Does Racial Residential Segregation Influence Smoking Behaviors? The Multi-Ethnic Study of Atherosclerosis

Tobacco cigarette smoking remains the leading cause of preventable morbidity and mortality in the United States. Racial residential segregation (RRS) in American cities may be contributing to high rates of smoking in some communities. Yet, limited research exists investigating the association between segregation and smoking behaviors. The aim of this study was to examine the negative effects of RRS on smoking status and smoking intensity. We also investigated whether the association of segregation and smoking was modified by race and ethnicity. While past RRS research mainly focused on the smoking disparities between White and Black individuals, this study included the effects of RRS on Hispanic and Chinese individuals to better understand how neighborhood segregation may influence individual smoking behaviors among a diverse study sample. Methods:We used longitudinal data from the Multi-Ethnic Study of Atherosclerosis (MESA) with repeated observations over five study visits between 2000 and 2012. Segregation was operationalized with Divergence Index z-score tertile categories (Low, Med, High), calculated at the census-tract level. Our primary outcome was smoking status (Former/Never vs. Current), and our secondary outcome was smoking intensity (<10 vs >= 10 cigarettes per day). We used generalized estimating equations (GEE) to account for the longitudinal nature of the data (multiple observations per person). Models were adjusted for key covariates (age, gender, race and ethnicity, birthplace, and field center), and stratified by race and ethnicity. Results:Our final sample consisted of 28,912 observations from 6,710 individuals. At baseline, individuals who reported being a current cigarette smoker were more likely to be male gender, Black race, born in the U.S. and have a younger age than the overall study population. While those living in areas categorized as “Low RRS” had a lower prevalence of current smokers than higher RRS categories, current smokers living in low segregation had a higher median smoking intensity. In our GEE models, we found that participants living in high segregation had 1.51 (95% CI: 1.21,1.88) times higher odds of being a current smoker compared to participants living in low segregation. Black participants living in either medium (OR: 1.92, 95% CI: 1.24,2.97) or high (OR: 1.59, 95% CI: 1.09,2.32) segregation, and Hispanic/Latinx participants living in medium segregation (OR: 1.63, 95% CI: 1.08,2.48), had statistically higher odds of reporting as a current smoker than among those living in low segregation, adjusted for key covariates. There was no significant association between smoking status and segregation for Chinese or White participants. There were also no significant adjusted ORs for smoking intensity and segregation, even when stratified by race and ethnicity. Conclusions:This study suggests that racial segregation may be associated with being a current smoker, though segregation may not influence smoking intensity among current smokers. Previous research has shown that even smoking a few cigarettes per day can increase the chances of developing cardiovascular disease and other smoking-related health outcomes. Our study is a crucial piece in understanding the health behaviors of segregated communities, especially among Black and Hispanic/Latinx populations.