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Mayorga NA, Smit T, Salwa A, Buitron V, Garza M, Ochoa-Perez M, Lemaire C, Zvolensky MJ. Examining Financial Strain and Subjective Social Status in Terms of Behavioral Health Among Latinx Adults in a Federally Qualified Health Center. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02146-2. [PMID: 39287763 DOI: 10.1007/s40615-024-02146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024]
Abstract
There is a growing recognition that Social Determinants of Health (SDoH) can inform some sources of physical and mental health disparities among the Latinx population. The current study sought to expand previous research by exploring the singular and interactive influence of financial strain and subjective social status-two common and clinically important SDoH factors-on pain intensity, pain disability, general depression, social anxiety, and anxious arousal. The current sample consisted of 155 Latinx adults (81.3% female; Mage = 40.02 years, SD = 10.61) presenting for care at a Federally Qualified Health Center (FQHC). Multivariate results demonstrated that financial strain was statistically significantly associated with greater pain intensity, pain disability, general depression, and anxious arousal, but not social anxiety. Further, lower subjective social status was related to greater general depression, social anxiety, and anxious arousal but not with higher levels of pain indices. An interactive effect was found wherein the combination of higher levels of financial strain and low levels of subjective social status was related to general depression and anxious arousal. This is the first study to empirically evaluate the main and interactive effects of financial strain and subjective social status regarding numerous physical and mental health symptoms. These findings clarify how two prevalent SDoH factors influence health outcomes. Specifically, the results suggest that a multi-risk conceptualization can advance a fine-grained understanding of Latinx health disparities by showing differential associations between SDoH factors and clinical outcomes that are frequently the source of health inequities in the Latinx population.
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Affiliation(s)
- Nubia A Mayorga
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Aniqua Salwa
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Victor Buitron
- Department of Psychology, Florida International University, Miami, FL, USA
| | | | | | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Quansah F, Srem-Sai M, Agormedah EK, Ankomah F, Hagan JE, Schack T. Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana. Front Public Health 2024; 12:1325441. [PMID: 38638481 PMCID: PMC11025665 DOI: 10.3389/fpubh.2024.1325441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/08/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Although the relationship between subjective social status and depression in university students has been well-established, this association could be seen as a spurious one. Previous studies have shown that key variables like financial resources and age could play key roles in explaining the variances in social status and mental health outcomes. In this research, we assessed the complex interrelationships between subjective social status, financial resources at their disposal and depressive symptoms among university students within their young and middle adulthood stages. Methods A cross-sectional survey was conducted in a university in Ghana to sample 1134 university students through accidental sampling. The McArthur Scale and WHO-5 Well-being measure were used for the data collection. Results The results revealed that higher levels of subjective social status were associated with lower levels of depression. It was further found that the interaction between students' pocket money and age played unique roles in the relationship between subjective social status and depression. Conclusion The study findings call on stakeholders in education to explore funding opportunities and to examine ways of empowering parents (financially) to adequately support the students. Health educationists and promoters, including psychologists, school counsellors and parents could compliment these efforts by helping to train and empower students through self-regulation or management skills to help improve their well-being. Continuous efforts are required to improve the financial status and mental health of students.
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Affiliation(s)
- Frank Quansah
- Department of Educational Foundations, University of Education, Winneba, Ghana
| | - Medina Srem-Sai
- Department of Health, Physical Education, Recreation and Sports, University of Education, Winneba, Ghana
| | - Edmond Kwesi Agormedah
- Department of Business and Social Sciences Education, University of Cape Coast, Cape Coast, Ghana
| | - Francis Ankomah
- Department of Educational Studies, Patton College of Education, Ohio University, Athens, OH, United States
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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Potter LN, Schlechter CR, Nahum-Shani I, Lam CY, Cinciripini PM, Wetter DW. Socio-economic status moderates within-person associations of risk factors and smoking lapse in daily life. Addiction 2023; 118:925-934. [PMID: 36564898 PMCID: PMC10073289 DOI: 10.1111/add.16116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Individuals of lower socio-economic status (SES) display a higher prevalence of smoking and have more diffxiculty quitting than higher SES groups. The current study investigates whether the within-person associations of key risk (e.g. stress) and protective (self-efficacy) factors with smoking lapse varies by facets of SES. DESIGN AND SETTING Observational study using ecological momentary assessment to collect data for a 28-day period following a smoking quit attempt. Multi-level mixed models (i.e. generalized linear mixed models) examined cross-level interactions between lapse risk and protective factors and indicators of SES on smoking lapse. PARTICIPANTS A diverse sample of 330 adult US smokers who completed a larger study examining the effects of race/ethnicity and social/environmental influences on smoking cessation. MEASUREMENTS Risk factors included momentary urge, negative affect, stress; protective factors included positive affect, motivation, abstinence self-efficacy; SES measures: baseline measures of income and financial strain; the primary outcome was self-reported lapse. FINDINGS Participants provided 43 297 post-quit observations. Mixed models suggested that income and financial strain moderated the effect of some risk factors on smoking lapse. The within-person association of negative [odds ratio (OR) = 0.967, 95% CI= 0.945, 0.990, P < 0.01] and positive affect (OR = 1.023, 95% CI = 1.003, 1.044, P < 0.05) and abstinence self-efficacy (OR = 1.020, 95% CI = 1.003, 1.038, P < 0.05) on lapse varied with financial strain. The within-person association of negative affect (OR = 1.005, 95% CI = 1.002, 1.008, P < 0.01), motivation (OR = 0.995, 95% CI = 0.991, 0.999, P < 0.05) and abstinence self-efficacy (OR = 0.996, 95% CI = 0.993, 0.999, P < 0.01) on lapse varied by income. The positive association of negative affect with lapse was stronger among individuals with higher income and lower financial strain. The negative association between positive affect and abstinence self-efficacy with lapse was stronger among individuals with lower financial strain, and the negative association between motivation and abstinence self-efficacy with lapse was stronger among those with higher income. The data were insensitive to detect statistically significant moderating effects of income and financial strain on the association of urge or stress with lapse. CONCLUSION Some risk factors (e.g. momentary negative affect) exert a weaker influence on smoking lapse among lower compared to higher socio-economic status groups.
