while neighborhood cohesion was not (p = .06). Although tests of interactions were not significant, subgroup analyses showed that neighborhood disorder, and not social cohesion, was associated with poorer physical function only in Whites. Discussion: Disadvantaged neighborhood social environment may contribute to differences in physical function among older adults. Racial and ethnic differences warrant closer investigation in studies of neighborhoods and functional health.

National Rate of Tobacco and Substance Use Disorders Among Hospitalized Heart Failure Patients

BACKGROUND

Several cardiotoxic substances impact heart failure incidence. The burden of comorbid tobacco or substance use disorders among heart failure patients is under-characterized. We describe the burden of tobacco and substance use disorders among hospitalized heart failure patients in the United States.

METHODS

We calculated the proportion of primary heart failure hospitalizations in the 2014 National Inpatient Sample with tobacco or substance use disorders accounting for demographic factors.

RESULTS

Of 989,080 heart failure hospitalizations, 15.5% (n = 152,965) had documented tobacco (n = 119,285, 12.1%) or substance (n = 61,510, 6.2%) use disorder. Female sex was associated with lower rates of tobacco (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.70-0.74) and substance (OR 0.37; 95% CI, 0.36-0.39) use disorder. Tobacco and substance use disorder rates were highest for hospitalizations <55years of age. Native American race was associated with increased risk of alcohol use disorder (OR 1.67; 95% CI, 1.27-2.20) and black race with alcohol (OR 1.09; 95% CI, 1.02-1.16) or drug (OR 1.63; 95% CI, 1.53-1.74) use disorder. Medicaid insurance or income in the lowest quartile were associated with increased risk of tobacco and substance use disorders.

CONCLUSIONS

Tobacco and substance use disorders affect vulnerable heart failure populations, including those of male sex, younger age, lower socioeconomic status, and racial/ethnic minorities. Enhanced screening for tobacco and substance use disorders in hospitalized heart failure patients may reveal opportunities for treatment and secondary prevention.

Disparities in Criminal Justice Outcomes After Beginning Treatment for Substance Use Disorders: The Influence of Race/Ethnicity and Place

OBJECTIVE

This study examined whether racial/ethnic disparities exist in posttreatment arrests and assessed the extent to which community characteristics account for such disparities.

METHOD

Administrative data on clients (N = 10,529) receiving publicly funded services in Washington State were linked with criminal justice and census data. Multilevel survival models were used for two outcomes measuring time (in days) to any arrest and to any substance-related arrest. Community characteristics included a factor measuring community economic disadvantage and the proportions of residents in the client's residential census tract who were Black, Latino, or American Indian/Alaskan Native.

RESULTS

When we controlled for age, sex, substance use, referral source, and prior criminal justice involvement, Black clients (hazard ratio [HR] = 1.47, p < .01) had a higher hazard of any arrest compared with White clients, and Black (HR = 1.27, p < .05) and Latino (HR = 1.20, p < .05) clients had a higher hazard of a substance-related arrest. Clients living in census tracts with a higher proportion of Black residents had a higher hazard of any arrest (HR = 1.25, p < .01) as well as substance-related arrests (HR = 1.39, p < .01). Community characteristics did not account for racial/ethnic disparities in arrests but provided an independent effect.

CONCLUSIONS

Disparities in arrest outcomes are influenced by both individual- and community-level factors; therefore, strategies for reducing disparities in this treatment outcome should be implemented at both levels.

Disparities in Criminal Justice Outcomes After Beginning Treatment for Substance Use Disorders: The Influence of Race/Ethnicity and Place

OBJECTIVE

This study examined whether racial/ethnic disparities exist in posttreatment arrests and assessed the extent to which community characteristics account for such disparities.

METHOD

Administrative data on clients (N = 10,529) receiving publicly funded services in Washington State were linked with criminal justice and census data. Multilevel survival models were used for two outcomes measuring time (in days) to any arrest and to any substance-related arrest. Community characteristics included a factor measuring community economic disadvantage and the proportions of residents in the client's residential census tract who were Black, Latino, or American Indian/Alaskan Native.

