Everyday discrimination can influence unhealthy coping behaviors such as smoking, thereby increasing the risk of heart disease, according to a new study.

However, the impact differs depending on one’s identity, with Hispanic women experiencing the greatest risk for heart disease as a result of discrimination.

“Experiences of discrimination are framed by individual cultural realities and contexts,” says Stephanie Cook, assistant professor of biostatistics and social and behavioral sciences at the New York University School of Global Public Health and the study’s lead author. “Discrimination at the intersection of multiple marginalized identities may be particularly damaging to health.”

Heart disease is the leading cause of death in the US, but some people are at greater risk based on their race, ethnicity, or sex. These disparities can be explained, in part, by social determinants of health—the environmental conditions in which we live that influence our health, from income and education to air pollution and access to healthy foods.

Discrimination is another social determinant of health, and research shows that stress caused by this unjust treatment can worsen heart health. This may be because discrimination changes how our physiological stress systems function, which can cause inflammation and lead to the thickening of arteries. Studies also show that being discriminated against can lead to unhealthy coping behaviors, including smoking, a well-known risk factor for heart disease.

Most research looks at the health effects of discrimination in the context of a single identity, such as race, gender, or sexual orientation. But this neglects the reality of having overlapping identities, a concept known as intersectionality.

To understand the connection between discrimination, smoking, and heart health, Cook and her colleagues analyzed data from the Multi-Ethnic Study of Atherosclerosis, a national study sponsored by the National Heart Lung and Blood Institute (NHLBI). More than 6,800 adults without a diagnosis of heart disease were asked about their health behavior, heart disease-related risk factors, demographics, and whether they feel that they are subject to discrimination. The researchers examined the associations among discrimination, cigarette smoking, and two measures of heart health: carotid intima-media thickness and plaque in the carotid arteries, both of which are strong predictors of future cardiovascular events.

Read the full article about discrimination and public health by Rachel Harrison at Futurity.