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Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI, USA
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1330, Houston, TX, 77230, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
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Savoy EJ, Businelle MS, Nguyen N, Chen TA, Neighbors C, Norton PJ, Taing M, Reitzel LR. Examining moment to moment affective determinants of smoking rate following a quit attempt among homeless daily smokers. Addict Behav 2021; 115:106788. [PMID: 33360279 DOI: 10.1016/j.addbeh.2020.106788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cigarette smoking disproportionately affects homeless individuals, who have a higher smoking prevalence, fewer resources, and increased stressors compared to domiciled smokers. Little is known about how to facilitate smoking cessation among this population although some findings support focusing efforts on affective variables as well as alternate outcomes in order to optimize interventions for this group. METHODS Participants were homeless adults recruited from a Dallas, TX, shelter (N = 57, 61.4% male, Mage = 48.8 ± 9.0) to participate in tobacco cessation classes using an American Cancer Society-based therapy and support group with nicotine replacement therapy. Moment-to-moment changes in affect [e.g., negative affect (NA), positive affect (PA), and stress] were recorded via Ecological Momentary Assessments to assess whether they were associated with concurrent changes in cigarettes smoked per day (CPD) following a specific quit attempt. Separate generalized linear models (GLM) were evaluated for each predictor to examine the associations between affective variables and CPD in covariate-adjusted analyses. RESULTS Significant interaction effects of time and affect were found for all variables (NA: p = 0.0011, PA: p = 0.0006, stress: p = 0.0259), whereby the association of affect and CPD were significant in the early part of the week but the effects faded as time progressed. With regard to main effects, only increases in PA during the post-quit week significantly predicted fewer CPD (adjusted incidence rate ratio = 0.924, SE = 0.027, p = 0.0032). CONCLUSIONS Homeless smokers may be more likely to decrease their cigarette consumption during periods of greater PA throughout the post-quit week. Relationship between positive affect and reduction in CPD suggest focus on affective variables with homeless smokers may be an effective avenue for change in smoking behaviors, particularly in the days immediately following a quit attempt. Time effects should be further investigated to determine when these interventions might best be implemented.
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Affiliation(s)
- Elaine J Savoy
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA; Inpatient Program, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Michael S Businelle
- mHealth Shared Resource at Oklahoma Tobacco Research Center at the Stephenson Cancer Center, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nga Nguyen
- Biostatistics Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tzu-An Chen
- HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Clayton Neighbors
- Social Influences and Health Behaviors Lab, University of Houston, Houston, TX, USA
| | - Peter J Norton
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Matthew Taing
- HEALTH Research Institute, University of Houston, Houston, TX, USA; Department of Psychological, Health, & Learning Sciences, University of Houston, Texas, USA
| | - Lorraine R Reitzel
- HEALTH Research Institute, University of Houston, Houston, TX, USA; Department of Psychological, Health, & Learning Sciences, University of Houston, Texas, USA
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Potter LN, Lam CY, Cinciripini PM, Wetter DW. Intersectionality and Smoking Cessation: Exploring Various Approaches for Understanding Health Inequities. Nicotine Tob Res 2021; 23:115-123. [PMID: 32208484 PMCID: PMC7789945 DOI: 10.1093/ntr/ntaa052] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/20/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes. METHODS A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes. RESULTS Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse. CONCLUSIONS Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes. IMPLICATIONS Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes.
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Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David W Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT
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Nollen NL, Ahluwalia JS, Sanderson Cox L, Okuyemi K, Lawrence D, Samuels L, Benowitz NL. Assessment of Racial Differences in Pharmacotherapy Efficacy for Smoking Cessation: Secondary Analysis of the EAGLES Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2032053. [PMID: 33464316 PMCID: PMC7816102 DOI: 10.1001/jamanetworkopen.2020.32053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/04/2020] [Indexed: 01/02/2023] Open
Abstract
Importance Understanding Black vs White differences in pharmacotherapy efficacy and the underlying reasons is critically important to reducing tobacco-related health disparities. Objective To compare pharmacotherapy efficacy and examine variables to explain Black vs White differences in smoking abstinence. Design, Setting, and Participants This study is a secondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) double-blind, placebo-controlled, randomized clinical trial, which took place at clinical trial centers, academic centers, and outpatient clinics in 29 states in the US. US Black and White smokers who smoked 10 or more cigarettes per day with and without psychiatric comorbidity were enrolled between November 2011 and January 2015. Data analysis was performed from July 2019 to January 2020. Interventions Participants were randomized (1:1:1:1) in a double-blind, triple-dummy, placebo- and active-controlled (nicotine patch) trial of varenicline and bupropion for 12 weeks with follow-up through week 24. Main Outcomes and Measures Biochemically verified continuous cigarette abstinence rate (CAR) from weeks 9 to 24. Baseline, postbaseline treatment, and safety characteristics were examined as variables to explain race differences in abstinence. Results Of the 1065 Black smokers enrolled, 255 were randomized to receive varenicline, 259 received bupropion, 286 received nicotine replacement therapy (NRT [ie, nicotine patch]), and 265 received placebo. Among the 3044 White smokers enrolled, 778 were randomized to receive varenicline, 769 received bupropion, 738 received NRT, and 759 received placebo. Participants were predominantly female (614 Black [57.7%] and 1786 White [58.7%] women) and heavy smokers (mean [SD] cigarettes per day, 18.2 [7.9] for Black and 20.0 [7.5] for White smokers), with a mean (SD) age of 47.2 (11.2) years for Black and 46.5 (12.7) years for White participants. Treatment and race were associated with CAR for weeks 9 to 24. The CAR was 4.9% lower for Black vs White participants (odds ratio [OR], 0.53; 95% CI, 0.41-0.69; P < .001); differences were found across all treatments. Pooling psychiatric and nonpsychiatric cohorts, varenicline (OR, 2.63; 95% CI, 1.90-3.63; P < .001), bupropion (OR, 1.75; 95% CI, 1.25-2.46; P = .001), and NRT (OR, 1.52; 95% CI, 1.07-2.16; P = .02) had greater efficacy than placebo for White participants. Only varenicline (OR, 2.63; 95% CI, 1.26-5.48; P = .01) had greater efficacy than placebo for Black participants. Baseline, postbaseline, and safety characteristics differed by race, but these variables did not eliminate the association of race with CAR. Black participants had 49% reduced odds of CAR for weeks 9 to 24 compared with White participants in the adjusted model (OR, 0.51; 95% CI, 0.39-0.66; P < .001). Conclusions and Relevance Black and White smokers achieved the highest rate of abstinence while taking varenicline, suggesting that it is the best first-line therapy for these groups. However, Black smokers were less responsive to all therapies, including placebo. Understanding variables (eg, socioeconomic or biological) beyond those may lead to improved treatment outcomes for Black smokers. Trial Registration ClinicalTrials.gov Identifier: NCT01456936.
