Smoking-Related Behavior, Beliefs,and Social Environment of YoungBlack Women in Subsidized PublicHousing in ChicagoClara Manfredi, PhD, Loretta Lacey, RN, DrPH, Richard Wamecke, PhD,and Mananne Buis, PhD

IniwdutonSmoking prevalence rates among

young Black women of low socioeco-nomic status are high1-3 and projected toremain so on the basis of current smokingcessation trends.4-6 Smoking cessationprograms tailored to this population areneeded,3,7 but few data are available aboutsmoking differences within the Black pop-ulation that are attributable to socioeco-nomic factors.

Smoking cessation may be particu-larly difficult to achieve among individualswith several of the characteristics associ-ated with high smoking rates (includinglow education, income below povertylevel, unemployment, employment in ser-vice-level jobs, and unmarried status5'7'8)and among those living in urban commu-nities who have been descnbed as over-whelmed by problems of poverty, crime,and decaying environment.9-12 Underthese cumulative conditions, beliefs andsocial norms favoring smoking cessationare likely to be weak and not very salient.

In thispaperwe explore the smoking-related beliefs and social environment ofsuch a population and compare them withthose of a general population of smokers.Survey data are presented for femalesmokers aged 18 to 39 in three groups: (1)Black residents of Chicago subsidizedpublic housing ("Black SPH Residents"),a population subgroup of known low so-cioeconomic status13; (2) Blacks from thegeneral metropolitan Chicago population("Other Blacks") who are not SPH resi-dents; (3) Whites from the general metro-politan Chicago population ("Whites")who are not SPH residents.

Methods

SamplesAs part of the evaluation of a tele-

vised smoking cessation intervention,baseline telephone interviews were con-ducted with a general population sampleof2398 smokerswhowatched the evening

news at least three times per week. Thiswas a random-digit-dialing sample of thenoninstitutionalized population, 18 yearsof age or older, in the Chicago metropol-itan area.'4 The interviews were con-ducted 6 months before the intervention.The sample yielded 117 Other Black fe-males and 496 White females aged 18 to39. The SPH sample was identified byscreening a random sample of 1849 apart-ments in three public housing develop-ments. Each development and its build-ings were sampled with probabilityproportionate to its share of the three de-velopments' total population. Of these,19% were unoccupied, the occupants of9% refused or were unavailable, and 58%had no smokers qualifying by sex, age, orTV viewing habits.* Face-to-face inter-views were completed with 246 (96%) ofthe 256 eligible respondents.

Table 1 shows education level, in-come, and employment, marital, and sin-gle-parenthood status for the three studygroups.

HypothesesHypothesis #1: Because of the high

smoking prevalence rates associated withlow socioeconomic status, Black SPHResidents are expected to be heavier

*About 87% of the general population sampleand 89% of the SPH sample who were con-tacted andwho otherwise qualified for the studywere regularviewers ofthe local evening news,either between 4 PM and 6:30 PM or at 10 PM.

Clara Manfredi and Loretta Lacey are with thePrevention Research Center and Richard War-necke is with the Survey Research Laboratoiy,all at the University of Illinois at Chicago. Mar-ianne Buis is with the Department of HealthBehavior, University of Alabama at Birming-ham.

Requests for reprints should be sent toClara Manfredi, PhD, Prevention ResearchCenter, University of Illinois at Chicago, 850WJackson Blvd, Suite 400, Chicago, IL 60607.

This paper was submitted to the journalOctober 23, 1990, and accepted with revisionsJuly 18, 1991.

American Journal of Public Health 267

Public Health Briefs

smokers and to haveweaker motivation toquit smoking, fewer beliefs consistentwith smoking cessation, weaker socialpressure, and less social support to quitthan Other Blacks.

Hypothesis #2: Because of the in-creasing smoking rates among youngBlack females in general (and regardless ofthe well-known smaller daily cigaretteconsumption among Blacksl5), OtherBlacks are expected to have weaker mo-tivation to quit smoking, fewer beliefsconsistent with smoking cessation,weaker social pressure, and less socialsupport to quit than Whites.

Variables and Statistical MethodsWe used 45 dependent variables,

listed in Tables 2 and 3, to test the hypoth-eses above and to reflect psychosocial fac-tors commonly appearing in the smokingcessation literature.16-18 For each vari-able, differences between Black SPH Res-idents and Other Blacks and betweenOther Blacks and Whites are presentedwith 95% confidence intervals.

