Minority teen boys smoke more when they perceive discrimination; girls do not

INDIANAPOLIS – The perception of discrimination increases the amount teenage minority boys smoke but does not increase the amount teenage minority girls smoke, according to a new study from the Indiana University School of Medicine.

This study, to be published in the March 2010 issue of the American Journal of Public Health, has been posted by the journal under "First Look" at http://ajph.aphapublications.org/first_look.shtml.

While the IU researchers found that minority boys smoke more when they perceived discrimination, girls reacted differently. There does not appear to be an association between perceived discrimination and smoking in minority girls, ages 12 to 15. For minority girls ages 16 to 19, perceived discrimination is associated with lower, not higher, rates of smoking.

"We looked at the association between self-reported discrimination and adolescent smoking because both the perception of discrimination and the rate of smoking are so high in minority teens. Our findings in girls, especially in the older girls, really surprised us. We do not know why older girls who perceived discrimination were less likely to smoke but there may be a possibility that they perceived discrimination because they were pregnant and also that they did not smoke due to the pregnancy," said study first author Sarah E. Wiehe, M.D., M.P.H., assistant professor of pediatrics at the IU School of Medicine and a Regenstrief Institute affiliated scientist.

The researchers investigated 2,561 black and Latino adolescents, ages 12-19, from low-income households residing in Baltimore, Boston, Chicago, Los Angeles and New York. One in four of these adolescents reported discrimination in at least one setting in the last six months. Twelve percent reported smoking in the last 30 days.

Dr. Wiehe said she and her colleagues studied the association between perceived discrimination and adolescent smoking because the rates of both are so high in minority teens.

Previous studies have found perceived racial/ethnic discrimination to be associated with adolescent and young adult smoking, but did not break down the linkage by gender.

"Boys and girls may experience discrimination differently due to where they spend time and that may account for the differences in whether discrimination was associated with smoking. In other words, the context of discrimination matters. We need to be aware that discrimination is a public health problem for adolescents – one related to major health issues like smoking – and need to actively work to reduce these occurrences," said Dr. Wiehe.

Boys' increased smoking in higher discrimination settings may reflect increased stress from gender-specific targeting by police and businesses, the study concluded. "Because of the very high smoking rates among young minority men, law enforcement, schools, and health care providers need to work closely with communities to prevent smoking initiation" said J. Dennis Fortenberry M.D., M.S, professor of pediatrics at the IU School of Medicine and senior author of the paper. "Successful prevention may need to include a more comprehensive approach to the issues young minority men encounter in their daily lives."

The researchers plan to follow teens to determine where they spend time and their experiences in those places to see how these are related to health behaviors such as smoking to better target strategies to reduce the likelihood of smoking initiation or progression of smoking and other risky behaviors. In previous studies, Dr. Wiehe has explored ways to track teens including the use of GPS-enabled cellular telephones.

Co-authors of the AJPH study, in addition to Dr. Wiehe and Dr. Fortenberry are Matthew C. Aalsma, Ph.D. and Gilbert C. Liu, M.D., M.S., also of the IU School of Medicine's Department of Pediatrics. Dr. Liu is a Regenstrief Institute affiliated scientist.

The IU School of Medicine and the Regenstrief Institute are located on the campus of Indiana University-Purdue University Indianapolis.

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