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Affiliation(s)
- Nicole L. Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Jasjit S. Ahluwalia
- Alpert Medical School, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Alpert Medical School, Department of Medicine, Brown University School of Public Health, Providence, Rhode Island
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City
| | | | | | - Neal L. Benowitz
- Department of Medicine, Bioengineering, and Therapeutic Sciences, University of California, San Francisco
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Langlois S, Zern A, Anderson S, Ashekun O, Ellis S, Graves J, Compton MT. Subjective social status, objective social status, and substance use among individuals with serious mental illnesses. Psychiatry Res 2020; 293:113352. [PMID: 32795772 PMCID: PMC7669552 DOI: 10.1016/j.psychres.2020.113352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
Subjective social status (SSS) and objective socioeconomic status (OSS) may appear to be similar social determinants of mental health, but are actually independently associated with diverse health outcomes including substance use and substance use disorders (SUDs). Such associations have not been examined among individuals with serious mental illnesses (SMI) despite their high prevalence of comorbid substance use; frequent treatment and recovery complications associated with such use; and high levels of economic disadvantage, discrimination, and inequities in this marginalized population. These psychosocial adversities manifest as poor mental illness outcomes, poor physical health, and early mortality in populations with SMI. We hypothesized that both SSS and OSS would predict substance use severity and SUD diagnoses in 240 patients with SMI. SSS, measured by the MacArthur Scale of Subjective Social Status, was unassociated with a composite measure of income and education used to operationalize OSS. Additionally, SSS and OSS were differentially associated with various types of substance use disorders. Only OSS was associated with whether individuals smoked cigarettes, or the level of nicotine dependence. Conversely, only SSS was associated with drug use severity. Our results shed light on the potential for differential impacts of SSS and OSS among persons with SMI.
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Affiliation(s)
| | - Adria Zern
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
| | | | | | | | | | - Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,Corresponding Author: Michael T. Compton, M.D., M.P.H. Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168th Street, Room R249, New York, NY 10032.
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Nollen NL, Mayo MS, Sanderson Cox L, Benowitz NL, Tyndale RF, Ellerbeck EF, Scheuermann TS, Ahluwalia JS. Factors That Explain Differences in Abstinence Between Black and White Smokers: A Prospective Intervention Study. J Natl Cancer Inst 2020; 111:1078-1087. [PMID: 30657926 DOI: 10.1093/jnci/djz001] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/03/2018] [Accepted: 01/02/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Black-white differences in smoking abstinence are not well understood. This trial sought to confirm previously reported differences in quitting between blacks and whites and to identify factors underlying this difference. METHODS During enrollment, 224 black and 225 white low-income smokers were stratified on race and within race on age and sex to ensure balance on these factors known to impact abstinence. The intervention included varenicline for 12 weeks and six guideline-based smoking cessation counseling sessions. The primary endpoint was cotinine-verified 7-day point prevalence smoking abstinence at week 26. A priori socioeconomic, smoking, treatment process (eg, treatment utilization, side effects, withdrawal relief), psychosocial, and biological factors were assessed to investigate race differences in abstinence. Unadjusted odds ratios (OR) were used to compare abstinence between blacks and whites. Adjusted odds ratios from logistic regression models were used to examine predictors of abstinence. All statistical tests were two-sided. RESULTS Blacks were less likely to achieve abstinence at week 26 (14.3% vs 24.4%, OR = 0.51, 95% confidence interval [CI] = 0.32 to 0.83, P = .007). Utilizing best subsets logistic regression, five factors associated with race jointly predicted abstinence: home ownership (yes/no, OR = 3.03, 95% CI = 1.72 to 5.35, P < .001), study visits completed (range = 0-6, OR = 2.81, 95% CI = 1.88 to 4.20, P < .001), income (household member/$1000, OR = 1.03, 95% CI = 1.01 to 1.06, P = .02), plasma cotinine (per 1 ng/mL, OR = 0.997, 95% CI = 0.994 to 0.999, P = .002), and neighborhood problems (range = 10-30, OR = 0.88, 95% CI = 0.81 to 0.96, P = .003). CONCLUSIONS The race difference in abstinence was fully explained by lack of home ownership, lower income, greater neighborhood problems, higher baseline cotinine, and higher visit completion, which were disproportionately represented among blacks. Findings illuminate factors that make it harder for blacks in the United States to quit smoking relative to whites and provide important areas for future studies to reduce tobacco-related health disparities.
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Alexander AC, Olurotimi O, Hébert ET, Ra CK, Businelle MS, Kendzor DE. Subjective social status is indirectly associated with short-term smoking cessation through nicotine withdrawal symptoms. J Health Psychol 2020; 26:2320-2329. [PMID: 32191140 DOI: 10.1177/1359105320911432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study used data collected from a smoking cessation program (N = 146) to evaluate whether subjective social status was indirectly associated with smoking cessation through nicotine withdrawal symptoms. Findings indicated that subjective social status was indirectly associated with smoking cessation through withdrawal symptoms, specifically through anger and anxiety symptoms. People with lower subjective social status reported more withdrawal symptoms, particularly symptoms related to anger and anxiety, shortly after a quit attempt, and as such, were less likely to achieve smoking abstinence. Findings from this study provide insight into why socioeconomically disadvantaged adults are less likely to remain abstinent after a quit attempt.
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Vinci C, Guo L, Spears CA, Li L, Correa-Fernández V, Etcheverry PE, Lam CY, Hoover DS, Wetter DW. Socioeconomic indicators as predictors of smoking cessation among Spanish-Speaking Mexican Americans. ETHNICITY & HEALTH 2019; 24:841-853. [PMID: 28859518 PMCID: PMC5832556 DOI: 10.1080/13557858.2017.1373074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 08/21/2017] [Indexed: 05/16/2023]
Abstract
Objective: Smoking-related illnesses are the leading cause of death among Latinos, and within this ethnic group, Mexican Americans are the largest subgroup in the U.S. Understanding the factors associated with successful smoking cessation could inform interventions for this population. Although socioeconomic status (SES) is a powerful predictor of cessation outcomes in the general U.S. population, it has generally been a poor predictor of quitting smoking among Latinos. Within a sample of Spanish-speaking Mexican Americans (n = 199), this study examined a broad array of objective and subjective indicators of SES (i.e. income, education, employment, subjective social status, financial strain, insurance status) as predictors of smoking cessation. Design: Data for the current study came from a longitudinal cohort study examining the pathways linking the social determinants of health with smoking cessation. Generalized estimating equation modeling examined the association of each predictor variable with smoking abstinence across quit day, and the 3 and 26-weeks post-quit time points. Results: Results indicated that both low financial strain and insurance status predicted an increased likelihood of abstinence when controlling for covariates in the intention-to-treat analyses (p = .02 and p = .01, respectively). However, these models only approached significance in the multiple imputation analyses (all ps > .05). Other indicators of SES (i.e. income, education, employment) that have been predictive of cessation in other populations were not predictive of abstinence in this sample. Conclusions: These findings suggest that SES may indeed influence smoking cessation among Spanish-speaking Mexican Americans similarly to its influence in other populations, but that capturing the construct of SES may require assessing a broader range of SES indicators. Specifically, low financial strain and having insurance predicted a greater likelihood of achieving smoking abstinence, whereas other indicators of SES (i.e. income, education) were not predictive.
