Diminished Effect of Smoking Intensity on African American and Latino Smokers’ Tobacco Risk Perception

Abstract

Background: According to the Minorities’ Diminished Returns (MDRs), highly educated African American (AA) and Latino people remain at high risk of tobacco use. One hypothesis suggests that this high risk of tobacco use stems from AA and Latino people remaining unrealistically optimistic, resulting in the risks of tobacco use being discounted. Aims: To better understand the role of cognitive bias as a mechanism behind the high risk of smoking in highly educated minorities, we studied ethnic variation in the association between smoking intensity and perceiving oneself as a smoker among young American adult established current smokers. Methods: In this cross-sectional study, we used baseline data of 2,475 young adults (18-24 years) who were current established smokers. The data came from the Population Assessment of Tobacco and Health (PATH; 2013) study, a nationally representative survey in the US. The independent variable was smoking intensity. The dependent variable was not perceiving oneself as a smoker (probably due to optimistic cognitive bias and discounting the risk). Age, gender, and education were the covariates. Ethnicity was the moderator. Logistic regressions were used to analyze the data. Results: From the total number of 2,475 current smokers, 2106 (85.1%) perceived themselves-as a smoker, and 369 (14.9%) smokers perceived themselves as a non-smoker. A high level of smoking intensity was associated with lower odds of not perceiving oneself as a smoker. Two significant interactions were found between Latino and AA ethnicity and smoking intensity, suggesting that the effect of smoking intensity on perceiving oneself as a smoker is weaker in AAs than Whites and Latinos than non-Latinos. Conclusions:While tobacco use intensity is associated with a lower likelihood of optimistic cognitive bias and not perceiving oneself as a smoker, Latino and AA young adults who smoke many cigarettes a day are more likely than their non-Latino White counterparts with the same smoking risk not to perceive themself as a smoker. This finding suggests a psychological discounting of risk among AA and Latino smokers. Such cognitive bias may help them avoid cognitive dissonance and reduce their own perceived risk of cancer and other fatal conditions from smoking. A cognitive bias may increase the smoking burden of AA and Latino young adults through discounting smoking risk.