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Perceived racial/ethnic discrimination and cigarette smoking behaviors among a sample of people with HIV

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Abstract

This study was a secondary analysis of baseline data from a clinical trial of an intensive group-based smoking cessation treatment for people with HIV (PWH) who smoke. It examined the cross-sectional relationship between perceived ethnic discrimination (PED) and cigarette smoking variables (i.e., nicotine dependence, motivation to quit smoking, self-efficacy to quit smoking) among PWH and explored whether depressive symptoms mediated the relationship between PED and smoking variables. Participants (N = 442; Mage = 50.6; 52.8% Male; 56.3% Black, non-Hispanic; 6.3% White, non-Hispanic; 13.3% Hispanic; 87.7% unemployed; 81.6% single) completed measures of demographics, cigarette smoking, depressive symptoms, and PED. Greater PED was related to lower self-efficacy to quit smoking, greater perceived stress, and greater depressive symptoms. In addition, depressive symptoms mediated the relationship between PED and two cigarette smoking variables (i.e., nicotine dependence, self-efficacy to quit smoking). Findings highlight the need for smoking interventions to target PED, self-efficacy, and depressive symptoms to improve smoking cessation variables among PWH.

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References

  • Aggleton, P., & Parker, R. (2002). World AIDS campaign 2002–2003—A conceptual framework and basis for action: HIV/AIDS stigma and discrimination. Joint United Nations Programme on HIV/AIDS.

  • Alexander, A. C., Hebert, E. T., Businelle, M. S., & Kendzor, D. E. (2019). Everyday discrimination indirectly influences smoking cessation through post-quit self-efficacy. Drug and Alcohol Dependence, 198, 63–69.

    Article  PubMed  Google Scholar 

  • Arnold, T., Polenick, C., & Blow, F. (2020). Association between discrimination and depressive symptoms among older Blacks: A pilot study. Innovation in Aging, 4, 304–304.

    Article  PubMed Central  Google Scholar 

  • Asfar, T., Perez, A., Shipman, P., et al. (2021). National estimates of prevalence, time-trend, and correlates of smoking in US people living with HIV (NHANES 1999–2016). Nicotine Tobacco Research, 15, 1308–1317.

    Article  Google Scholar 

  • Assari, S., Moazen-Zadeh, E., Caldwell, C. H., & Zimmerman, M. A. (2017). Racial discrimination during adolescence predicts mental health deterioration in adulthood: Gender differences among Blacks. Frontiers in Public Health, 5, 104.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berjot, S., & Gillet, N. (2011). Stress and coping with discrimination and stigmatization. Frontiers in Psychology, 2, 33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Biener, L., & Abrams, D. B. (1991). The contemplation ladder: Validation of a measure of readiness to consider smoking cessation. Health Psychology, 10, 360–365.

    Article  CAS  PubMed  Google Scholar 

  • Bird, S. T., Bogart, L. M., & Delahanty, D. L. (2004). Health-related correlates of perceived discrimination in HIV care. AIDS Patient Care and STDs, 18, 19–26.

    Article  PubMed  Google Scholar 

  • Blair, I. V., Danyluck, C., Judd, C. M., et al. (2021). Validation of the Brief Perceived Ethnic Discrimination Questionnaire-Community version in American Indians. Cultural Diversity and Ethnic Minority Psychology, 27, 47–59.

    Article  PubMed  Google Scholar 

  • Boarts, J. M., Bogart, L. M., Tabak, M. A., Armelie, A. P., & Delahanty, D. L. (2008). Relationship of race-, sexual orientation-, and HIV-related discrimination with adherence to HIV treatment: A pilot study. Journal of Behavioral Medicine, 31, 445–451.

    Article  PubMed  Google Scholar 

  • Bogart, L. M., Landrine, H., Galvan, F. H., Wagner, G. J., & Klein, D. J. (2013). Perceived discrimination and physical health among HIV-positive Black and Latino men who have sex with men. AIDS Behavior, 17, 1431–1441.

    Article  PubMed  Google Scholar 

  • Bogart, L. M., Wagner, G. J., Galvan, F. H., & Klein, D. J. (2010). Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-serostatus, race, and sexual orientation among African-American men with HIV. Annals of Behavioral Medicine, 40, 184–190.