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Affiliation(s)
- Christine Vinci
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Lin Guo
- Corona LLC, Southborough, MA, USA
| | - Claire A. Spears
- Division of Health Promotion & Behavior, Georgia State University, School of Public Health, Atlanta, GA, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Paul E. Etcheverry
- Department of Psychology, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Cho Y. Lam
- Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Diana S. Hoover
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David W. Wetter
- Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Gugushvili A, McKee M, Murphy M, Azarova A, Irdam D, Doniec K, King L. Intergenerational Mobility in Relative Educational Attainment and Health-Related Behaviours. SOCIAL INDICATORS RESEARCH 2018; 141:413-441. [PMID: 31467460 PMCID: PMC6694039 DOI: 10.1007/s11205-017-1834-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 06/07/2023]
Abstract
Research on intergenerational social mobility and health-related behaviours yields mixed findings. Depending on the direction of mobility and the type of mechanisms involved, we can expect positive or negative association between intergenerational mobility and health-related behaviours. Using data from a retrospective cohort study, conducted in more than 100 towns across Belarus, Hungary and Russia, we fit multilevel mixed-effects Poisson regressions with two measures of health-related behaviours: binge drinking and smoking. The main explanatory variable, intergenerational educational mobility is operationalised in terms of relative intergenerational educational trajectories based on the prevalence of specified qualifications in parental and offspring generations. In each country the associations between intergenerational educational mobility, binge drinking and smoking was examined with incidence rate ratios and predicted probabilities, using multiply imputed dataset for missing data and controlling for important confounders of health-related behaviours. We find that intergenerational mobility in relative educational attainment has varying association with binge drinking and smoking and the strength and direction of these effects depend on the country of analysis, the mode of mobility, the gender of respondents and the type of health-related behaviour. Along with accumulation and Falling from Grace hypotheses of the consequences of intergenerational mobility, our findings suggest that upward educational mobility in certain instances might be linked to improved health-related behaviours.
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Affiliation(s)
- Alexi Gugushvili
- 1Department of Social Policy and Intervention and Nuffield College, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER UK
| | - Martin McKee
- 2European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Murphy
- 3Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Aytalina Azarova
- 4Department of Sociology, University of Cambridge, Cambridge, UK
| | - Darja Irdam
- 4Department of Sociology, University of Cambridge, Cambridge, UK
| | - Katarzyna Doniec
- 4Department of Sociology, University of Cambridge, Cambridge, UK
| | - Lawrence King
- 4Department of Sociology, University of Cambridge, Cambridge, UK
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Anxiety Sensitivity and Age: Roles in Understanding Subjective Social Status among Low Income Adult Latinos in Primary Care. J Immigr Minor Health 2017; 20:632-640. [DOI: 10.1007/s10903-017-0623-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Zvolensky MJ, Paulus DJ, Langdon KJ, Robles Z, Garey L, Norton PJ, Businelle MS. Anxiety sensitivity explains associations between anxious arousal symptoms and smoking abstinence expectancies, perceived barriers to cessation, and problems experienced during past quit attempts among low-income smokers. J Anxiety Disord 2017; 48:70-77. [PMID: 28024913 PMCID: PMC5476482 DOI: 10.1016/j.janxdis.2016.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/07/2016] [Accepted: 12/15/2016] [Indexed: 11/23/2022]
Abstract
Disproportionately more smokers report low-income and mental health problems relative to non-smokers. Low-income smokers may use smoking to alleviate negative emotional states resulting from exposure to multiple stressors. Yet, little work has been devoted to elucidating mechanisms that may explain the association between negative emotional states and smoking-related processes among low-income smokers. The present study sought to address this gap by examining anxiety sensitivity, a transdiagnostic factor related to both anxiety and smoking, as a potential mediator for the influence of anxiety symptoms on smoking-related processes, including threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. Participants included treatment-seeking daily cigarette smokers (n=101; 68.3% male; Mage=47.1; SD=10.2). Results indicated that anxiety symptoms exerted a significant indirect effect through anxiety sensitivity for threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. The present results provide empirical support that anxiety sensitivity may be an underlying mechanism that partially explains the relation between anxiety symptoms and smoking processes among low-income treatment-seeking smokers. Findings broaden current theoretical understanding of pathways through which anxiety symptoms contribute to maladaptive smoking processes and cognitions among socioeconomically disadvantaged smokers.
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Affiliation(s)
- Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States.
| | - Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Kirsten J Langdon
- Rhode Island Hospital, Department of Psychiatry, Providence, RI, United States
| | - Zuzuky Robles
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Lorra Garey
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Peter J Norton
- Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Michael S Businelle
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Subjective Social Status and Anxiety and Depressive Symptoms and Disorders among Low Income Latinos in Primary Care: The Role of Emotion Dysregulation. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9844-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Reitzel LR, Childress SD, Obasi EM, Garey L, Vidrine DJ, McNeill LH, Zvolensky MJ. Interactive Effects of Anxiety Sensitivity and Subjective Social Status on Psychological Symptomatology in Black Adults. Behav Med 2017; 43:268-276. [PMID: 26963636 PMCID: PMC6093854 DOI: 10.1080/08964289.2016.1150805] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anxiety sensitivity is the fear of anxiety-related sensations and subjective social status is a self-perception of social standing relative to others: both constructs have been linked to psychological symptomatology. This study investigated the interactive effects of anxiety sensitivity and social status in relation to anxiety and depressive symptomatology expression among 124 black adults. Participants provided sociodemographics and completed self-report questionnaires. The interactive associations between anxiety sensitivity and social status on anxiety symptomatology and depressive symptomatology were examined with hierarchical linear regressions adjusted for sociodemographics and negative affectivity. Significant interactions between anxiety sensitivity and social status were evident only for anxiety symptoms: specifically, the association between anxiety sensitivity and anxiety symptoms was much stronger for individuals with lower (versus higher) subjective social status. Black adults with this higher anxiety sensitivity/lower social status phenotype may be at heightened risk for the expression of anxiety symptomatology, and may benefit from interventions to reduce anxiety sensitivity.
