# Racism, discrimination, and distress: A cross-sectional examination of smoking behaviors among adults who smoke during the COVID-19 pandemic

## TL;DR

This study finds that experiences with racism and discrimination during the pandemic are linked to both increased quit attempts and higher relapse rates among smokers.

## Contribution

The paper introduces new evidence linking racial discrimination to changes in smoking behaviors during the pandemic.

## Key findings

- Participants who experienced racism were more likely to make serious quit attempts during the pandemic.
- Experiences with discrimination predicted higher relapse rates among smokers.
- Black participants reported higher levels of discrimination and were more likely to be avoided or insulted due to race.

## Abstract

Racial and ethnic disparities in tobacco use and related health consequences persist. Experiences with racial discrimination have been associated with higher likelihood of smoking and worse cessation outcomes. The purpose of this study is to examine associations between perceived discrimination with serious quit attempts, smoking relapse, and changes in motivation to quit smoking, during the COVID-19 pandemic.

Data came from an October–November 2020 US nationally representative cross-sectional survey of adults who currently smoked cigarettes (n=1223). Participants reported changes in smoking frequency, motivation to quit, quit attempts, and relapse since February 2020. Perceived discrimination was assessed using a modified Everyday Discrimination Scale, the Complementary and Integrative Research Lab Pandemic Impact Questionnaire, and Domain-Specific Stress Scales. In addition to the associations between discrimination and smoking behaviors, we explored differences in smoking behaviors by race.

Approximately 13–25% of participants reported having relapsed to smoking since the beginning of the COVID-19 pandemic. Black participants perceived higher levels of everyday discrimination and were more likely to report having been avoided or insulted because of their race or ethnicity. Participants who experienced racism and discrimination were more likely to have made a serious attempt to quit smoking since the beginning of COVID-19 (AOR=1.80; 95% CI: 1.08–3.03). Experiences with police brutality (AOR=1.61; 95% CI: 1.31–1.97), as well as being avoided or insulted because of their race or ethnicity (AOR=4.70; 95% CI: 2.75–8.04) was associated with higher likelihood of relapse.

Perceived experiences with racism and discrimination among people who smoke were associated with making a serious smoking quit attempt but also predicted relapse. Further research can develop smoking cessation interventions that consider various social stressors, such as experiences with racism and discrimination.