    Article  PubMed  Google Scholar 

  • Bogart, L. M., Wagner, G. J., Galvan, F. H., Landrine, H., Klein, D. J., & Sticklor, L. A. (2011). Perceived discrimination and mental health symptoms among Black men with HIV. Cultural Diversity and Ethnic Minority Psychology, 17, 295–302.

    Article  PubMed  Google Scholar 

  • Bottorff, J. L., Haines-Saah, R., Kelly, M. T., et al. (2014). Gender, smoking and tobacco reduction and cessation: A scoping review. International Journal for Equity in Health, 13, 114.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brondolo, E., Beatty, D. L., Cubbin, C., et al. (2009). Sociodemographic variations in self-reported racism in a community sample of Blacks and Latino(a)s. Journal of Applied Social Psychology, 39, 407–429.

    Article  Google Scholar 

  • Brondolo, E., Brady, N., Thompson, S., et al. (2008). Perceived racism and negative affect: Analyses of trait and state measures of affect in a community sample. Journal of Social and Clinical Psychology, 27, 150–173.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brondolo, E., Hausmann, L. R., Jhalani, J., et al. (2011). Dimensions of perceived racism and self-reported health: Examination of racial/ethnic differences and potential mediators. Annals of Behavioral Medicine, 42, 14–28.

    Article  PubMed  Google Scholar 

  • Brondolo, E., Kellp, K. P., Coakley, V., et al. (2005). The Perceived Ethnic Discrimination Questionnaire: Development and preliminary validation of a community version. Journal of Applied Social Psychology, 35, 335–365.

    Article  Google Scholar 

  • Burgess, D. J., Ding, Y., Hargreaves, M., van Ryn, M., & Phelan, S. (2008). The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. Journal of Health Care for the Poor and Underserved, 19, 894–911.

    Article  PubMed  Google Scholar 

  • Carlisle, S. K. (2015). Perceived discrimination and chronic health in adults from nine ethnic subgroups in the USA. Ethnicity & Health, 20, 309–326.

    Article  Google Scholar 

  • Clark, T. T. (2014). Perceived discrimination, depressive symptoms, and substance use in young adulthood. Addictive Behaviors, 39, 1021–1025.

    Article  PubMed  PubMed Central  Google Scholar 

  • Coley, S. L., Mendes de Leon, C. F., Ward, E. C., Barnes, L. L., Skarupski, K. A., & Jacobs, E. A. (2017). Perceived discrimination and health-related quality-of-life: Gender differences among older African Americans. Quality of Life Research, 26, 3449–3458.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cornelius, M. E., Wang, T. W., Jamal, A., Loretan, C. G., & Neff, L. J. (2020). Tobacco product use among adults—United States, 2019. MMWR and Morbidity and Mortality Weekly Report, 69, 1736–1742.

    Article  PubMed  Google Scholar 

  • Corral, I., & Landrine, H. (2012). Racial discrimination and health-promoting vs damaging behaviors among African-American adults. Journal of Health Psychology, 17, 1176–1182.

    Article  PubMed  Google Scholar 

  • Crockett, K. B., Rice, W. S., & Turan, B. (2018). Associations between multiple forms of discrimination and tobacco use among people living with HIV: The mediating role of avoidance coping. Journal of Acquired Immune Deficiency Syndromes, 78, 9–15.

    Article  PubMed  Google Scholar 

  • Cuevas, A. G., Reitzel, L. R., Cao, Y., et al. (2013). Mediators of discrimination and self-rated health among African Americans. American Journal of Health Behavior, 37, 745–754.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dolezsar, C. M., McGrath, J. J., Herzig, A. J. M., & Miller, S. B. (2014). Perceived racial discrimination and hypertension: A comprehensive systematic review. Health Psychology, 33, 20–34.

    Article  PubMed  PubMed Central  Google Scholar 

  • Edwards, S., Fitzgerald, L., Mutch, A., et al. (2021). Views and preferences of people living with HIV about smoking, quitting and use of nicotine products. The International Journal on Drug Policy, 97, 103349.

