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© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.037812
RESEARCH AND PRACTICE |
Gary G. Bennett and Kathleen Yaus Wolin are with Harvard School of Public Health and the Center for Community-Based Research at the Dana-Farber Cancer Institute, Boston, Mass. Elwood L. Robinson is with North Carolina Central University, Durham. Sherrye Fowler is with the North Carolina Governor’s Institute on Alcohol and Substance Abuse, Research Triangle Park. Christopher L. Edwards is with Duke University Medical Center, Durham, NC.
Correspondence: Requests for reprints should be sent to Gary G. Bennett, PhD, Harvard School of Public Health and Dana-Farber Cancer Institute, Center for Community-Based Research, 44 Binney St, SM256, Boston, MA 02115 (e-mail: gbennett{at}hsph.harvard.edu).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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We examined the association between perceived racial/ethnic harassment and tobacco use in 2129 African American college students in North Carolina. Age-adjusted and multivariate analyses evaluated the effect of harassment on daily and less-than-daily tobacco use. Harassed participants were twice as likely to use tobacco daily (odds ratio = 2.01; 95% confidence interval=1.94, 2.08) compared with those with no reported harassment experiences. Experiences of racial/ethnic harassment may contribute to tobacco use behaviors among some African American young adults.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Tobacco use remains a leading preventable cause of death in the United States, particularly among African American individuals who experience disproportionately high rates of tobacco-related chronic disease incidence and mortality.1–3
For some, tobacco use may serve as a means of managing psychosocial stress.4 This type of use may be especially common among African American individuals,5–7 who, throughout the life course, may encounter heightened levels of psychosocial stress from perceived racial discrimination.8–10 Perceived racial discrimination has been associated with adverse health-related outcomes, including tobacco use.11–15
Few studies have examined the health consequences of experiencing racial/ethnic harassment, a behavioral manifestation of racial discrimination. We suspected that as an acute, episodic, and intense psychosocial exposure, racial/ethnic harassment might be associated with tobacco use behaviors among African American young adults.
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METHODS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Sample
These data were drawn from a study of health behaviors at historically Black colleges and universities in North Carolina. The study sample included 729 males (36.9%) and 1246 females (63.1%); the participants’ ages ranged from 17 to 53 years.
All of North Carolina’s 11 historically Black colleges and universities were invited to participate in the study, and 8 were enrolled (73%). A convenience sample was recruited through seminars, academic counseling centers, and other university-based activities to complete a brief self-report questionnaire.16 The sample’s composition approximated the enrollment of the represented institutions.17 All subjects were volunteers, and each institution approved data collection methods. Data collection occurred during the 2000 to 2001 academic year.
Measures
Our harassment item was drawn from a standardized survey16: "indicate whether any of the following have happened to you within the last year while you were in and around campus: ethnic or racial harassment." A yes or no response option was provided. Participants reported their tobacco use over the previous 30-day period; 7 response options were available, ranging from "zero" to "all 30 days." Occupational status was categorized as part time, full time, or not working. Because of limited variability, age at tobacco use initiation was dichotomized as either adolescence or older. Grade point average ranged from A+ to F. Current residence was considered either on or off campus.
Analyses
Tobacco use occurring on all of the past 30 days was considered daily use. Use on any, but not all, of the previous 30 days constituted less-than-daily tobacco use. We first tested for differences in each potential covariate by harassment. To allow for the potential nonindependence of students within a university, we used generalized estimating equations with a binary distribution. Age-adjusted models were estimated, and, subsequently, additional covariates were included.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Descriptive data are presented in Table 1
. Of the 219 participants, 10% reported experiencing racial/ethnic harassment. Harassed participants were more likely to be male (45.7%), work full time (13.7%), and reside on campus (71.4%), compared with those who did not report harassment (35.9%, 7.0%, and 78.5%, respectively).
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In age-adjusted analyses, participants reporting harassment were twice as likely to use tobacco daily (odds ratio [OR] = 2.01; 95% confidence interval [CI] = 1.94, 2.08; see Table 2
). This effect persisted after adjustment for other covariates (OR = 2.10; 95% CI = 1.23, 3.58), including gender, campus residence, grades, occupational status, and age at tobacco use initiation.
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Harassed participants were 70% more likely to have used tobacco on any of the previous 30 days, compared with the nonharassed participants (OR=1.70; 95% CI=1.21, 2.41); however, this effect diminished after adjustment for covariates (OR = 1.45; 95% CI = 0.89, 2.35).
