Summary, Study Limitations, & Conclusion Perceived Racism and Smoking: The Moderating Roles of Neighborhood – Level Socioeconomic Advantage and Ethnic Density Angela Monge, PhD & Elizabeth Brondolo, PhD - St. John’s University Neighborhood Variables: Factor Analysis (i.e. principle components, oblique rotation) of block group census SES variables produced three factors with Eigenvalues > 1; Two were interpretable and labelled N-Advantage (Eigenvalue = 10.65; 39% of variance; a = 0.93) and N-Disadvantage (Eigenvalue 2.67; 10% variance; a = 0.89). Factors were negatively correlated (r = -0.73). Ethnic Density - % Black & % Hispanic of block group. “Relative Deprivation”: Variable 1: Standardized income difference: the standardized difference between the census-derived median family income for the participants' block group (reference group) and their individual adjusted gross household income. Variable 2: Income proportion: participant’s adjusted gross household income/census-average family income for the participant’s block group. Smoking: Diary data collected every 20 minutes via PDA device. Participants who endorsed smoking at least once were labelled “smokers” (i.e. Smoking Status). Smoking Frequency was the proportion of readings in which smoking was endorsed. Overview Measures Results Cont’d These results were surprising and prompted us to evaluate potential deprivation explanations. Was objective advantage on the neighborhood-level associated with relative disadvantage on the individual-level? We found that for 65% of the participants, household income was lower than the census derived household income attributed to their given block group. Controlling for “income difference/relative difference” the previously significant interaction of N-Advantage X Discrimination was eliminated. Experiencing recent racism (i.e., within the past week) (p = .05) as well as workplace racism (over the lifetime) (p = .02), significantly predicted smoking for individuals whose income was at or above the median for their block group. Ethnic Density “High” and “low” Moderation Findings: Analyses for “high” Hispanic neighborhoods yielded significant findings for Black participants (B = 1.46; SE = 0.70; Wald = 4.43; p = .04; OR = 4.32; CI [1.11 = 16.85]), but not for the Hispanic participants. For every one unit increase in recent racism, Black participants living in predominantly Hispanic neighborhoods were four times more likely to be smokers. This relationship remained significant in models controlling for N-Advantage (p = .04). Perceived racism has been consistently positively related to smoking status in prior research. Neighborhood socioeconomic status (SES) is negatively related to smoking. Neighborhood ethnic density (ED)(i.e., the proportion of same-race individuals) has been associated with lower rates of smoking and racism, but not in all studies. There is limited research on the degree to which neighborhood factors (I.e., SES or ED) exacerbate or mitigate the effects of racism on smoking. ​ Aim: The present study  utilized Ecological Momentary Assessment  (EMA) methods to test the hypotheses that neighborhood socioeconomic advantage and ED will moderate the relationship of racism (i.e., past week vs. lifetime) to smoking status and frequency.​ APS; 3/2016; Denver, Colorado Perceived racism has been consistently associated with greater likelihood of smoking (Bennett et al., 2005; Borrell et all., 2013; Brondolo et al., 2015; Gibbons et al., 2012; Purnell et al., 2012) Low SES is strongly related to higher rates of smoking on an individual (CDC, 2014) and neighborhood level of observation (Chuang et al., 2005; Cronley et al., 2012; Datta et al., 2006). Data on neighborhood ethnic density and smoking is limited and less consistent. Some studies find the higher ethnic density protects against smoking (Rearden, Brennan, Buka, 2002); others find no relationship (Lakon, Hipp, Timberlake, 2010). The effects may vary depending on the SES of the neighborhood, with lower SES neighborhoods diminishing the advantages of higher same-race density (Cronley et al., 2012). Living in a neighborhood with higher same-race residents may benefit individuals because they are exposed to lower levels of racism (Welch et al., 2001; Dailey et al., 2010).