Each dependent variable in Tables 4and 5 was regressed in simultaneous logs-tic regression19 with education (a three-level category) and study group. This wasdone separately for the two group compar-isonsbecause (1) the patternsofdifferences

by study groups, shown in tables 2 and 3,do not warrant treating the three groups ascategories in an ordinal variable and (2) formany variables the effect of education isdifferent or even reversed by study group.Adjusted and unadjusted odds ratios and95% confidence intervals20 were calculatedfor the group comparisons and for higherversus lower education. Results are pre-sented only for variables for which thegroup comparison is significantly (a = .05)altered by education or for which educa-tion itself has a significant effect.

ResulsRegarding Hypothesis 1, on virtually

every comparison shown in Tables 2 and3 Black SPH Residents revealed charac-teristics unfavorable to smoking cessa-tion, and 24 of the 45 comparisons showdifferences in proportions significantly dif-ferent from zero (a = .05). These bivari-ate relationships remainwhen adjusted foreducation. Among Black SPH Residents,increased education is significantly asso-ciated only with smoking initiation afterage 17, increased recognition of risk asso-ciated with current smoking level, andawareness of sources of support for quit-ting (see Table 4). Higher education is neg-

atively associated with plans to quit (notsignificant) and worry about getting lungcancer.

Regarding Hypothesis 2, there ismuch less consistency in the comparisonsshown in Tables 2 and 3 between OtherBlacks and Whites. Compared withWhites, Other Blacks started smoking atan older age; smoke fewer cigarettes perday; have a stronger desire to quit and per-ceive less effort needed to quit; are morelikely to expect to get lung cancer and tobevery concerned about the effect ofsmokingon health in general; and are more likely toconsider health concerns, restrictions atwork, the expense of cigarettes, and show-ing that they are not hooked on cigarettesas very important reasons to quit.

On the other hand, compared withWhites, Other Blacks are more likely tobelieve the risk of lung cancer is the samefor smokers and nonsmokers, are moreconcerned about feeling uncomfortablearound smokers and being unable to dealwith stress if they quit, and are less likelyto know where to get help in quitting.These relationships remain after adjustingfor education. However, the adjustedodds ratios and the percentages by edu-cation level shown in Table 5 indicate that,in general, educational differences aremore consistent than racial differencesand that as education increases, racial dif-ferences diminish. Thus differences byrace are most apparent among the leasteducated. Education is negatively relatedto age of smoking onset, amount smoked,and perceived difficulties with quitting; itis positively related to plans to quit, beliefsthat smoking is related to lung cancer andthat lung cancer would have serious con-sequences, and knowledge ofwhere to gofor help in quitting. Those with more ed-ucation are also more likely to live in en-vironments that are supportive of cessa-tion and that have fewer smokers.

DiswusionStudy Linitations

This was a mixed-mode study, withface-to-face interviews with the SPH sam-ple and telephone interviews with the oth-ers; the questionnaires, however, wereidentical, and there are no indications ofmethod effects in responses to eithermode,although the telephone response rate waslower (73%vs 96%). The uniqueness oftheSPH sample may limit generalizability, butthis population is a growing segment inmany urban areas and hence is importantto study. Finally, in this study we exam-

268 American Journal of Public Health February 1992, Vol. 82, No. 2

Public Health Briefs

American Journal of Public Health 269February 1992, Vol. 82, No. 2

Public Health Briefs

ined characteristics of smokers only. Dif-ferent pattems might be found if formersmokers and nonsmokers were also in-cluded.

ImplicationsDespite these limitations, the present

study does have implications for smoking

cessation interventions. First, the mes-sage that smoking increases the risk oflung cancer has not reached or been ac-cepted by a large proportion of youngBlack female smokers with less educa-tion, although they are concerned aboutthe effect of cigarettes on their health ingeneral. Compared with White or better-

educated females, Black females living inSPH and those with less education tend tobe very concemed about their currenthealth problems or those of people closeto them, the expense of cigarettes, andbeing addicted to cigarettes. Smoking ces-sation messages may gain increased atten-tion by emphasizing these concems. Sec-

270 American Journal of Public Health February 1992, Vol. 82, No. 2

Pubik Health Brieft

......................... ...............

.............

...........

0 iiiiiiiiiiiiii...........................

...................................... ........................................

....................... MWR................

.............................................

........... ...................................

............................................. UU PU

........................................................

.....................................

.......

.........................................

............. ...................

.................................

...................................

..........

.............

......

............................

.......

...............

..........................................................

...............

.... ............................