    Article  PubMed  Google Scholar 

  • Fagerstrom, K. O., & Schneider, N. G. (1989). Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12, 159–182.

    Article  CAS  PubMed  Google Scholar 

  • Graves, B. S., Hall, M. E., Dias-Karch, C., Haischer, M. H., & Apter, C. (2021). Gender differences in perceived stress and coping among college students. PLoS ONE, 16, e0255634.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hawkins, D. M. (2004). The problem of overfitting. Journal of Chemical Information and Modeling, 44, 1–12.

    CAS  Google Scholar 

  • Hayes, A. F. (2013). Methodology in the social sciences. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.

    Google Scholar 

  • Helleberg, M., Afzal, S., Kronborg, G., et al. (2013). Mortality attributable to smoking among HIV-1-infected individuals: A nationwide, population-based cohort study. Clinical Infectious Diseases, 56, 727–734.

    Article  PubMed  Google Scholar 

  • Herrero, J., & Meneses, J. (2006). Short web-based versions of the perceived stress (PSS) and Center for Epidemiological Studies-Depression (CESD) Scales: A comparison to pencil and paper responses among internet users. Computers in Human Behavior, 22, 830–846.

    Article  Google Scholar 

  • Herskovits, R., Knackmuhs, E., Stanton, C., & Shuter, J. (2011). The relationship between perceived racism/discrimination and smoking habits in persons living with HIV and AIDS. In Paper presented at the 6th international AIDS society conference on HIV pathogenesis, treatment, and prevention, Rome, Italy.

  • Hile, S. J., Feldman, M. B., Alexy, E. R., & Irvine, M. K. (2016). Recent tobacco smoking is associated with poor HIV medical outcomes among HIV-infected individuals in New York. AIDS and Behavior, 20, 1722–1729.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hwang, W. C., & Goto, S. (2008). The impact of perceived racial discrimination on the mental health of Asian American and Latino college students. Cultural Diversity and Ethnic Minority Psychology, 14, 326–335.

    Article  PubMed  Google Scholar 

  • Ingersoll, K. S., Cropsey, K. L., & Heckman, C. J. (2009). A test of motivational plus nicotine replacement interventions for HIV positive smokers. AIDS and Behavior, 13, 545–554.

    Article  PubMed  Google Scholar 

  • Kerrigan, D., Vazzano, A., Bertoni, N., Malta, M., & Bastos, F. I. (2017). Stigma, discrimination and HIV outcomes among people living with HIV in Rio de Janeiro, Brazil: The intersection of multiple social inequalities. Global Public Health, 12, 185–199.

    Article  PubMed  Google Scholar 

  • Lam, J. O., Levine-Hall, T., Hood, N., Alexeeff, S. E., Horberg, M. A., Young-Wolff, K. C., Sterling, S. A., Williams, A., Weisner, C., Satre, D. D., & Silverberg, M. J. (2020). Smoking and cessation treatment among persons with and without HIV in a U.S. integrated health system. Drug and Alcohol Dependence, 213, 108128.

  • Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Pub. Co.

    Google Scholar 

  • Lee, Y., & Bierman, A. (2018). Loneliness as a mediator of perceived discrimination and depression: Examining education contingencies. The International Journal of Aging and Human Development, 89, 91415018763402.

    Google Scholar 

  • Leserman, J. (2008). Role of depression, stress, and trauma in HIV disease progression. Psychosomatic Medicine, 70, 539–545.

    Article  PubMed  Google Scholar 

  • Logie, C., James, L., Tharao, W., & Loutfy, M. R. (2011). HIV, gender, race, sexual orientation, and sex work: A qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Medicine, 8, e1001124.

    Article  PubMed  PubMed Central  Google Scholar 

  • Logie, C., James, L., Tharao, W., & Loutfy, M. (2013). Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black women in Ontario. Canada. AIDS Patient Care and STDS, 27, 114–122.

    Article  PubMed  Google Scholar 

  • Mdodo, R., Frazier, E. L., Dube, S. R., et al. (2015). Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: Cross-sectional surveys. Annals of Internal Medicine, 162, 335–344.

    Article  PubMed  Google Scholar 

  • Meade, C. S., & Sikkema, K. J. (2005). HIV risk behavior among adults with severe mental illness: A systematic review. Clinical Psychology Review, 25, 433–457.

