Do Biological Differences Help Explain Tobacco-Related Disparities?

Gender Differences in Negative Affect During Acute Tobacco Abstinence Differ Between African American and White Adult Cigarette Smokers

INTRODUCTION

Prior studies have found heightened negative affect following tobacco abstinence in women compared to men. However, experimental work addressing whether these findings generalize across racial groups is scarce. This study investigated whether race (non-Hispanic White vs. non-Hispanic African American) moderated gender differences in abstinence-induced negative affect and smoking behavior.

METHODS

Data were collected from 2010 to 2017 from two separate laboratory studies investigating experimentally manipulated tobacco abstinence. Following a baseline session, adult daily smokers (≥10 cigarettes/day; women: n = 297, 83.8% non-Hispanic African American; men: n = 492, 86.2% non-Hispanic African American) attended two counterbalanced lab sessions (16 hours abstinent vs. non-abstinent) and completed self-report measures of negative affect followed by a laboratory analogue smoking reinstatement task.

RESULTS

We found a gender × race interaction for several negative affect states and composite negative affect (βs = -.12 to -.16, Ps < .05). Analyses stratified by race showed that non-Hispanic White women compared to non-Hispanic White men exhibited greater abstinence-induced increases in anger, anxiety, and composite negative affect (βs = -.20 to -.29, Ps < .05). No significant gender differences in abstinence-induced negative affect were found for non-Hispanic African American smokers (βs = .00 to - .04, Ps > .05).

CONCLUSION

These findings suggest that negative affect during acute tobacco abstinence may be a clinically important and intervenable factor that can inform cessation interventions specifically for non-Hispanic White women smokers. Further empirical exploration of mechanisms underlying interactions of gender and race in tobacco addiction may benefit smoking cessation efforts in non-Hispanic African American women smokers.

IMPLICATIONS

This study contributes to a scant body of research examining the intersectional influence of race and gender on abstinence-induced negative affect-a central, motivationally prepotent feature of tobacco withdrawal. Using a laboratory-based design to experimentally manipulate abstinence, we provide evidence of a gender × race interaction on negative affect-related withdrawal. Our findings suggest that gender differences in abstinence-induced negative affect observed among non-Hispanic White smokers may not generalize to non-Hispanic African American smokers, highlighting the need for future work to address potential mechanisms underlying the racially discrepant impact of gender on affective tobacco withdrawal.

Happiness as a Buffer of the Association Between Dependence and Acute Tobacco Abstinence Effects in African American Smokers

Introduction

African American (AA) smokers are at disproportionate risk of tobacco dependence, utilizing smoking to regulate stress, and poor cessation outcomes. Positive emotional traits may function as coping factors that buffer the extent to which dependence increases vulnerability to adverse responses to acute tobacco abstinence (ie, tobacco withdrawal). This laboratory study examined subjective happiness (SH; dispositional orientation towards frequent and intense positive affect [PA] and life satisfaction) as a moderator of the relation between tobacco dependence and subjective and behavioral abstinence effects among AA smokers.

Methods

AA smokers (N = 420, 39.0% female) completed self-report measures of tobacco dependence and SH followed by two counterbalanced experimental sessions (nonabstinent vs. 16-hour abstinent) involving self-report measures of composite withdrawal, urge to smoke, and mood, and a behavioral smoking task in which participants could: (1) earn money to delay smoking reinstatement, and (2) subsequently purchase cigarettes to smoke.

Results

Tobacco dependence was positively associated with increased abstinence effects in composite withdrawal, urge to smoke, PA, and latency to smoking reinstatement (ps < .04). SH significantly moderated the relation between dependence and abstinence-induced increases in composite withdrawal (β = -.17, p < .001), such that the predictive power of dependence on withdrawal severity grew proportionately weaker as levels of SH increased.

Conclusions

SH may insulate against adverse effects of dependence on withdrawal during acute smoking abstinence, particularly withdrawal symptom clusters that are craving- and mood-based. Consideration of positive emotional traits as stress-coping factors in the dependence-withdrawal link may be warranted in research and practice with AA smokers.

Implications

The current study contributes to a growing body of literature examining the potentially advantageous role of positive emotional traits to smokers. We do so by identifying a relatively understudied psychological construct within tobacco research-subjective happiness-that may suppress the extent to which more severe tobacco dependence increases risk for subjective withdrawal-related distress during acute smoking abstinence in AA smokers. In doing so, the study provides a primer for future targeting of subjective happiness and other positive emotional traits as means to understand and treat acute tobacco abstinence effects among dependent AA smokers.

Interaction between ethnicity and smoker type with dependence: A comparison of daily and intermittent African American and Caucasian smokers

Ethnic differences in smoking patterns and dependence have been observed between Caucasian and African American smokers: African Americans who smoke are more likely to be intermittent smokers (ITS), and daily smokers (DS) consume fewer cigarettes yet report more dependence. Participants' (N = 482, 67% Caucasian, 54% ITS) dependence was assessed by primary and secondary dependence subscales of the Wisconsin Inventory of Smoking Dependence Motives, the Nicotine Dependence Syndrome Scale, the Hooked on Nicotine Checklist, the Fagerström Test of Nicotine Dependence, and time to first cigarette after waking. We tested associations with dependence for ethnicity, smoker type, and an Ethnicity × Smoker Type interaction, using multivariable linear regression, with adjustment for age, sex, and education. Additional models adjusted for cigarettes per day and history of daily smoking. There was a significant interaction between ethnicity and smoker type for 5 of 6 measures of dependence (each scale assessed separately), such that African American ITS reported more dependence than Caucasian ITS, whereas dependence did not differ by ethnicity among DS. African American ITS smoked more cigarettes per day and were more likely to have a history of daily smoking than Caucasian ITS; after further adjustments for these differences, there were no significant interactions of ethnicity and smoker type for any measure. Among DS, dependence did not differ by race. African American ITS were more dependent than Caucasian ITS; this difference was explained by higher cigarette consumption and a higher proportion converted from DS to ITS among African Americans versus Caucasians. (PsycINFO Database Record