​ Background Example of Diary Icons Main Effects Past week racism was associated with an increased likelihood being a smoker; Lifetime racism significantly predicted higher smoking frequency rates (See Brondolo et al., 2015). No main effects of Neighborhood variables (N-Advantage /Disadvantage, %Black, & %Hispanic) on Past Week Racism, Lifetime Racism, Smoking Status or Frequency. RD was significantly predicted smoking rates, such that individuals with greater incomes than their block group were less likely to smoke (Est. = -0.30; SE = 0.12; Wald = 5.89; OR = 0.73; CI [0.58 – 0.94]). No effects of RD on racism. Moderation Models: Logistic Regression analyses revealed that N-Advantage significantly moderated the relationship between recent racism and smoking status (unadjusted: Est. 0.37; SE = 0.18; Wald = 4.43; p = .04; OR = 1.45; CI [1.03 – 2.05]). Both models remained significant after controlling for the individual – level socioeconomic and demographic variables as well as lifetime racism. To confirm the observed relationships presented by the graphs (below), we statistically examined “high” and “low” levels of N-Advantage and N-Disadvantage. One standard deviation was added and subtracted from the centered variables and follow-up adjusted (i.e., for individual covariates) logistic regressions were conducted. For every 1 unit increase in recent racism, participants living in High Advantage neighborhood were 2X as likely to be smokers as those living in low Advantage neighborhoods. (OR = 2.00, CI [1.26 – 3.18], p = .003). Recent racism had a greater effect on smoking status for those in more advantaged areas. Results Relative Deprivation (RD): One additional question is whether the effects of neighborhood SES or ethnic density on smoking are a function of absolute or relative levels of material advantage. RD suggests that the difference between a person’s absolute SES position and the SES of their reference group can produce a negative psychosocial effect (Kuo & Chiang, 2013)​. RD may account for 33 to 94% of the variance between individual income and health outcomes (Subramanyam et al., 2009), and is independently associated with symptoms of depression and an increased likelihood of smoking (Eibner & Evans, 2001; Kuo & Chiang, 2013). ​ Poverty Level: <Poverty Level: 39.7% 1 – 2x: 23.8% 2 – 3x: 13.4% > 3x: 23.1% Smoking Status: Smokers (n=267) 55.17% Non-smokers (217)44.83% Findings suggest that racism is positively associated smoking, and – for Black participants – living in a neighborhood in which many residents in the neighborhood do not share one’s identity may exacerbate the effect of perceived racism to smoking. Measures of Relative Deprivation may explain some of the effects of absolute income to health outcomes, and may independently contribute to health outcomes. Earning less income compared to one's neighbors increases the likelihood of smoking. Even for individuals whose income was equivalent to or greater than their neighbors, past week racism and workplace racism (over the lifetime) significantly predicted smoking. It is possible that doing well economically may heighten awareness of and objection to interpersonal racism. Studies examining neighborhood socioeconomic status may need to consider the individual’s social position within the neighborhood to fully interpret the effects. Study Limitations: There are several limitations to internal and external validity, such as: Measurement of smoking status and frequency from EMA data. Our measurement of “income difference” is not consistent with other measurements of “relative deprivation” which employ the Yitzhaki Index approach (Yitzhaki, 1979). Further, there is controversy about the best reference group to employ. In this case, we used neighborhood block group income level for the assessment of relative deprivation, as we were evaluating the effects of absolute neighborhood advantage (Smith, Pettigrew, Pippin, & Bialosiewicz, 2012). Conclusions: These data suggest that lower social position or outsider status may contribute to the decision to smoke. Further research is needed to understand the mechanisms linking both actual and perceived social position to health behaviors, including smoking. Participants: N=484 Race/ethnicity: 247 Black; 237 Latino(a) Sex: 242 Men, 242 Women Age: Mean: 38.88 (9.45); 19–64 Education: 29.3% less than HS 51.3% HS degree 19.4% College degree or + Methods Summary, Study Limitations, & Conclusion Perceived Racism: Perceived Ethnic Discrimination Questionnaire – Community Version (PEDQ-CV; Brondolo et al., 2005): 34 item scale (ɑ = .90).The PEDQ-CV consisted of a total lifetime discrimination score and four subscales: race-related exclusion, race-related stigmatization, race-related threat, race-related work discrimination. The Past Week discrimination scale includes 10 items assessing recent episodes of discrimination. Neighborhood Socioeconomic Status and Ethnic Density: Participants ‘ addresses were geocoded – U.S. Census Bureau - Year 2000; Geocoded data was then merged with original data –set . Given the nature of the urban setting and prior research (Diez - Roux et al., 2001; Krieger, Chen, Waterman, Rehkopf, & Subramanian, 2003), we utilized Block Group parameters for measurement of neighborhoods for a more fine – grained analysis. CENSUS TRACT BLOCK GROUP___________ Measures N-Advantage Moderating Past Week Racism to smoking Status