The influence of racism on cigarette smoking: Longitudinal study of young people in a British multiethnic cohort

Introduction
Studies, predominantly from the US, suggest that positive parenting, social support, academic achievement, and ethnic identity may buffer the impact of racism on health behaviours, including smoking, but little is known about how such effects might operate for ethnically diverse young people in the United Kingdom. We use the Determinants of young Adult Social well-being and Health (DASH), the largest UK longitudinal study of ethnically diverse young people, to address the following questions: a) Is racism associated with smoking? b) Does the relationship between racism and smoking vary by gender and by ethnicity? (c) Do religious involvement, parenting style and relationship with parents modify any observed relationship? and d) What are the qualitative experiences of racism and how might family or religion buffer the impact?
Methods
The cohort was recruited from 51 London schools. 6643 were seen at 11-13y and 4785 seen again at 14-16y. 665 participated in pilot follow-up at 21-23y, 42 in qualitative interviews. Self-report questionnaires included lifestyles, socio-economic and psychosocial factors. Mixed-effect models examined the associations between racism and smoking.
Results
Smoking prevalence increased from adolescence to age 21-23y, although ethnic minorities remained less likely to smoke. Racism was an independent longitudinal correlate of ever smoking throughout adolescence (odds ratio 1.77, 95% Confidence Interval 1.45–2.17) and from early adolescence to early 20s (1.90, 95% CI 1.25–2.90). Smoking initiation in late adolescence was associated with cumulative exposure to racism (1.77, 95% CI 1.23–2.54). Parent-child relationships and place of worship attendance were independent longitudinal correlates that were protective of smoking. Qualitative narratives explored how parenting, religion and cultural identity buffered the adverse impact of racism.
Conclusions
Racism was associated with smoking behaviour from early adolescence to early adulthood, regardless of gender, ethnicity or socio-economic circumstances adding to evidence of the need to consider racism as an important social determinant of health across the life course.

Introduction
既往研究（多来自美国）表明，积极教养、社会支持、学业成就与种族认同或可缓冲种族主义对包括吸烟在内的健康行为的负面影响，但目前针对英国境内种族多元青年群体中此类效应的作用机制仍知之甚少。本研究依托英国规模最大的种族多元青年纵向研究——青年成人社会福祉与健康决定因素（Determinants of young Adult Social well-being and Health, DASH），旨在解答以下问题：a) 种族主义是否与吸烟行为存在关联？b) 种族主义与吸烟的关联是否会因性别与种族群体而异？c) 宗教参与、教养方式及亲子关系是否会调节上述观测到的关联？d) 种族主义的质性体验如何，家庭或宗教又如何缓冲其负面影响？

Methods
本研究队列从伦敦51所学校招募受试者。共有6643名受试者在11~13岁阶段参与调研，另有4785名受试者于14~16岁阶段完成随访。其中665名受试者在21~23岁阶段参与了追踪预随访，42名受试者参与了质性访谈。自我报告问卷涵盖生活方式、社会经济状况与社会心理因素等维度。研究采用混合效应模型分析种族主义与吸烟行为之间的关联。

Results
研究结果显示，从青少年时期至21~23岁阶段，人群吸烟率呈上升趋势，尽管少数族裔群体的吸烟率仍相对更低。种族主义是贯穿青少年时期的曾吸烟行为的独立纵向关联因素（优势比（odds ratio）=1.77，95%置信区间（Confidence Interval, CI）：1.45~2.17），同时也是从青少年早期至20岁早期的曾吸烟行为的独立纵向关联因素（优势比=1.90，95%CI：1.25~2.90）。青少年晚期的吸烟起始行为与累积性种族主义暴露相关（优势比=1.77，95%CI：1.23~2.54）。亲子关系与礼拜场所参与频率是独立的纵向保护因素，可降低吸烟风险。质性访谈资料进一步探讨了教养、宗教与文化认同如何缓冲种族主义带来的负面影响。

Conclusions
研究结论表明，无论性别、种族群体或社会经济背景如何，从青少年早期至成年早期，种族主义均与吸烟行为存在关联，这进一步佐证了需将种族主义视为贯穿全生命周期的重要健康社会决定因素。