Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization

Background: Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use. Objectives: This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations. Methods: We used nationally representative data from the 2009–2010 and 2011–2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents. Results: Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions. Conclusions: We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen—and it is often minority Americans who lack access and trust. If minority Americans’ health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.