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Racial and non-racial discrimination and smoking status among South African adults 10 years after apartheid
  1. Lauren M Dutra1,
  2. David R Williams2,
  3. Ichiro Kawachi2,
  4. Cassandra A Okechukwu2
  1. 1The Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
  2. 2Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Lauren M Dutra, University of California San Francisco, Center for Tobacco Control Research and Education, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143-1390, USA; lauren.dutra{at}


Background Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa.

Methods This analysis examined chronic (day-to-day) and acute (lifetime) experiences of racial and non-racial (eg, age, gender or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health study. Logistic regression models were constructed using SAS-Callable SUDAAN.

Results Both chronic racial discrimination (RR=1.45, 95% CI 1.14 to 1.85) and chronic non-racial discrimination (RR=1.69, 95% CI 1.37 to 2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and non-racial) chronic discrimination (RR=1.46, 95% CI 1.20 to 1.78) and total acute discrimination (RR=1.28, 95% CI 1.01 to 1.60) predicted a higher risk of current smoking.

Conclusions Racial and non-racial discrimination may be related to South African adults’ smoking behaviour, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalisability and consider the implications of these findings for smoking cessation approaches in South Africa.

  • Disparities
  • Priority/special populations
  • Global health

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