Sociocultural Risk Factors for Elevated Perceived Stress among African American Smokers

Introduction: African Americans experience unique stressors that may inhibit smoking cessation and enhance relapse rates. Few studies, however, have focused on risk factors for perceived stress among treatment seekers. Because African Americans are less likely to quit compared to the larger community, understanding factors associated with perceived stress among smokers has the potential to improve intervention outcomes. This study examined psychosocial and cultural correlates of stress in a sample of African American participants in a randomized controlled trial. Methods: At baseline, participants reported demographic factors and completed assessments of smoking history, alcohol use, friend and household smoking, weight concerns, acculturation, depressive symptoms, and perceived stress (N = 325). Bivariate associations were examined, followed by multiple regression analyses to test independent relationships. The sample was comprised of mostly middle-aged males, with at least a high school education, who were single, and reported low household income. Participants were moderately nicotine dependent and smoked 18 cigarettes per day for 26 years. Results: Perceived stress was inversely associated with age (r = -.16, p = .004), education (r = -.11, p = .04), household income (r = -.11, p = .047), and positively associated with being male (r = .13, p = .02). Stress perceptions were positively related to cigarettes per day (r = .11, p = .049), nicotine dependence (r = .20, p = .001), drinking frequency (r = .15, p = .008), drinking intensity (r = .14, p=.02), and inversely related to smoking duration (r = -.12, p = .03). We found positive associations between perceived stress and household smokers (r = .18, p = .004), and friends who smoke (r = .15, p = .01). Perceived stress was also positively associated with post-cessation weight concern (r = .14, p = .01), a traditional African American cultural orientation; r = .12, p = .04), and depressive symptoms (r = .65, p Conclusion: These findings have important intervention implications. Many of the risk factors for distress among African American smokers are modifiable. Interventions should prioritize addressing depression, household smoking environment, and stress among younger smokers, in addition to managing other stress-enhancing concerns like alcohol use