UC Irvine

Discrimination is the unfair or unjust treatment of an individual, especially because of their age, race, gender, or disability. Discrimination may also occur in the housing sector, and have an adverse impact on housing status among disadvantaged groups. Among homeless populations, African Americans are more likely to report at least one discriminatory experience in their lifetime compared to Whites. Discrimination experiences may also impact mental health outcomes such as depression and anxiety. Coping mechanisms to combat discrimination among people experiencing homelessness may include cigarette smoking. To our knowledge, there is a dearth of literature exploring discrimination experiences and its impact on depression, anxiety, and cigarette smoking among African American homeless adult smokers. We conducted an explanatory sequential mixed methods study to explore the association between everyday discrimination and mental health outcomes depression and anxiety, and readiness to quit cigarette smoking. Our study examined this association among African American people experiencing homelessness who smoke cigarettes. Using a subset of this sample, we continued the exploration of discrimination experiences and cigarette smoking through the use of focus group discussions. We found discrimination experiences were positively associated with depressive symptoms (b: 0.19; 95% CI: 0.01, 0.37; p=0.02). Though these associations did not reach statistical significance, we found everyday discrimination among our sample was associated with anxiety symptoms (b: 0.05; 95% CI: 0.03, 0.14; p=0.22), and readiness to quit cigarette smoking (b: 0.02; 95% CI: -0.04, 0.08 p=0.47). We also found that depressive and anxiety symptoms mediated the association between everyday discrimination and readiness to quit cigarette smoking (depression: b: 0.02; 95% CI: 0.01, 0.07; p=0.02), (anxiety: b: 0.03; 95% CI: 0.01, 0.05; p=0.04). Additionally, we also found everyday discrimination scores were higher among those who reported race (Yes-mean: 29.89; SD: 9.09 vs. No-mean: 36.42; SD: 12.02; p=0.003) or discrimination (Yes-mean: 34.68; SD: 10.7 vs. No-mean: 31.54; SD:11.7; p=0.18) as the main reasons for experiencing homelessness. These same reasons for discrimination experiences were also reported in the qualitative focus group discussions. Also in the focus groups, we found three common themes: “Experiencing Discrimination while Black”, “The Social Fabric - Why Quitting is a Challenge”, and “The Lesser of Two Evils - Choosing to Smoke over more Harmful Options.” More work on creating tools to combat discrimination among people experiencing homelessness needs to occur. Additionally, smoking cessation programs that explore reasons for both continued smoking, mental health outcomes and discrimination experiences may be of benefit to people experiencing homelessness.