.............

ond, interventions must address the highsmoking prevalence and weak norms andsupport for quitting in the social environ-ment of low-socioeconomic status femalesmokers and the likely side effects of ces-sation. Third, help with cessation must bemore readily available to and more heavilypromoted in this population, whose mem-bers are unaware of the help available.Increased visibility of smoking cessationprograms may enhance both their use andsmokers' perception of the social desir-ability of quitting. Finally, those who tar-get programs toward poorly educatedyoung Black female smokers must realizethat this group includes women with in-tensified needs and barriers-exemplifiedby the public housing residents who arethe main focus of this study-who needspecial attention. a

AcknowledgmentsThis research was supported by GrantCA42760 from the National Cancer Institute.The authors are grateful to Drs Thomas Cook,Kathleen Crittenden, Frederick Kviz, and Pa-tricia Langenberg for helpful suggestions onearlier drafts.

References1. Schramm WF. WIC prenatal participation

and its relationship to newborn Medicaidcosts in Missouri: a cost/benefit analysis.Am JPublic Health. 1985;75:851-857.

2. Warnecke R, Graham S, Rosenthal S, Man-fredi C. Social and psychological correlatesofsmokingbehavior among blackwomen.JHealth Soc Behav. 1978;19:397-410.

3. US Department of Health and HumanServices. Report of the Secretary's TaskForce on Black and Minoity Health. Vol-ume III: Cancer. Washington, DC: USGovermment Printing Office; 1986. DHHSpublication 86-0017.

4. Fiore MJ, Novotny TE, Pierce JP, Hatzi-andreau EJ, Patel KM, Davis RM. Trendsin cigarette smoking in the United States:the changing influence of gender and race.JAMA. 1989;261:49-55.

5. Pierce JP, Fiore MC, Novotny TE, Hatzi-andreu EJ, Davis RM. Trends in cigarettesmoking in the United States: educationaldifferences are increasing. JAMA.1989;261:56-60.

6. Pierce JP, Fiore MC, Novotny TE, Hatzi-andreu EJ, Davis RM. Trends in cigarettesmoking in the United States: projectionsto the Year 2000. JAMA4. 1989;261:61-65.

7. US Department of Health and HumanServices. The Health Consequences ofSmoking: Nicotine Addiction. Report ofthe Surgeon General. DHHS; 1988. NIHpublication 88-8406. Centers for DiseaseControl, Rockville, Md: Office on Smokingand Health.

8. Novotny TE, Warner KE, Kendrick JS,Remington PL. Smoking by Blacks andWhites: socioeconomic and demographicdifferences. Am J Public Health. 1988;78:1187-1189.

9. Leffall LD. Program priorities for the fu-ture. In: Mettlin C, Murphy GP, eds. Can-ceramong Black Populations. New York,NY: Alan R. Liss; 1981:253-263.

10. Cardwell JJ, Collier WV. Racial differ-ences in cancer awareness. Urban Health.October 1981:29-32.

11. Auletta K The Underclass. New York:Random House; 1982.

12. Glasgow DG. The Black Underclass: Pov-erty, Unemployment, and Entrapment ofGhetto Youth. San Francisco, Calif: Jos-sey-Bass; 1980.

13. Wilson WJ. The TndyDisadvantaged. TheInner City, the Underclass, andPublic Pol-icy. Chicago, Ill: University of ChicagoPress; 1987.

14. Warnecke RB, Flay BR, Kviz FJ, et al.Characteristics of participants in a tele-vised smoking cessation intervention. PrevMedL 1991;20:389-403.

15. Orleans CT, Schoenbach V, Salmon M, etal. A survey of smoking and quitting pat-terns among Black Americans.Am JPub-lic Health. 1989;79:176-180.

16. Becker MH, Haefner DP, Kasl SV, Kir-scht JP, Maiman LA, Rosenstock IM. Se-lected psychosocial models and correlatesof health-related behaviours. Med Care.1977;15 (May suppl):27-46.

17. Rosenstock IM. The Health Belief Modeland preventive health behavior. In: BeckerMH, ed. The Health Belie.fModeland Per-sonal Health Behavior. Thorofare, NJ:Charles B. Slack; 1974:27-59.

18. Kviz FJ, Crittenden KS, Belzer LJ, War-necke RB. Psychosocial factors in enroll-ment in a televised smoking cessation pro-gram. Health Educ Q. In press.

19. Minium EW. Statistical Reasoning in Psy-chology and Education. 2nd ed. NewYork, NY: John Wiley & Sons Inc; 1978.

20. Hosmer DW, Lemeshow S. Applied Lo-gistic Regression. New York, NY: JohnWiley & Sons Inc; 1989.

February 1992, Vol. 82, No. 2 American Journal of Public Health 271

Pubfic Heidi Briefs

272 American Journal of Public HealthF Febmary 1992, Vol. 82, No. 2