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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We found that African American college students who reported experiencing racial/ethnic harassment were twice as likely to use tobacco products daily over a 30-day period. Our study supports and extends previous findings13,14 and suggests that tobacco may be used to manage the psychosocial stress associated with experiencing racial/ethnic harassment. Harassment was more common for participants who were employed full time and on-campus residents, contexts perhaps where interracial interaction was more common. Future work should contextualize the construct, evaluate potential modifiers (e.g., coping), and evaluate the influence of harassment, compared with other known determinants of young adult tobacco use.
Several limitations should be noted. Because of institutional concerns, the recruitment of a convenience sample was necessary. We used a nonvalidated harassment measure that did not assess the intensity, frequency, or setting of harassment episodes. However, we consider this measurement approach justified given the preliminary nature of the study and our speculation that a face-valid item might have minimized measurement error. Additionally, socioeconomic position data were unavailable; however, some evidence indicates that adjustment for socioeconomic position might have limited influence on tobacco use outcomes in comparable populations.18–20 Although we posited that harassment preceded tobacco use, evidence regarding the causal direction between psychosocial or affective exposures and tobacco use is mixed.21,22 Finally, we were unable to adjust for selected social contextual factors that have been associated with young adult tobacco use.23,24
Further work is necessary, but our findings appear to support the disaggregation of harassment in future studies of discrimination. Given African American individuals’ delayed tobacco use initiation,18,23–32 recent resurgence of tobacco use,25 and higher tobacco-related mortality rates,1,3 our findings highlight a potentially important determinant and setting (historically Black colleges and universities) for intervention.
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Acknowledgments |
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This project was funded in part by the North Carolina Governor’s Institute on Alcohol and Substance Abuse. G. G. Bennett was supported in part by the Dana-Farber/Harvard Cancer Center and the Liberty Mutual Foundation. K. Y. Wolin is supported by a National Cancer Institute training grant (5 T32 CA09001-28).
We would like to gratefully acknowledge the assistance of the individual institutions represented in this investigation. We appreciate the reviews and helpful comments offered by Karen M. Emmons. We also thank Sandy Askew and Kerry Kokkinogenis for their assistance in the preparation of this brief.
Human Participant Protection
Each participating institution approved data collection methods.
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Footnotes |
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Peer Reviewed
Contributors
G.G. Bennett originated the study, synthesized the analyses, and led the writing of the brief. K.Y. Wolin assisted in the conceptualization of the study, performed the analyses, and contributed to the writing of the brief. E.L. Robinson and S. Fowler developed the parent study and assisted in the interpretation of findings. C.L. Edwards developed the parent study, assisted in the interpretation of findings, and reviewed drafts of the article.
Accepted for publication July 1, 2004.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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1. Tobacco Use Among US Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General Atlanta, Ga: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1998.
2. Prevalence of cigarette use among 14 racial/ethnic populations—United States, 1999–2001. MMWR Morb Mortal Wkly Rep. 2004;53:49–52.[Medline]
3. Leistikow B. Lung cancer rates as an index of tobacco smoke exposures: validation against black male approximate non-lung cancer death rates, 1969–2000. Prev Med. 2004;38:511–515.[CrossRef][Web of Science][Medline]
4. Shadel WG, Mermelstein RJ. Cigarette smoking under stress: the role of coping expectancies among smokers in a clinic-based smoking cessation program. Health Psychol. 1993;12:443–450.[CrossRef][Web of Science][Medline]
5. Byrne DG, Byrne AE, Reinhart MI. Personality, stress and the decision to commence cigarette smoking in adolescence. J Psychosom Res. 1995;39:53–62.[CrossRef][Web of Science][Medline]
6. Guthrie BJ, Young AM, Boyd CJ, Kintner EK. Dealing with daily hassles: smoking and African-American adolescent girls. J Adolesc Health. 2001;29: 109–115.
7. Ludman EJ, Curry SJ, Grothaus LC, Graham E, Stout J, Lozano P. Depressive symptoms, stress, and weight concerns among African American and European American low-income female smokers. Psychol Addict Behav. 2002;16:68–71.[CrossRef][Web of Science][Medline]
8. Williams DR. Race, socioeconomic status, and health: the added effects of racism and discrimination. Ann N Y Acad Sci. 1999;896:173–188.[CrossRef][Web of Science][Medline]
9. Kessler RC, Mickelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav. 1999;40:208–230.[CrossRef][Web of Science][Medline]
10. Clark R. Perceptions of interethnic group racism predict increased vascular reactivity to a laboratory challenge in college women. Ann Behav Med. 2000;22: 214–222.[Web of Science][Medline]
11. Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health. 1996;86:1370–1378.