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Affiliation(s)
- Lorraine R. Reitzel
- University of Houston, Department of Psychological, Health, and Learning Sciences, 491 Farish Hall, Houston, TX 77204-5029
| | - Sarah D. Childress
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, P.O. Box 301402, Houston, TX 77230-1402
| | - Ezemenari M. Obasi
- University of Houston, Department of Psychological, Health, and Learning Sciences, 491 Farish Hall, Houston, TX 77204-5029
| | - Lorra Garey
- The University of Houston, College of Liberal Arts and Social Sciences, Department of Psychology, 126 Heyne Building, Suite 104, Houston, TX 77204
| | - Damon J. Vidrine
- The University of Oklahoma Stephenson Cancer Center, Department of Family and Preventative Medicine, Oklahoma City, OK
| | - Lorna H. McNeill
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, P.O. Box 301402, Houston, TX 77230-1402
| | - Michael J. Zvolensky
- The University of Houston, College of Liberal Arts and Social Sciences, Department of Psychology, 126 Heyne Building, Suite 104, Houston, TX 77204
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Psychosocial Mechanisms Linking the Social Environment to Mental Health in African Americans. PLoS One 2016; 11:e0154035. [PMID: 27119366 PMCID: PMC4847864 DOI: 10.1371/journal.pone.0154035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022] Open
Abstract
Resource-poor social environments predict poor health, but the mechanisms and processes linking the social environment to psychological health and well-being remain unclear. This study explored psychosocial mediators of the association between the social environment and mental health in African American adults. African American men and women (n = 1467) completed questionnaires on the social environment, psychosocial factors (stress, depressive symptoms, and racial discrimination), and mental health. Multiple-mediator models were used to assess direct and indirect effects of the social environment on mental health. Low social status in the community (p < .001) and U.S. (p < .001) and low social support (p < .001) were associated with poor mental health. Psychosocial factors significantly jointly mediated the relationship between the social environment and mental health in multiple-mediator models. Low social status and social support were associated with greater perceived stress, depressive symptoms, and perceived racial discrimination, which were associated with poor mental health. Results suggest the relationship between the social environment and mental health is mediated by psychosocial factors and revealed potential mechanisms through which social status and social support influence the mental health of African American men and women. Findings from this study provide insight into the differential effects of stress, depression and discrimination on mental health. Ecological approaches that aim to improve the social environment and psychosocial mediators may enhance health-related quality of life and reduce health disparities in African Americans.
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Nollen NL, Cox LS, Yu Q, Ellerbeck EF, Scheuermann TS, Benowitz NL, Tyndale RF, Mayo MS, Ahluwalia JS. A clinical trial to examine disparities in quitting between African-American and White adult smokers: Design, accrual, and baseline characteristics. Contemp Clin Trials 2016; 47:12-21. [PMID: 26667382 PMCID: PMC4818177 DOI: 10.1016/j.cct.2015.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/24/2015] [Accepted: 12/03/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND African-Americans smoke fewer cigarettes per day than Whites but experience greater smoking attributable morbidity and mortality. African-American-White differences may also exist in cessation but rigorously designed studies have not been conducted to empirically answer this question. METHODS/DESIGN Quit2Live is, to our knowledge, the first head-to-head trial designed with the primary aim of examining African-American-White disparities in quitting smoking. Secondary aims are to identify mechanisms that mediate and/or moderate the relationship between race and quitting. The study is ongoing. Study aims are accomplished through a 5-year prospective cohort intervention study designed to recruit equal numbers of African-Americans (n=224) and Whites (n=224) stratified on age (<40, ≥40) and gender, key factors known to impact cessation, and all within a restricted income range (≤400% federal poverty level). All participants will receive 12 weeks of varenicline in combination with smoking cessation counseling. The primary outcome is cotinine-verified 7-day point prevalence abstinence from smoking at week 26. Secondary outcomes are cotinine-verified 7-day point prevalence abstinence from smoking at weeks 4 and 12. DISCUSSION Findings from Quit2Live will not only address if African-American-White disparities in quitting smoking exist but, more importantly, will examine mechanisms underlying the difference. Attention to proximal, modifiable mechanisms (e.g., adherence, response to treatment, depression, stress) maximizes Quit2Live's potential to inform practice. Findings will provide an empirically-derived approach that will guide researchers and clinicians in identifying specific factors to address to improve cessation outcomes and reduce tobacco-related morbidity and mortality in African-American and White smokers. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT01836276.
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Affiliation(s)
- Nicole L Nollen
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas, United States.
| | - Lisa Sanderson Cox
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas, United States.
| | - Qing Yu
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, Kansas, United States.
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas, United States.
| | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas, United States.
| | - Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, San Francisco, California, United States; Department of Medicine, University of California, San Francisco, San Francisco, California, United States; Department of Bioengineering, University of California, San Francisco, San Francisco, California, United States; Department of Therapeutic Sciences, University of California, San Francisco, San Francisco, California, United States.
| | - Rachel F Tyndale
- Center for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada.
| | - Matthew S Mayo
- Department of Biostatistics, University of Kansas School of Medicine, Kansas City, Kansas, United States.
| | - Jasjit S Ahluwalia
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, United States.
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Garey L, Reitzel LR, Kendzor DE, Businelle MS. The Potential Explanatory Role of Perceived Stress in Associations Between Subjective Social Status and Health-Related Quality of Life Among Homeless Smokers. Behav Modif 2015; 40:303-24. [PMID: 26530474 DOI: 10.1177/0145445515612396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Homeless individuals smoke at high rates relative to the general population and are at heightened risk of tobacco-related illnesses and poor health-related quality of life (HRQoL). Homeless smokers also report low subjective social status (SSS) or perceived social standing relative to others. SSS may contribute to poor HRQoL, potentially through perceived stress. The current study examined the role of perceived stress in the association of SSS and HRQoL among 227 (70.9% male, Mage = 43.2) homeless smokers. Participants completed self-report measures of SSS, perceived stress, and HRQoL. Perceived stress partially explained the relation between SSS (United States and Community) and HRQoL in covariate-adjusted analyses. Results suggested that perceived stress is a pathway through which SSS contributes to HRQoL among homeless smokers. Findings broaden current understanding of the impact of social disadvantage and perceived stress on HRQoL among homeless smokers.
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Affiliation(s)
| | | | - Darla E Kendzor
- The University of Texas Southwestern Medical Center, Dallas, TX, USA The University of Texas School of Public Health, Dallas, TX, USA
| | - Michael S Businelle
- The University of Texas Southwestern Medical Center, Dallas, TX, USA The University of Texas School of Public Health, Dallas, TX, USA
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19
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Bello MS, Pang RD, Cropsey KL, Zvolensky MJ, Reitzel LR, Huh J, Leventhal AM. Tobacco Withdrawal Amongst African American, Hispanic, and White Smokers. Nicotine Tob Res 2015; 18:1479-87. [PMID: 26482061 DOI: 10.1093/ntr/ntv231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/01/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Persistent tobacco use among racial and ethnic minority populations in the United States is a critical public health concern. Yet, potential sources of racial/ethnic disparities in tobacco use remain unclear. The present study examined racial/ethnic differences in tobacco withdrawal-a clinically-relevant underpinning of tobacco use that has received sparse attention in the disparities literature-utilizing a controlled laboratory design. METHODS Daily smokers (non-Hispanic African American [n = 178], non-Hispanic white [n = 118], and Hispanic [n = 28]) attended two counterbalanced sessions (non-abstinent vs. 16-hour abstinent). At both sessions, self-report measures of urge, nicotine withdrawal, and affect were administered and performance on an objective behavioral task that assessed motivation to reinstate smoking was recorded. Abstinence-induced changes (abstinent scores vs. non-abstinent scores) were analyzed as a function of race/ethnicity. RESULTS Non-Hispanic African American smokers reported greater abstinence-induced declines in several positive affect states in comparison to other racial/ethnic groups. Relative to Hispanic smokers, non-Hispanic African American and non-Hispanic white smokers displayed larger abstinence-provoked increases in urges to smoke. No racial/ethnic differences were detected for a composite measure of nicotine withdrawal symptomatology, negative affect states, and motivation to reinstate smoking behavior. CONCLUSIONS These results suggest qualitative differences in the expression of some components of tobacco withdrawal across three racial/ethnic groups. This research helps shed light on bio-behavioral sources of tobacco-related health disparities, informs the application of smoking cessation interventions across racial/ethnic groups, and may ultimately aid the overall effort towards reducing the public health burden of tobacco addiction in minority populations. IMPLICATIONS The current study provides some initial evidence that there may be qualitative differences in the types of tobacco withdrawal symptoms experienced among non-Hispanic African American, Hispanic, and non-Hispanic white smokers. Extending this line of inquiry may elucidate mechanisms involved in tobacco-related health disparities and ultimately aid in reducing the public health burden of smoking in racial/ethnic minority populations.