    Article  PubMed  Google Scholar 

  • Molina, K. M., Estrella, M. L., Durazo-Arvizu, R., et al. (2019). Perceived discrimination and physical health-related quality of life: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Social Science & Medicine, 222, 91–100.

    Article  Google Scholar 

  • Nadimpalli, S. B., James, B. D., Yu, L., Cothran, F., & Barnes, L. L. (2015). The association between discrimination and depressive symptoms among older African Americans: The role of psychological and social factors. Experimental Aging Research, 41, 1–24.

    Article  PubMed  PubMed Central  Google Scholar 

  • Park, L. S., Hernandez-Ramirez, R. U., Silverberg, M. J., Crothers, K., & Dubrow, R. (2016). Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS: A meta-analysis. AIDS, 30, 273–291.

    Article  CAS  PubMed  Google Scholar 

  • Pascoe, E. A., & Smart, R. L. (2009). Perceived discrimination and health: A meta-analytic review. Psychological Bulletin, 135, 531–554.

    Article  PubMed  PubMed Central  Google Scholar 

  • Purnell, J. Q., Peppone, L. J., Alcaraz, K., et al. (2012). Perceived discrimination, psychological distress, and current smoking status: Results from the behavioral risk factor surveillance system reactions to race module, 2004–2008. American Journal of Public Health, 102, 844–851.

    Article  PubMed  PubMed Central  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Reynolds, N. R., Neidig, J. L., & Wewers, M. E. (2004). Illness representation and smoking behavior: A focus group study of HIV-positive men. Journal of the Association of Nurses in AIDS Care, 15, 37–47.

    Article  Google Scholar 

  • Sabin, C. A., Ryom, L., De Wit, S., et al. (2013). Associations between immune depression and cardiovascular events in HIV infection. AIDS, 27, 2735–2748.

    Article  PubMed  Google Scholar 

  • Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143, 783–822.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sims, M., Diez-Roux, A. V., Gebreab, S. Y., et al. (2016). Perceived discrimination is associated with health behaviours among African-Americans in the Jackson Heart Study. Journal of Epidemiology and Community Health, 70, 187–194.

    Article  PubMed  Google Scholar 

  • Soto, J. A., Dawson-Andoh, N. A., & BeLue, R. (2011). The relationship between perceived discrimination and generalized anxiety disorder among African Americans, Afro Caribbeans, and non-Hispanic Whites. Journal of Anxiety Disorders, 25, 258–265.

    Article  PubMed  Google Scholar 

  • Stanton, C. A., Kumar, P. N., Moadel, A. B., Cunningham, C. O., Schechter, C. B., Kim, R. S., Shuter, J. (2020). A multicenter randomized controlled trial of intensive group therapy for tobacco treatment in HIV-infected cigarette smokers. JAIDS Journal of Acquired Immune Deficiency Syndromes, 83(4), 405–414. https://doi.org/10.1097/QAI.0000000000002271

    Article  PubMed  Google Scholar 

  • Sumari-de Boer, I. M., Sprangers, M. A., Prins, J. M., & Nieuwkerk, P. T. (2012). HIV stigma and depressive symptoms are related to adherence and virological response to antiretroviral treatment among immigrant and indigenous HIV infected patients. AIDS and Behavior, 16, 1681–1689.

    Article  PubMed  Google Scholar 

  • Sun, C. J., Ma, A., Tanner, A. E., et al. (2016). Depressive symptoms among Latino sexual minority men and Latina transgender women in a new settlement state: The role of perceived discrimination. Depression Research and Treatment, 2016, 4972854.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tami-Maury, I., Vidrine, D. J., Fletcher, F. E., Danysh, H., Arduino, R., & Gritz, E. R. (2013). Poly-tobacco use among HIV-positive smokers: Implications for smoking cessation efforts. Nicotine & Tobacco Research, 15, 2100–2106.

    Article  Google Scholar 

  • Unger, J. B. (2018). Perceived discrimination as a risk factor for use of emerging tobacco products: More similarities than differences across demographic groups and attributions for discrimination. Substance Use & Misuse, 53, 1638–1644.