12. Clark R, Anderson NB, Clark VR, Williams DR. Racism as a stressor for African Americans: a biopsychosocial model. Am Psychol. 1999;54:805–816.[CrossRef][Medline]
13. Landandrine H, Klonoff EA. Racial discrimination and cigarette smoking among Blacks: findings from two studies. Ethn Dis. 2000;10:195–202.[Medline]
14. Guthrie BJ, Young AM, Williams DR, Boyd CJ, Kintner EK. African American girls’ smoking habits and day-to-day experiences with racial discrimination. Nurs Res. 2002;51:183–190.[CrossRef][Web of Science][Medline]
15. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93:200–208.
16. Presley CA, Meilman PW, Leichliter JS, Harrold R. The Core Alcohol and Drug Survey User’s Manual. 6th ed. Carbondale: Core Institute, Southern Illinois University at Carbondale; 1998.
17. College Foundation of North Carolina. Comparative View—my CFNC. Available at: http://secure.ncmentor.org/CompareView/default.asp. Accessed June 2, 2004.
18. Wechsler H, Rigotti NA, Gledhill-Hoyt J, Lee H. Increased levels of cigarette use among college students: a cause for national concern. JAMA. 1998;280: 1673–1678.
19. Rigotti NAMD, Lee JED, Wechsler HP, Gledhill-Hoyt JMPH, Lee HP. US college students’ use of tobacco products: results of a national survey increased levels of cigarette use among college students: a cause for national concern. JAMA. 2000;284:699–705.
20. Wetter DW, Kenford SL, Welsch SK, et al. Prevalence and predictors of transitions in smoking behavior among college students. Health Psychol. 2004;23: 168–177.[CrossRef][Web of Science][Medline]
21. Kandandel DB, Davies M, Karus D, Yamaguchi K. The consequences in young adulthood of adolescent drug involvement: an overview. Arch Gen Psychiatry. 1986;43:746–754.
22. Goodman E, Capitman J. Depressive symptoms and cigarette smoking among teens. Pediatrics. 2000; 106:748–755.
23. Griesler PC, Kandel DB, Davies M. Ethnic differences in predictors of initiation and persistence of adolescent cigarette smoking in the National Longitudinal Survey of Youth. Nicotine Tob Res. 2002;4:79–93.[Abstract]
24. Johnson CC, Li D, Perry CL, et al. Fifth through eighth grade longitudinal predictors of tobacco use among a racially diverse cohort: CATCH. J Sch Health. 2002;72:58–64.[Web of Science][Medline]
25. Moon-Howard J. African American women and smoking: starting later. Am J Public Health. 2003;93: 418–420.
26. Juon HS, Ensminger ME, Sydnor KD. A longitudinal study of developmental trajectories to young adult cigarette smoking. Drug Alcohol Depend. 2002;66: 303–314.[CrossRef][Web of Science][Medline]
27. Kelder SH, Prokhorov A, Barroso CS, Murray N, Orpinas P, McCormick L. Smoking differences among African American, Hispanic, and White middle school students in an urban setting. Addict Behav. 2003;28: 513–522.[CrossRef][Web of Science][Medline]
28. Kiefe CI, Williams OD, Lewis CE, Allison JJ, Sekar P, Wagenknecht LE. Ten-year changes in smoking among young adults: are racial differences explained by socioeconomic factors in the CARDIA study? Am J Public Health. 2001;91:213–218.[Abstract]
29. Wallace JM Jr, Forman TA, Guthrie BJ, Bachman JG, O’Malley PM, Johnston LD. The epidemiology of alcohol, tobacco and other drug use among black youth. J Stud Alcohol. 1999;60:800–809.[Web of Science][Medline]
30. Prevalence of current cigarette smoking among adults and changes in prevalence of current and some day smoking—United States, 1996–2001. MMWR Morb Mortal Wkly Rep. 2003;52:303–304, 306–307.[Medline]
31. Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2001 [published erratum appears in MMWR Morb Mortal Wkly Rep. 2003;52:1025]. MMWR Morb Mortal Wkly Rep. 2003;52:953–956.[Medline]
32. Tobacco use among high school students—United States, 1997. MMWR Morb Mortal Wkly Rep. 1998;47: 229–233.[Medline]
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