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Affiliation(s)
- Mariel S Bello
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Karen L Cropsey
- Department of Psychiatry, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA; Department of Psychology, University of Southern California, Los Angeles, CA;
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Jin L, Tam T. Investigating the effects of temporal and interpersonal relative deprivation on health in China. Soc Sci Med 2015; 143:26-35. [PMID: 26340369 DOI: 10.1016/j.socscimed.2015.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022]
Abstract
We argue that in addition to interpersonal relative deprivation, it is important to examine how temporal relative deprivation influences health, especially in rapidly changing societies such as China. We develop four competing hypotheses regarding the possible effects of temporal relative deprivation on health. Moreover, we propose that temporal relative deprivation may confound the health effects of interpersonal relative deprivation, and for the sake of conceptual clarity, temporal relative deprivation needs to be accounted for in the examination of interpersonal relative deprivation. We use data from a nationally representative survey in China; our analytical sample consists of 10,828 respondents. The dependent variables are self-rated health and the frequency of experiencing depressive symptoms. Interpersonal relative deprivation is measured by individuals' evaluation of their current positions on a 10-rung 'ladder'. We also assess individuals' subjective positions at 14 years of age and from 10 years ago. To measure temporal relative deprivation, current subjective status is compared with subjective status at the two time points in the past to construct indicators of perceived upward and downward mobility. Both diagonal mobility models and conventional logistic regression are used and the results from the two types of model are comparable. The majority of Chinese people felt that they moved up the social ladder compared with their parents or themselves 10 years ago. Perceived upward mobility is not associated with health outcomes, whereas perceived downward mobility, especially intra-generational, is a strong predictor of worse mental and physical health. These patterns are consistent with the argument that the effects of bad experiences are stronger and longer lasting than those of good ones. They also focus our attention on those who perceived downward mobility. Furthermore, evidence suggests that the health effects of current subjective status also include the cumulative influence of prior changes in one's social status.
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Affiliation(s)
- Lei Jin
- Department of Sociology, RM 431, Sino Building, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
| | - Tony Tam
- Department of Sociology, RM 431, Sino Building, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
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Ko MJ, Lee EY, Kim K. Objective and Subjective Socioeconomic Position and Current Smoking Among Korean Adolescents. Asian Pac J Cancer Prev 2014; 15:8877-81. [DOI: 10.7314/apjcp.2014.15.20.8877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
PURPOSE OF REVIEW Subjective social status (SSS) predicts health outcomes above and beyond traditional objective measures of social status, such as education, income and occupation. This review summarizes and integrates recent findings on SSS and health. RECENT FINDINGS Current studies corroborate associations between low SSS and poor health indicators by extending previous findings to further populations and biological risk factors, providing meta-analytic evidence for adolescents and by demonstrating that negative affect may not confound associations between SSS and self-rated health. Recent findings also highlight the relevance of SSS changes (e.g. SSS loss in immigrants) and the need to consider cultural/ethnical differences in psychological mediators and associations between SSS and health. SUMMARY SSS is a comprehensive measure of one's social position that is related to several poor health outcomes and risk factors for disease. Future investigation, particularly prospective studies, should extend research on SSS and health to further countries/ethnic groups, also considering additional psychological and biological mediators and dynamic aspects of SSS. Recently developed experimental approaches to manipulate SSS may also be promising.
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Reitzel LR, Kendzor DE, Cao Y, Businelle MS. Subjective Social Status Predicts Quit-Day Abstinence among Homeless Smokers. Am J Health Promot 2014; 29:43-5. [DOI: 10.4278/ajhp.130228-arb-88] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Smoking prevalence is alarmingly high among the homeless. Few studies have focused on predictors of smoking abstinence in this population. Subjective social status, a person's ranking of their own social standing relative to others in the United States or in their own self-defined communities, has predicted smoking cessation among domiciled smokers in analyses adjusted for objective socioeconomic status and other demographic variables. This study examined if subjective social status predicted quit-day abstinence among homeless smokers making a quit attempt. Design. Longitudinal study using self-reported survey data. Setting. Transitional homeless shelter in Dallas, Texas. Subjects. A total of 57 homeless smokers enrolled in a cessation program. Measures. Predictors were the Subjective Social Status-U.S (SSS-U.S.) and the Subjective Social Status-Community (SSS-Community) ladders measured 1 week pre quit. Covariates were sociodemographics and tobacco dependence measured 1 week pre quit. The outcome was self-reported and biochemically verified smoking abstinence on the quit day. Analysis. Covariate-adjusted logistic regression models. Results. Higher rankings on the SSS-U.S. ladder, but not the SSS-Community ladder, predicted abstinence on the quit day (p = .005). Conclusion. Lower rankings on the SSS-U.S. ladder predicted increased risk of relapse on the quit day or the inability to quit at all. The SSS-U.S. ladder might be useful in identifying homeless smokers needing additional preparation and intervention before initiating a quit attempt.
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The relation between social cohesion and smoking cessation among Black smokers, and the potential role of psychosocial mediators. Ann Behav Med 2014; 45:249-57. [PMID: 23135831 DOI: 10.1007/s12160-012-9438-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Social cohesion, the self-reported trust and connectedness between neighbors, may affect health behaviors via psychosocial mechanisms. PURPOSE Relations between individual perceptions of social cohesion and smoking cessation were examined among 397 Black treatment-seeking smokers. METHODS Continuation ratio logit models examined the relation of social cohesion and biochemically verified continuous smoking abstinence through 6 months post-quit. Indirect effects were examined in single mediator models using a nonparametric bootstrapping procedure. All analyses controlled for sociodemographics, tobacco dependence, and treatment. RESULTS The total effect of social cohesion on continuous abstinence was non-significant (β = 0.05, p = 0.10). However, social cohesion was associated with social support, positive affect, negative affect, and stress, which, in turn, were each associated with abstinence in adjusted models (ps < 0.05). CONCLUSIONS Results suggest that social cohesion may facilitate smoking cessation among Black smokers through desirable effects on psychosocial mechanisms that can result from living in a community with strong interpersonal connections.
