Tobacco Use Disparities Research Articles

Hunger and housing: Economic disparities in current and daily tobacco use among high school students in the United States in 2021

IntroductionEconomic disparities in tobacco use and dependence are well-documented among adults but not adolescents. This study aims to examine economic disparities in patterns of tobacco use among a nationally representative sample of high school students in Spring 2021. MethodsWe analyzed data from n = 6,750 US high school student via the 2021 Adolescent Behaviors and Experiences Survey (ABES). We estimated the association between experiencing homelessness and food insecurity (analyzed independently) and current (past 30-day) and daily (all 30 days) use of four tobacco products (e-cigarettes; cigarettes; cigars; smokeless). Models controlled for sex, race/ethnicity, age, and sexual identity. ResultsOverall, ∼1.8 % experienced homelessness and 23.7 % experienced food insecurity. Experiencing homeless was significantly associated with greater odds of current use for e-cigarette (aOR: 3.43), cigarettes (aOR: 5.58), cigars (aOR: 10.47), and smokeless tobacco (aOR: 4.41) as well as greater risk for daily use of e-cigarettes (aOR: 2.66), cigarettes (aOR: 10.94), and cigars (aOR: 5.23) but not smokeless tobacco (aOR: 2.48; 95 %CI: 0.51 – 12.16). Food insecurity was significantly associated with greater odds of current use of e-cigarettes (aOR: 2.00), cigarettes (aOR: 2.15), and cigars (aOR: 2.44) but not smokeless (aOR: 1.04; 95 % CI: 0.56 – 1.93). No association was observed between food insecurity and daily tobacco use. ConclusionSubstantial economic disparities in tobacco use were observed in a nationally representative sample of high school students. Interventions should consider prioritizing economic determinants of health during adolescence, including a focus on preventing youth tobacco use as well as addressing upstream determinants of homelessness and food insecurity.

Sex differences in tobacco use, attempts to quit smoking, and cessation among dual users of cigarettes and e-cigarettes: Longitudinal findings from the US Population Assessment of Tobacco and Health Study

SignificanceA growing number of adults use more than one tobacco product, with dual use of cigarettes and e-cigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex. MethodsData came from Waves 4–6 (12/2016–11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency. ResultsAmong US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9–16.4) of females and 23.4% (20.0–26.9) of males were young adults (aged 18–24), 11.7% (9.2–14.2) of females and 14.4% (11.6–17.2) of males had <high school education, and 82.2% (79.4–84.5) of females and 78.7% (75.1–82.4) of males were white. Overall, 44.9% (41.6–48.1) of females compared with 37.4% (33.5–41.3) of males made an attempt to quit smoking between a baseline and follow-up wave (Adjusted Risk Ratio [ARR] = 1.23, 1.05–1.45). In contrast, there were no apparent differences between females (22.1%, 19.0–25.2) and males (24.3%, 21.5–27.1) in smoking cessation (ARR = 1.06, 0.84–1.35). ConclusionUS females who dually use e-cigarettes and cigarettes were more likely to attempt to quit smoking, but not more likely to succeed at quitting, than males.

Feasibility and Preliminary Effects of a Social Media-Based Peer-Group Mobile Messaging Smoking Cessation Intervention Among Chinese Immigrants who Smoke: Pilot Randomized Controlled Trial.

Chinese immigrants experience significant disparities in tobacco use. Culturally adapted tobacco treatments targeting this population are sparse and the use is low. The low use of these treatment programs is attributed to their exclusive focus on individuals who are ready to quit and the wide range of barriers that Chinese immigrants face to access these programs. To support Chinese immigrant smokers at all levels of readiness to quit and address their access barriers, we developed the WeChat Quit Coach, a culturally and linguistically appropriate WeChat (Tencent Holdings Limited)-based peer group mobile messaging smoking cessation intervention. This study aims to assess the feasibility, acceptability, and preliminary effects of WeChat Quit Coach. We enrolled a total of 60 Chinese immigrant smokers in 2022 in New York City for a pilot randomized controlled trial (RCT) and a single-arm pilot test. The first 40 participants were randomized to either the intervention arm (WeChat Quit Coach) or the control arm (self-help print material) using 1:1 block randomization stratified by sex. WeChat Quit Coach lasted 6 weeks, featuring small peer groups moderated by a coach, daily text messages with text questions, and chat-based instant messaging support from the coach in response to peer questions. The next 20 participants were enrolled in the single-arm pilot test to further assess intervention feasibility and acceptability. All 60 participants were offered a 4-week supply of complimentary nicotine replacement therapy. Surveys were administered at baseline and 6 weeks, with participants in the pilot RCT completing an additional survey at 6 months and biochemical verification of abstinence at both follow-ups. Of 74 individuals screened, 68 (92%) were eligible and 60 (88%) were enrolled. The majority of participants, with a mean age of 42.5 (SD 13.8) years, were male (49/60, 82%) and not ready to quit, with 70% (42/60) in the precontemplation or contemplation stage at the time of enrollment. The pilot RCT had follow-up rates of 98% (39/40) at 6 weeks and 93% (37/40) at 6 months, while the single-arm test achieved 100% follow-up at 6 weeks. On average, participants responded to daily text questions for 25.1 days over the 42-day intervention period and 23% (9/40) used the chat-based instant messaging support. Most participants were satisfied with WeChat Quit Coach (36/39, 92%) and would recommend it to others (32/39, 82%). At 6 months, self-reported 7-day point prevalence abstinence rates were 25% (5/20) in the intervention arm and 15% (3/20) in the control arm, with biochemically verified abstinence rates of 25% (5/20) and 5% (1/20), respectively. WeChat Quit Coach was feasible and well-received by Chinese immigrants who smoke and produced promising effects on abstinence. Large trials are warranted to assess its efficacy in promoting abstinence in this underserved population. ClinicalTrials.gov NCT05130788; https://clinicaltrials.gov/study/NCT05130788.

