Smoking is the leading preventable behavioral risk factor of early mortality in the United States. It's associated with anxiety, depression, low quality of life, chronic medical conditions, and mortality. Smoking increases the risk of cancer, hypertension, heart disease, and stroke. This is particularly consequential in older adults, as tobacco use can also increase risk of pneumonia and cognitive decline. Many of these effects are seen together with alcohol drinking which increases the risk of cognitive decline and some types of cancer such as renal, liver, and colon.
However, very little information exists on the epidemiology of these behaviors for low-income African American adults in urban settings. Such data is essential for designing and implementing cessation programs for economically disadvantaged African Americans who use tobacco.
The pattern and predictors of smoking in the African American community can differ from those in other communities. For instance, many Black neighborhoods are subject to predatory and targeted tobacco advertisements, the increased availability of tobacco outlets, differential patterns of smoking initiation, and a lower likelihood of access to cessation services. All of these factors increase the risk and vulnerability of this population to substance use problems – the phenomenon is called the telescoping effect, In short, African Americans who engage in substance use are more likely to experience undesired substance use trajectories, which disproportionately increase the risk of undesired consequences, including tobacco use.
We know that socioeconomic status is among the strongest social determinants of health, with a particularly strong impact on smoking and drinking. For African Americans, research indicates that financial difficulties in particular may have large effects on the community's health outcomes. On the other hand, educational attainment did not predict smoking cigarettes and drinking alcohol among economically disadvantaged African American adults. Of course, the detrimental effects of financial difficulty are highest when the population lacks access to buffering resources, such as social support.
L.A. CADA looks forward to more studies on how limited resources in urban areas and residential segregation or discrimination against Black Americans reduce the health gains of educational attainment. Future research must also test which and how economically disadvantaged African American adults tend to drink and smoke to cope with stress due to financial difficulties and other types of pressure.
Black History Month in February is a good time to take a look at Black Americans and behavioral health.
Over 57 million American adults experience mental illness each year, and it occurs across the lines of race, ethnicity, and gender. Yet, while African Americans make up only 12% of the U.S. population, they represent almost 19% of those affected by mental illness. Moreover, African Americans with mental illness have more chronic disease, higher levels of disability, higher rates of inpatient service use, lower rates of outpatient mental health service use, and more barriers to seeking mental health treatment. Factors that impact help-seeking, include socioeconomic determinants of health, such as poverty and higher levels of trauma.
Another factor uncovered by recent studies of mental illness is that African Americans view mental illness as highly stigmatizing. Older African Americans in particular viewed mental illness, particularly depression, as a weakness. This results in low treatment-seeking.
In contrast to these findings, African Americans have been found to have positive beliefs and attitudes toward seeking mental health services. For instance, in one study of racial differences in beliefs about how mental illness relates to perceptions of treatment effectiveness, African Americans were more likely than Caucasians to believe that mental healthcare professionals could help individuals with mental illness.
However, Black Americans were also more likely to believe that mental health problems could improve on their own, thus restricting the use of mental health services as a coping tool. Religious strategies appeared to be the most preferred coping mechanism for Black Americans, highlighting the need for the behavioral health treatment field to work with community faith leaders in delivery of mental health prevention education. Importantly, more research is needed to examine how the attitudes of Black Americans might be a treatment barrier or could how they can facilitate treatment-seeking behaviors.
During Black History Month in February, L.A. CADA is looking at the relationship between Black Americans and alcohol. Alcohol use in the Black community is often overshadowed by issues of drug use, even as the cost of alcoholism is high and exacerbates other socioeconomic problems. Yet, most studies on alcoholism have been done on whites, and there is still a lot we don't know about alcoholism in the African American community.
Historically, kola-nut and palm wines were used by Africans in ceremonial activities. During American slavery, alcohol was usually forbidden for slaves; limited to use on holidays and special occasions. In the 19th century South, the alcohol prohibition movement became associated with racism, and Black leaders withdrew their support for it. And as Blacks migrated north in the 1920's and 30's, their alcohol-related problems increased. During the 1950's and 60's, studies of alcoholism among Black Americans focused on theories of social disorganization and segments of the Black underclass. More recently, studies have placed the issue in a broader context.
Varying factors contribute to alcoholism in African-Americans, including minority stress, anxiety, or depression. Similar to the LGBTQIA+ community, African-Americans endure unique social stigmas and violence due to racial discrimination. Social pressure to conform to behavioral expectations based on societal ideals, as well as projected prejudice is often a chronic source of stress and ill health. In response to higher levels of minority stress coupled with the stress of daily life, Black people may self-medicate by drinking alcohol and gradually increasing their intake.
Although African-Americans do drink less alcohol than their Caucasian counterparts, Blacks are more likely to suffer alcohol-related health problems. Death from conditions such as cirrhosis is 1.27 times more common in African-American drinkers compared to Caucasians. Additionally, there is a 10% higher rate of death from alcohol-abuse in Black Americans despite overall lower alcohol rates.
Hypertension, liver disease, oral cancer, major depression, and stroke from alcohol abuse are other common consequence of increased drinking. Lastly, because African-Americans are less likely to get help for alcoholism, they experience more alcohol-related health risks that lead to higher mortality rates.
L.A. CADA provides culturally-relevant treatment for alcoholism and drug abuse. If you know someone who wants helps, ask them to call us at (562) 906-2676.