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Reitzel LR, Buchanan TS, Nguyen N, Ahluwalia JS. Associations of subjective social status with nondaily and daily smoking. Am J Health Behav 2014; 38:245-53. [PMID: 24629553 DOI: 10.5993/ajhb.38.2.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore associations between subjective social status (SSS) and smoking level among 2274 adult current smokers. METHODS Associations were investigated using a covariate-adjusted proportional odds cumulative logit model. Moderation (via race/ethnicity or sex) and mediation (via depressive symptoms, social/emotional support, or life satisfaction) were explored in additional models. RESULTS Higher SSS was associated with greater likelihood of nondaily versus light daily or moderate/ heavy daily smoking (p = .017). Life satisfaction partially mediated the association of SSS and smoking level (p = .003). CONCLUSIONS Higher SSS was associated with greater likelihood of nondaily relative to light daily or moderate to heavy smoking, potentially via greater life satisfaction. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Educational Psychology, College of Education, University of Houston, Houston, Department of Health Disparities Research at The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Taneisha S Buchanan
- Center for Health Equity and Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nga Nguyen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jasjit S Ahluwalia
- Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN, USA
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Camelo LDV, Giatti L, Barreto SM. Subjective social status, self-rated health and tobacco smoking: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Health Psychol 2013; 19:1388-99. [PMID: 23818507 DOI: 10.1177/1359105313490772] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using baseline data from ELSA-Brasil (N = 15,105), we investigated whether subjective social status, measured using three 10-rung "ladders," is associated with self-rated health and smoking, independently of objective indicators of social position and depression symptoms. Additionally, we explored whether the magnitude of these associations varies according to the reference group. Subjective social status was independently associated with poor self-rated health and weakly associated with former smoking. The references used for social comparison did not change these associations significantly. Subjective social status, education, and income represent distinct aspects of social inequities, and the impact of each of these indicators on health is different.
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Affiliation(s)
| | - Luana Giatti
- Universidade Federal de Minas Gerais, Brazil Universidade Federal de Ouro Preto, Brazil
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Abstract
Higher socioeconomic status smokers are more successful at smoking cessation. Few studies have investigated the prospective association between multiple measures of socioeconomic status and Hispanic smoking cessation. We assessed four measures to examine which predicted smoking cessation. Hispanics without debt had 18.5 times higher odds of 30-day cessation (odds ratio = 18.47, 95% confidence interval = 3.26-104.66, p < .01) and 11-fold increased odds of 7-day point prevalence abstinence (odds ratio = 11.32, 95% confidence interval = 2.45-52.24, p < .01) at 3-month follow-up. Yearly income, education, work status, money to see a doctor, and money for medications were not predictive of smoking cessation. Debt level may better measure socioeconomic inequities by capturing objective and subjective social status associated with Hispanic smoking cessation.
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Affiliation(s)
- Karl Chiang
- Mass Memorial Health Care and The University of Massachusetts Medical School, USA
| | - Belinda Borrelli
- Warren Alpert Medical School at Brown University and The Miriam Hospital
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Reitzel LR, Nguyen N, Strong LL, Wetter DW, McNeill LH. Subjective social status and health behaviors among African Americans. Am J Health Behav 2013; 37:104-11. [PMID: 22943107 DOI: 10.5993/ajhb.37.1.12] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine associations of the US and community subjective social status (SSS) ladders with smoking status, at-risk drinking, fruit and vegetable intake, physical activity, and body mass index among 1467 church-going African American adults from a larger cohort study. METHODS Regression analyses, adjusted for sociodemographics, examined associations between SSS ladders and health behaviors. RESULTS The SSS-US ladder was significantly associated with fruit and vegetable consumption (p = .007) and physical activity (p = .005). The SSS-community ladder was not significantly associated with any health behaviors. CONCLUSIONS Among this sample of African Americans, the SSS-US ladder is more predictive of some health behaviors than is the SSS-community ladder.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Bergen AW, Javitz HS, Su L, He Y, Conti DV, Benowitz NL, Tyndale RF, Lerman C, Swan GE. The DRD4 exon III VNTR, bupropion, and associations with prospective abstinence. Nicotine Tob Res 2012; 15:1190-200. [PMID: 23212438 DOI: 10.1093/ntr/nts245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION DRD4 Exon III Variable Number of Tandem Repeat (VNTR) variation was found to interact with bupropion to influence prospective smoking abstinence, in a recently published longitudinal analyses of N = 331 individuals from a randomized double-blind placebo-controlled trial of bupropion and intensive cognitive-behavioral mood management therapy. METHODS We used univariate, multivariate, and longitudinal logistic regression to evaluate gene, treatment, time, and interaction effects on point prevalence and continuous abstinence at end of treatment, 6 months, and 12 months, respectively, in N = 416 European ancestry participants in a double-blind pharmacogenetic efficacy trial randomizing participants to active or placebo bupropion. Participants received 10 weeks of pharmacotherapy and 7 sessions of behavioral therapy, with a target quit date 2 weeks after initiating both therapies. VNTR genotypes were coded with the long allele dominant resulting in 4 analysis categories. Covariates included demographics, dependence measures, depressive symptoms, and genetic ancestry. We also performed genotype-stratified secondary analyses. RESULTS We observed significant effects of time in longitudinal analyses of both abstinence outcomes, of treatment in individuals with VNTR long allele genotypes for both abstinence outcomes, and of covariates in some analyses. We observed non-significantly larger differences in active versus placebo effect sizes in individuals with VNTR long allele genotypes than in individuals without the VNTR long allele, in the directions previously reported. CONCLUSIONS VNTR by treatment interaction differences between these and previous analyses may be attributable to insufficient size of the replication sample. Analyses of multiple randomized clinical trials will enable identification and validation of factors mediating treatment response.
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Affiliation(s)
- Andrew W Bergen
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
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Whembolua GL, Davis JT, Reitzel LR, Guo H, Thomas JL, Goldade KR, Okuyemi KS, Ahluwalia JS. Subjective social status predicts smoking abstinence among light smokers. Am J Health Behav 2012; 36:639-46. [PMID: 22584091 DOI: 10.5993/ajhb.36.5.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To determine if community subjective social status (SSS) predicted smoking abstinence through 26 weeks postrandomization among 755 African American light smokers of low SES (socioeconomic status). METHODS Participants were enrolled in a double-blind, placebo-controlled, randomized clinical trial, which examined the efficacy of nicotine gum and counseling for smoking cessation. RESULTS Results indicated that SSS predicted smoking abstinence over time [P=.046; odds ratio (OR) =1.075 (1.001-1.155)] after adjusting for covariates. CONCLUSIONS Further research is needed to understand the effects of community SSS on smoking cessation among heavy smokers and other ethnic groups.
