Individual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial

Darla E. Kendzor, Lorraine R. Reitzel, Carlos A. Mazas, Ludmila M. Cofta-Woerpel, Yumei Cao, Lingyun Ji, Tracy J. Costello, Jennifer Irvin Vidrine, Michael S. Businelle, Yisheng Li, Yessenia Castro, Jasjit S. Ahluwalia, Paul M. Cinciripini, David W. Wetter

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

African Americans suffer disproportionately from the adverse health consequences of smoking, and also report substantially lower socioeconomic status than Whites and other racial/ethnic groups in the U.S. Although socioeconomic disadvantage is known to have a negative influence on smoking cessation rates and overall health, little is known about the influence of socioeconomic status on smoking cessation specifically among African Americans. Thus, the purpose of the current study was to characterize the impact of several individual- and area-level indicators of socioeconomic status on smoking cessation among African Americans. Data were collected as part of a smoking cessation intervention study for African American smokers (. N = 379) recruited from the Houston, Texas, metropolitan area, who participated in the study between 2005 and 2007. The separate and combined influences of individual-level (insurance status, unemployment, education, and income) and area-level (neighborhood unemployment, education, income, and poverty) indicators of socioeconomic status on continuous smoking abstinence were examined across time intervals using continuation ratio logit modeling. Individual-level analyses indicated that unemployment was significantly associated with reduced odds of smoking abstinence, while higher income was associated with greater odds of abstinence. However, only unemployment remained a significant predictor of abstinence when unemployment and income were included in the model together. Area-level analyses indicated that greater neighborhood unemployment and poverty were associated with reduced odds of smoking abstinence, while greater neighborhood education was associated with higher odds of abstinence. However, only neighborhood unemployment remained significantly associated with abstinence status when individual-level income and unemployment were included in the model. Overall, findings suggest that individual- and area-level unemployment have a negative impact on smoking cessation among African Americans. Addressing unemployment through public policy and within smoking cessation interventions, and providing smoking cessation treatment for the unemployed may have a beneficial impact on tobacco-related health disparities.

Original languageEnglish (US)
Pages (from-to)1394-1401
Number of pages8
JournalSocial Science and Medicine
Volume74
Issue number9
DOIs
StatePublished - May 2012

Bibliographical note

Funding Information:
This research was supported by grants R01-CA094826 , R25T-CA57730 , and K07-CA121037 awarded by the National Cancer Institute , grant MRSGT-10-104-01-CPHPS awarded by the American Cancer Society , and grants K01-DP001120 and K01-DP000086 awarded by the Centers for Disease Control and Prevention . This research was also supported, in part, by the National Institutes of Health through MD Anderson Cancer Center Support Grant CA016672 . We are grateful for the contributions of the following research team members who were integral in the data collection, database design, and counseling provision on the parent project: Karla Anderson, Jamie Barnes, Shanna Barnett, Barrett Blackmon, Vantrese Camiso, Alex De La Torre, Mark Evans, Debbie Lew, Devin Olivares-Reed, Krystal Robinson, Nikita Robinson, Maribel Robledo, Paul Rowan, and Jim Sikora. We are also grateful for the contributions of Richard Dela Mater who performed the geocoding and procured the US Census data for the project.

Keywords

  • African American
  • Neighborhood
  • Smoking cessation
  • Socioeconomic status
  • Tobacco
  • USA
  • Unemployment

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