Abstract Purpose: Structural racism, measured by mortgage lending bias, has been shown to have persistent effects on health inequities and may impact lung cancer disparities. Smoking cessation is crucial in reducing lung cancer risk, particularly in communities affected by structural racism, where discriminatory practices are associated with higher smoking rates. We examined the association between structural racism, as measured by residence in areas subjected to contemporary redlining and racial and ethnic bias in mortgage lending, with smoking cessation. Methods: Our study population includes two cohorts, the Multiethnic Cohort Study (MEC) and the Southern Community Cohort Study (SCCS), consisting of well-characterized older adult participations with up to 27 years of follow-up. The MEC was assembled between 1993-1996 in California and Hawaii and SCCS was recruited between 2002-2009 in the southeastern United States. Contemporary redlining and racial and ethnic bias in mortgage lending measures were developed using Home Mortgage Disclosure Data Act (HMDA) data. Redlining and racial and ethnic bias was measured as the odds ratio of denial of a mortgage application on the basis of the property location compared to property location in the county and applicant race and ethnicity compared to White applicants, respectively. This current study, comprises of a subgroup of MEC and SCCS participants who smoked at baseline with follow-up smoking status data (n=10,349 and 10,498, respectively). Among these participants, 6,134 MEC and 2,164 SCCS particpants reported changing smoking status on a follow-up survey (21 years). Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between smoking cessation status and structural racism, with age as the time-scale and adjusting for baseline age, sex, education, marital status, body mass index, alcohol consumption, smoking (pack-years), and state, with clustering by census tracts at baseline. Results: In MEC, among Black/African American participants, living in areas with the highest mortgage lending bias against Black/African American residents (e.g., lower racial and ethnic composition of Black/African American residents) was associated with higher hazard ratio of of smoking cessation (adjusted HR: 1.55, 95% CI: 1.17, 2.07) compared to the lowest mortgage lending bias. In SCCS, participants living in the most redlined areas were associated with lower rates of smoking cessation (adjusted HR: 0.83, 95% CI: 0.72, 0.95) compared to the least redlined areas. No association was found for other mortgage bias lending measures. Conclusions: We found that a place-level measure of structural racism, i.e., mortgage lending bias, were associated with smoking cessation for Black/African American populations. Findings differ by area and race/ethnicity, highlighting the complexity of the relationship between structural racism and smoking, a factor that influences lung cancer risk. Citation Format: Mimi Ton, Dian Gu, Cherie Guillermo, Yuhong Zhou, Meera Sangaramoorthy, Katherine Lin, Pushkar Inamdar, Jun Wu, Kirsten Beyer, Mindy C. DeRouen, Alexandra Binder, Daniel Stram, Scarlett L. Gomez, Salma Shariff-Marco, Lynne Wilkens, Loïc Le Marchand, Melinda C. Aldrich, S Lani Park, Iona Cheng. Association between mortgage lending bias and smoking cessation: The Multiethnic Cohort and Southern Community Cohort Study abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B155.
Ton et al. (Thu,) studied this question.
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