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Affiliation(s)
| | - Julia T. Davis
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Hongfei Guo
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Janet L. Thomas
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kate R. Goldade
- Program in Health Disparities Research, Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Kola S. Okuyemi
- Program in Health Disparities Research, Director, Minnesota Center for Cancer Collaborations and Co-Director, Office of Community Engagement for Health, CTSI and Associate Professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jasjit S. Ahluwalia
- Center for Health Equity, Director, Office of Interprofessional Career Development, Clinical and Translational Sciences Institute (CTSI), University of Minnesota Medical School, Minneapolis, MN, USA
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Drug-related cues exacerbate decision making and increase craving in heroin addicts at different abstinence times. Psychopharmacology (Berl) 2012; 221:701-8. [PMID: 22207241 DOI: 10.1007/s00213-011-2617-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
RATIONALE Relapse is a persistent problem in the management of addiction. Drug-related cues are powerful instigators of relapse. Impulsive decision making may contribute to relapse through a poorly considered assessment of the consequences of drug use. Drug cues robustly increase subjective craving, which is frequently associated with relapse. OBJECTIVE The present study explored the effects of drug-related cues on decision making and craving in heroin addicts at different abstinence times: 1, 3, 12, and 24 months. METHODS The 75 male participants were given 5 min exposure to neutral and drug-associated cues while decision making performance, craving, blood pressure, heart rate, and emotional state pre- and post-exposure were assessed. The Iowa Gambling Task was used to evaluate decision making ability in heroin addicts. RESULTS Drug-related cues exacerbated impulsive decision making and increased craving, heart rate, and systolic pressure in heroin addicts at all abstinence times. CONCLUSIONS Drug-related cues aggravated decision making and increased craving in former heroin addicts who had been drug-free for 1-24 months, which might have significant clinical implications for the prevention of relapse.
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Castro Y, Costello TJ, Correa-Fernández V, Heppner WL, Reitzel LR, Cofta-Woerpel L, Mazas CA, Cinciripini PM, Wetter DW. Differential effects of depression on smoking cessation in a diverse sample of smokers in treatment. Am J Prev Med 2011; 41:84-7. [PMID: 21665068 PMCID: PMC3733472 DOI: 10.1016/j.amepre.2011.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 01/31/2011] [Accepted: 03/04/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent cross-sectional evidence suggests that the effect of depression on smoking prevalence and quit ratios differs by race/ethnicity. PURPOSE This study prospectively examined the main and interactive effects of race/ethnicity and depressive symptoms on smoking cessation during a specific quit attempt among smokers receiving cessation treatment. METHODS Data from a longitudinal study of smokers in treatment were examined using continuation ratio logit modeling. Continuous abstinence across Weeks 1, 2, and 4 post-quit was the outcome variable. Data were collected between March 2005 and November 2007, and the current study analyses were conducted in April 2010. RESULTS Depressive symptoms predicted significantly lower cessation rates for whites and African Americans. In contrast, among Latinos there was no relationship between depression and cessation. CONCLUSIONS This research is the first to prospectively demonstrate a racially/ethnically differentiated effect of depressive symptoms on smoking cessation, and it has implications for targeted smoking-cessation treatments as it indicates that depression may not be a key treatment target for Latinos.
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Affiliation(s)
- Yessenia Castro
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, 77230, USA.
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Reitzel LR, Businelle MS, Kendzor DE, Li Y, Cao Y, Castro Y, Mazas CA, Cofta-Woerpel L, Cinciripini PM, Wetter DW. Subjective social status predicts long-term smoking abstinence. BMC Public Health 2011; 11:135. [PMID: 21352534 PMCID: PMC3050754 DOI: 10.1186/1471-2458-11-135] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 02/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between subjective social status (SSS), a person's perception of his/her relative position in the social hierarchy, and the ability to achieve long-term smoking abstinence during a specific quit attempt is unknown. The purpose of this study was to examine the relationship between SSS and long-term smoking abstinence among 421 racially/ethnically diverse smokers undergoing a specific quit attempt, as well as the interactive effects of race/ethnicity and sex. METHODS The main effects and moderated relationships of SSS on biochemically-confirmed, continuous smoking abstinence through 26 weeks post-quit were examined using continuation ratio logit models adjusted for sociodemographics and smoking characteristics. RESULTS Even after adjusting for the influence of socioeconomic status and other covariates, smokers endorsing lower SSS were significantly less likely to maintain long-term smoking abstinence during a specific quit attempt than those with higher SSS (OR = 1.14, 95% CI: 1.00 - 1.28; p = 0.044). The statistical significance of this relationship, however, did not vary by race/ethnicity or sex. CONCLUSIONS SSS independently predicts long-term smoking abstinence during a specific quit attempt. SSS may be a useful screener to identify smokers at elevated risk of relapse who may require additional attention to facilitate long-term abstinence. More research is needed to understand the mechanisms underlying the relationship between SSS and long-term smoking abstinence in order to appropriately tailor treatment to facilitate abstinence among lower SSS smokers.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Aubin HJ, Reynaud M. Evolutionary mechanisms underlying the effect of subjective social status on smoking abstinence: ultimate versus proximate explanations. Addiction 2010; 105:1499. [PMID: 20653627 DOI: 10.1111/j.1360-0443.2010.03036.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reitzel LR, Mazas CA, Cofta-Woerpel L, Vidrine JI, Businelle MS, Kendzor DE, Li Y, Cao Y, Wetter DW. Acculturative and neighborhood influences on subjective social status among Spanish-speaking Latino immigrant smokers. Soc Sci Med 2010; 70:677-83. [PMID: 20044186 PMCID: PMC5048887 DOI: 10.1016/j.socscimed.2009.11.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 10/09/2009] [Accepted: 11/16/2009] [Indexed: 02/03/2023]
Abstract
Subjective social status (SSS) reflects an individual's perception of her/his relative position in the social hierarchy. However, little is known about culturally-relevant, multilevel predictors of low SSS among low socioeconomic status (SES), minority populations. The goal of this study was to identify individual- and neighborhood-level variables predicting SSS among 297 Spanish-speaking Latino immigrant smokers living in several locations in Texas, with an emphasis on the association of SSS with acculturative and socioeconomic variables. Participants were recruited and enrolled through the National Cancer Institute's Cancer Information Service from August 2002 to March 2004. Determinants of SSS were explored using a series of linear regressions. In analyses adjusting for demographics (including objective indicators of SES), speaking Spanish at home and work and living in economically disadvantaged neighborhoods, respectively, were associated with low SSS. However, in analyses including demographics, acculturation, and neighborhood characteristics, only income, education, and acculturation remained associated with SSS. Consistent with results from a previous study in the area (Franzini & Fernandez-Esquer, 2006), less acculturation predicted low SSS among immigrant Latino smokers. However, unlike previous research, these associations were maintained after controlling for SES. Results suggest that the density of less acculturated Latinos within economically deprived neighborhoods might account for the disappearance of neighborhood effects in the final model.
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