RESULTS

When we controlled for age, sex, substance use, referral source, and prior criminal justice involvement, Black clients (hazard ratio [HR] = 1.47, p < .01) had a higher hazard of any arrest compared with White clients, and Black (HR = 1.27, p < .05) and Latino (HR = 1.20, p < .05) clients had a higher hazard of a substance-related arrest. Clients living in census tracts with a higher proportion of Black residents had a higher hazard of any arrest (HR = 1.25, p < .01) as well as substance-related arrests (HR = 1.39, p < .01). Community characteristics did not account for racial/ethnic disparities in arrests but provided an independent effect.

CONCLUSIONS

Disparities in arrest outcomes are influenced by both individual- and community-level factors; therefore, strategies for reducing disparities in this treatment outcome should be implemented at both levels.

Employment after beginning treatment for substance use disorders: The impact of race/ethnicity and client community of residence

Employment is an important substance use treatment outcome, frequently used to assess individual progress during and after treatment. This study examined whether racial/ethnic disparities exist in employment after beginning treatment. It also examined the extent to which characteristics of clients' communities account for such disparities. Analyses are based on data that linked individual treatment information from Washington State's Behavioral Health Administration with employment data from the state's Employment Security Department. Analyses subsequently incorporated community-level data from the U.S. Census Bureau. The sample includes 10,636 adult clients (Whites, 68%; American Indians, 13%, Latinos, 10%; and Blacks, 8%) who had a new outpatient treatment admission to state-funded specialty treatment. Heckman models were used to test whether racial/ethnic disparities existed in the likelihood of post-admission employment, as well as employment duration and wages earned. Results indicated that there were no racial/ethnic disparities in the likelihood of employment in the year following treatment admission. However, compared to White clients, American Indian and Black clients had significantly shorter lengths of employment and Black clients had significantly lower wages. With few exceptions, residential community characteristics were associated with being employed after initiating treatment, but not with maintaining employment or with wages. After accounting for community-level variables, disparities in length of employment and earned wages persisted. These findings highlight the importance of considering the race/ethnicity of a client when examining post-treatment employment alongside community characteristics, and suggest that the effect of race/ethnicity and community characteristics on post-treatment employment may differ based on the stage of the employment process.

Racial disparities in sleep: the role of neighborhood disadvantage

OBJECTIVE

Disparities in sleep duration and efficiency between Black/African American (AA) and White/European American (EA) adults are well-documented. The objective of this study was to examine neighborhood disadvantage as an explanation for race differences in objectively measured sleep.

METHODS

Data were from 133 AA and 293 EA adults who participated in the sleep assessment protocol of the Midlife in the United States (MIDUS) study (57% female; Mean Age = 56.8 years, SD = 11.4). Sleep minutes, onset latency, and waking after sleep onset (WASO) were assessed over seven nights using wrist actigraphy. Neighborhood characteristics were assessed by linking home addresses to tract-level socioeconomic data from the 2000 US Census. Multilevel models estimated associations between neighborhood disadvantage and sleep, and the degree to which neighborhood disadvantage mediated race differences in sleep controlling for family socioeconomic position and demographic variables.

RESULTS

AAs had shorter sleep duration, greater onset latency, and higher WASO than EAs (ps < 0.001). Neighborhood disadvantage was significantly associated with WASO (B = 3.54, p = 0.028), but not sleep minutes (B = -2.21, p = 0.60) or latency (B = 1.55, p = 0.38). Furthermore, race was indirectly associated with WASO via neighborhood disadvantage (B = 4.63, p = 0.035), which explained 24% of the race difference. When measures of depression, health behaviors, and obesity were added to the model, the association between neighborhood disadvantage and WASO was attenuated by 11% but remained significant.

CONCLUSION

Findings suggest that neighborhood disadvantage mediates a portion of race differences in WASO, an important indicator of sleep efficiency.