The Relationship Between Psychosocial Stressors and Cigarette Smoking Among Latino/a and African American Adults with Psychiatric Illness

Abstract

Introduction Tobacco use is the leading cause of preventable death in the U.S. While overall smoking prevalence among adults in the US has decreased, smoking disparities persist within certain groups, such as individuals with psychiatric disorders and racial/ethnic minorities. These groups also experience higher levels of psychosocial stress. This study examined the relationship between psychosocial stressors and (i) smoking status and (ii) nicotine dependence in a sample of African American and Hispanic adults with mental illness. In addition, an investigator-designed measure assessed psychiatric related stress in order to examine the relationship between such stress and (i) smoking status and (ii) nicotine dependence.

Methods Participants were recruited from the Adult Outpatient Psychiatric Clinic at Lincoln Medical Center in downtown Bronx, New York. Participants were asked questions regarding demographic information, smoking behaviors (e.g., smoking status, nicotine dependence), and substance use, as well as measures of psychosocial stress and psychiatric related stress

Results Ninety-five participants completed the study and the current smoking prevalence was 36.85%. A majority of participants were female, single, identified as Latino/a, had a high school education/GED or lower level of education, were unemployed, and had an income at or below the poverty level. The predominant psychiatric diagnoses in the sample were schizophrenia spectrum or other psychotic disorders, depressive disorders, and bipolar disorders. Participants who reported higher levels of stress associated with friend strain, lifetime discrimination, and stress associated with attending appointments to secure psychiatric medication were significantly more likely to be current cigarette smokers. Additionally, greater neighborhood stress was associated with lower levels of nicotine dependence.

Conclusions This study has advanced the research regarding the relationship between psychosocial and psychiatric related stressors and smoking among an at-risk population that has substantial smoking-related health disparities. In addition to confirming the high smoking prevalence in this population, results highlight the association between specific psychosocial stressors and smoking that could be targeted by clinicians during mental health treatment to facilitate smoking cessation. Results also suggest that the PRSS may be a useful tool in examining the relationship between stress associated with managing a chronic mental health condition and health behaviors.