Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States.
Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US.



We use longitudinal data from the Health and Retirement Study (HRS 1992-2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers.



The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19-0.99) and Latino (OR = 0.26, 95% CI: 0.11-0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05-6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes.



A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.
OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. quinones@ohsu.edu.|Portland VA Medical Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. quinones@ohsu.edu.
Ana R
AR
Quiñones
OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.|School of Nursing, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
Corey L
CL
Nagel
Department of Psychology, Portland State University, P.O. Box 751, Portland, OR, 97207, USA.
Jason T
JT
Newsom
Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
Nathalie
N
Huguet
OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
Paige
P
Sheridan
Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, 1660 South Columbian Way, Seattle, WA, 98108, USA.|Psychiatry and Behavioral Sciences, University of Washington, 1959 Pacific Avenue, Seattle, WA, 98195, USA.
Stephen M
SM
Thielke
D001741:Black or African American / Q000523:psychology*; D000368:Aged; D002908:Chronic Disease / Q000208:ethnology* / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000208:ethnology*; D016540:Smoking Cessation / Q000208:ethnology; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000523:psychology*
Behavior change; Chronic disease; Disease management; Racial/ethnic disparities; Smoking