Psychosocial stress and tobacco smoking among African American adults

Psychosocial stress is a significant risk factor for smoking, and African Americans experience particularly high levels of stress relative to other racial and ethnic groups. However, limited research exists on the relationship between psychosocial stress and smoking status among African Americans. A sample of African American adults (ages 34 to 85, n=592) was recruited from Milwaukee, Wisconsin as part of the Midlife United States Study, Wave II (2004-2006). Measures of psychosocial stress included psychological and physical work stress, work-family spillover, perceived inequality, relationship stress, discrimination, financial stress, recent problems, stressful events, early life adversity, and a cumulative summary score. Current smokers were significantly more likely than never smokers to score high on the subscales for psychological work stress, perceived inequality, relationship stress, neighborhood stress, discrimination, financial stress, stressful adult events, and stress summary score, after adjustment for age, gender, education, and income (p<.05; odds ratios-ORs- ranged from 1.74-2.97). Four of these types of stress (psychological work stress, relationship stress, neighborhood stress, stressful events) remained significant in a model that included all stressors concurrently (p<.05; ORs ranged from 1.92-2.20). Individuals who scored high on five or more stress domains were nearly four times as likely (OR=3.74, 95% CI: 2.09-6.71) to be current smokers, in comparison to individuals who reported no severe stressors. The results of this analysis demonstrate a strong relationship between stress and smoking behavior among urban African Americans, and suggest that it may be valuable for cessation programs to address modifiable stressors and the development of stress-management techniques.