    Article  Google Scholar 

  • Unger, J. B., Soto, D. W., & Baezconde-Garbanati, L. (2016). Trajectories of perceived discrimination from adolescence to emerging adulthood and substance use among Hispanic youth in Los Angeles. Addictive Behaviors, 53, 108–112.

    Article  PubMed  Google Scholar 

  • Velicer, W. F., Diclemente, C. C., Rossi, J. S., & Prochaska, J. O. (1990). Relapse situations and self-efficacy: An integrative model. Addictive Behaviors, 15, 271–283.

    Article  CAS  PubMed  Google Scholar 

  • Vidrine, D. J., Arduino, R. C., & Gritz, E. R. (2006). Impact of a cell phone intervention on mediating mechanisms of smoking cessation in individuals living with HIV/AIDS. Nicotine & Tobacco Research, 8, S103-108.

    Article  Google Scholar 

  • Ward, J. B., Feinstein, L., Vines, A. I., Robinson, W. R., Haan, M. N., & Aiello, A. E. (2019). Perceived discrimination and depressive symptoms among US Latinos: The modifying role of educational attainment. Ethnicity & Health, 24, 271–286.

    Article  Google Scholar 

  • White, K., Bell, B. A., Huang, S. J., & Williams, D. R. (2020). Perceived discrimination trajectories and depressive symptoms among middle-aged and older Black adults. Innovation in Aging, 4, igaa040.

    Article  Google Scholar 

  • Williamson, T. J., Mahmood, Z., Kuhn, T. P., & Thames, A. D. (2017). Differential relationships between social adversity and depressive symptoms by HIV status and racial/ethnic identity. Health Psychology, 36, 133–142.

    Article  PubMed  Google Scholar 

  • Wingood, G. M., Diclemente, R. J., Mikhail, I., et al. (2007). HIV discrimination and the health of women living with HIV. Women’s Health, 46, 99–112.

    Article  Google Scholar 

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Funding

This work was supported by award 1R01DA036445 (JS) from the National Institutes of Health (NIH)/National Institutes on Drug Abuse (NIDA) and by the Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI124414) which is supported by the following NIH co-funding and participating institutes and centers: NIAID, NCI, NICHD, NHBL, NIDA, NIMH, NIA, FIC and OAR.

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Authors and Affiliations

  1. Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY, 10461, USA

    Silvana Agterberg & Andrea H. Weinberger

  2. Albert Einstein College of Medicine, Bronx, NY, USA

    Andrea H. Weinberger & Jonathan Shuter

  3. Westat, Rockville, MD, USA

    Cassandra A. Stanton

  4. Georgetown University Medical Center, Washington, DC, USA

    Cassandra A. Stanton

Authors
  1. Silvana Agterberg
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  2. Andrea H. Weinberger
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Contributions

Silvana Agterberg ran the analyses and wrote the manuscript under the guidance and supervision of Dr. Andrea Weinberger. Dr. Jonathan Shuter and Dr. Cassandra oversaw study development, implementation, and data collection; provided feedback on multiple drafts of the manuscript. Perceived racial/ethnic discrimination and cigarette smoking behaviors among a sample of people with HIV.

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Correspondence to Silvana Agterberg.

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The authors Silvana Agterberg, Andrea H. Weinberger, Cassandra A. Stanton and Jonathan Shuter have no competing interests to declare that are relevant to the content of this article.

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Approval for this research was received by the institutional review boards of the Albert Einstein College of Medicine and MedStar Georgetown University Hospital. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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A research assistant explained the purpose and the procedures of the study in a private room and obtained written informed consent from eligible participants. Participants were made aware that they did not need to consent to participate immediately and were informed that they could decline participation or withdraw from the study at any time once participation had begun. In addition, participants were told that a decision not to participate would in no way affect the care they receive at the facility. A copy of the consent form was provided to participants for their own records.

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Agterberg, S., Weinberger, A.H., Stanton, C.A. et al. Perceived racial/ethnic discrimination and cigarette smoking behaviors among a sample of people with HIV. J Behav Med 46, 801–811 (2023). https://doi.org/10.1007/s10865-023-00401-1

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