Cigarette Smoking Among Low-Income African Americans

School of Social Work, University of Michigan, Ann Arbor, Michigan, United States
American Journal of Preventive Medicine (Impact Factor: 4.53). 11/2005; 29(3):218-20. DOI: 10.1016/j.amepre.2005.05.004
Source: PubMed


This study examines the current prevalence of cigarette smoking and the number of cigarettes smoked in a community-based sample of 1021 low-income African-American men and women.
Participants were selected using a two-stage, area probability sample design. Data were collected in 2002-2003 in face-to-face interviews and analyzed in 2005. All data and analyses were weighted to account for the complex sampling design.
Fifty-nine percent of men and 41% of women were current smokers, with younger individuals apparently initiating smoking at an earlier age than older individuals.
The high prevalence of cigarette use provides further evidence that the excess burden of tobacco-related disease among low-income African-American families may be on the rise. This is of great concern, and if confirmed by further research, indicates an urgent need for preventive intervention.

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    • "Additionally, few interventions exist to increase the range of smoking cessation services to individuals who lack access to transportation, have limited or no medical insurance, and typically do not utilize traditional health care facilities. Hence, employing innovative strategies to increase accessibility, availability, and affordability of smoking cessation services particularly among disadvantaged populations is a national public health priority [8,9]. "
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    ABSTRACT: Background Despite a significant decrease in smoking prevalence over the past ten years, cigarette smoking still represents the leading cause of preventable morbidity and mortality in the United States. Moreover, smoking prevalence is significantly higher among those with low levels of education and those living at, or below, the poverty level. These groups tend to be confronted with significant barriers to utilizing more traditional smoking cessation intervention approaches. The purpose of the study, Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods), is to utilize a mobile clinic model, a network of community sites (i.e., community centers and churches) and an interactive mobile messaging system to reach and deliver smoking cessation treatment to underserved, low-income communities. Methods/Design We are using a group-randomized design, with the community site as the sampling unit, to compare the efficacy of three smoking cessation interventions: 1) Standard Care - brief advice to quit smoking, nicotine replacement therapy (NRT), and self-help materials; 2) Enhanced Care - standard care components plus a cell phone-delivered text/graphical messaging component; and 3) Intensive Care - enhanced care components plus a series of 11 cell phone-delivered proactive counseling sessions. An economic evaluation will also be performed to evaluate the relative cost effectiveness of the three treatment approaches. We will recruit 756 participants (252 participants in each of the 3 intervention groups). At the time of randomization, participants complete a baseline assessment, consisting of smoking history, socio-demographic, and psychosocial variables. Monthly cell phone assessments are conducted for 6 months-post enrollment, and a final 12-month follow-up is conducted at the original neighborhood site of enrollment. We will perform mixed-model logistic regression to compare the efficacy of the three smoking cessation intervention treatment groups. Discussion It is hypothesized that the intensive care approach will most successfully address the needs of the target population and result in the highest smoking cessation rates. In addition to increasing cessation rates, the intervention offers several features (including neighborhood outreach and use of mHealth technology) that are likely to reduce treatment barriers while enhancing participant engagement and retention to treatment. Trial registration This randomized controlled trial is registered with registration number NCT00948129.
    Full-text · Article · Aug 2012 · BMC Public Health
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    • "The concentration of economic hardship and other psychosocial stressors in segregated neighborhoods can make it more difficult for residents to lead healthy lives and seek needed care. The levels of cigarette smoking are higher in some racially segregated, economically disadvantaged residential areas than would be predicted by national data (Dell et al. 2005; Delva et al. 2005). Stressors can facilitate the onset of smoking, make quitting more difficult and adherence to medical regimens more challenging (Berg et al. 2010; Webb and Carey 2008). "
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    ABSTRACT: To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities.
    Full-text · Article · Jun 2012 · Health Services Research
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    • "With probing, several participants recognized that the smoking prevalence among lower income African Americans is higher than among higher SES African Americans. This perception is consistent with previous research, which has found rates of smoking among low SES African Americans to be higher than the national average (Delva et al., 2005)—although participants provided estimates that were markedly higher than the average. One clinical implication of viewing health risk behaviors as normative is that this perception may attenuate motivation for behavior change, such as, smoking abstinence. "
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    ABSTRACT: When the following article originally appeared in the Journal of clinical Psychology (Volume 63, number 6, june 2007), a number of author corrections were omitted. We regret this oversight and now reprint the article in full. Researchers suggest that culturally specific (CS) interventions are important in addressing smoking-related health disparities. Yet, little research has examined the perspectives of African American smokers regarding these efforts. This qualitative study sought to gain insight into perceptions related to (a) the smoking prevalence among African Americans, (b) smoking-related health disparities, (c) expectancies for CS interventions, (d) methods of recruiting research participants, and (e) key intervention components. Six focus groups were conducted with 41 African American smokers (aged 21-64) at a community health center. Content analyses revealed several themes, including the perception that smoking is normative among African Americans, limited knowledge of racial health disparities, mixed perceptions regarding race as a risk factor for illness, and mixed expectancies for the efficacy of CS interventions. In conclusion, individual differences, such as smoking norms, knowledge of health disparities, and intervention expectations may influence receptivity to CS treatments. Implications for tobacco interventions among African Americans are discussed.
    Full-text · Article · Dec 2007 · Journal of Clinical Psychology
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