Racial/ethnic disparity in the associations of smoking status with uncontrolled hypertension subtypes among hypertensive subjects

Background

Racial/ethnic differences in the associations of smoking with uncontrolled blood pressure (BP) and its subtypes (isolated uncontrolled systolic BP (SBP), uncontrolled systolic-diastolic BP, and isolated uncontrolled diastolic BP (DBP)) have not been investigated among diagnosed hypertensive subjects.

Methods

A sample of 7,586 hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey 1999–2010. Race/ethnicity was classified into Hispanic, non-Hispanic white, and non-Hispanic black. Smoking was categorized as never smoking, ex-smoking, and current smoking. Uncontrolled BP was determined as SBP≥140 or DBP≥90 mm Hg. Isolated uncontrolled SBP was defined as SBP≥140 and DBP<90 mm Hg, uncontrolled SDBP as SBP≥140 and DBP≥90 mm Hg, and isolated uncontrolled DBP as SBP<140 and DBP≥90 mm Hg. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of uncontrolled BP and its subtypes were calculated using weighted logistic regression models.

Results

The interaction effect of race and smoking was significant after adjustment for the full potential confounding covariates (Adjusted p = 0.0412). Compared to never smokers, current smokers were 29% less likely to have uncontrolled BP in non-Hispanic whites (OR = 0.71, 95% CI = 0.56–0.90), although the likelihood for uncontrolled BP is the same for smokers and never smokers in Hispanics and non-Hispanic blacks. Current smokers were 26% less likely than never smokers to have isolated uncontrolled SBP in non-Hispanic whites (OR = 0.74, 95% CI = 0.58–0.95). However, current smoking is associated with an increased likelihood of uncontrolled systolic-diastolic BP in non-Hispanic blacks, and current smokers in this group were 70% more likely to have uncontrolled systolic-diastolic BP than never smokers (OR = 1.70, 95% CI = 1.10–2.65).

Conclusion

The associations between current smoking and uncontrolled BP differed over race/ethnicity. Health practitioners may need to be especially vigilant with non-Hispanic black smokers with diagnosed hypertension.

Can tobacco control be transformative? Reducing gender inequity and tobacco use among vulnerable populations

Tobacco use and exposure is unequally distributed across populations and countries and among women and men. These trends and patterns reflect and cause gender and economic inequities along with negative health impacts. Despite a commitment to gender analysis in the preamble to Framework Convention on Tobacco Control there is much yet to be done to fully understand how gender operates in tobacco control. Policies, program and research in tobacco control need to not only integrate gender, but rather operationalize gender with the goal of transforming gender and social inequities in the course of tobacco control initiatives. Gender transformative tobacco control goes beyond gender sensitive efforts and challenges policy and program developers to apply gender theory in designing their initiatives, with the goal of changing negative gender and social norms and improving social, economic, health and social indicators along with tobacco reduction. This paper outlines what is needed to progress tobacco control in enhancing the status of gendered and vulnerable groups, with a view to reducing gender and social inequities due to tobacco use and exposure.

Testing the invariance of adolescent survey-based smoking-related behaviors across ethnic groups and gender

The present study examined the factor structure of 3 smoking-related items administered as part of the California Health Interview Survey. Factorial invariance was examined across Asian Americans (N = 377), Caucasians (N = 1739), African Americans (N = 115), and Latin Americans (N = 814), and across young men (N = 1612) and women (N = 1767). Factorial invariance analyses revealed all minority ethnic groups to be significantly different (p < .05) from Caucasians, and men to differ significantly from women. These findings suggest that the types of smoking behaviors assessed in the California Health Interview Survey do not predict behaviors uniformly across groups.

A transnational study of migration and smoking behavior in the Mexican-origin population

OBJECTIVES

We examined migration-related changes in smoking behavior in the transnational Mexican-origin population.

METHODS

We combined epidemiological surveys from Mexico (Mexican National Comorbidity Survey) and the United States (Collaborative Psychiatric Epidemiology Surveys). We compared 4 groups with increasing US contact with respect to smoking initiation, persistence, and daily cigarette consumption: Mexicans with no migrant in their family, Mexicans with a migrant in their family or previous migration experience, migrants, and US-born Mexican Americans.

RESULTS

Compared with Mexicans with a migrant in their family or previous migration experience, migrants were less likely to initiate smoking (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.38, 0.83) and less likely to be persistent smokers (OR = 0.41; 95% CI = 0.26, 0.63). Among daily smokers, the US-born smoked more cigarettes per day than did Mexicans with a migrant in their family or previous migration experience for men (7.8 vs 6.5) and women (8.6 vs 4.3).

CONCLUSIONS

Evidence suggests that smoking is suppressed among migrants relative to the broader transnational Mexican-origin population. The pattern of low daily cigarette consumption among US-born Mexican Americans, noted in previous research, represents an increase relative to smokers in Mexico.