Investigating the association between tobacco use and oral health among security guards at a tertiary healthcare centre in New Delhi: a cross-sectional study.

Tobacco usage is a major global public health concern, contributing to millions of deaths annually. This study focuses on security guards, an occupational group facing unique challenges, to investigate tobacco prevalence, usage patterns, and associated oral health risks. A cross-sectional study was conducted among security guards at a Tertiary Health Care Centre, from October 2022 to February 2023. Data on demographics, tobacco habits, and comorbidities were collected via a structured questionnaire. Clinical oral examinations provisionally diagnosed Oral Potentially Malignant Disorders (OPMDs) based on clinical findings. Appropriate Statistical analyses were employed. Among 696 security guards, 40.1% used tobacco, including 15.0% smokers and 74.5% engaging in smokeless tobacco. Additionally, 10.3% reported using both smoking and smokeless forms. Non-tobacco users accounted for 59.9%. Tobacco users showed a higher prevalence of OPMDs (11.4%) compared to non-tobacco users (1.4%). Security guards demonstrated a higher tobacco prevalence, with smokeless tobacco being predominant. Gender disparities in tobacco use emphasize the need for gender-specific interventions. The study highlights the significant impact of tobacco on oral health, especially the risk of OPMDs. A high prevalence of tobacco usage (40.1%), particularly smokeless tobacco, among security guards, emphasizes the importance of targeted interventions within this occupational group. Oral Potentially Malignant Disorders (OPMDs) were significantly more prevalent (11.4%) in tobacco users. The association between tobacco usage and OPMDs reaffirms the well-established association between tobacco and adverse oral health outcomes.

Sex differences in tobacco use, attempts to quit smoking, and cessation among dual users of cigarettes and e-cigarettes: Longitudinal findings from the US Population Assessment of Tobacco and Health Study

SignificanceA growing number of adults use more than one tobacco product, with dual use of cigarettes and e-cigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex. MethodsData came from Waves 4–6 (12/2016–11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency. ResultsAmong US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9–16.4) of females and 23.4% (20.0–26.9) of males were young adults (aged 18–24), 11.7% (9.2–14.2) of females and 14.4% (11.6–17.2) of males had <high school education, and 82.2% (79.4–84.5) of females and 78.7% (75.1–82.4) of males were white. Overall, 44.9% (41.6–48.1) of females compared with 37.4% (33.5–41.3) of males made an attempt to quit smoking between a baseline and follow-up wave (Adjusted Risk Ratio [ARR] = 1.23, 1.05–1.45). In contrast, there were no apparent differences between females (22.1%, 19.0–25.2) and males (24.3%, 21.5–27.1) in smoking cessation (ARR = 1.06, 0.84–1.35). ConclusionUS females who dual use e-cigarettes and cigarettes were more likely to attempt to quit smoking, but not more likely to succeed at quitting, than males.

Selective Reduction of Socioeconomic Disparities in the Experimental Tobacco Marketplace: Effects of Cigarette and E-cigarette Flavor Restrictions.

Cigarette smoking accounts for >30% of the socioeconomic gap in life expectancy. Flavored restrictions claim to promote equity; however, no previous studies have compared the effect of cigarette and e-cigarette flavor restrictions among individuals who smoke with lower and higher socioeconomic status (SES). In a between-group within-subject design, individuals with lower (n = 155) and higher (n = 125) SES completed hypothetical purchasing trials in the experimental tobacco marketplace (ETM). Conditions were presented in a 2 × 2 factorial design (cigarette flavors restricted or unrestricted and e-cigarette flavors restricted or unrestricted) with increasing cigarette prices across trials. Results show (1) SES differences in cigarette, e-cigarette, and NRT purchases under unrestricted policies, with lower SES showing higher cigarette demand and lower e-cigarette and NRT substitution than higher SES, (2) cigarette restrictions decreased cigarette and increased NRT purchases among lower SES, but no significant changes among higher SES, (3) decreased SES differences in cigarette demand under cigarette restrictions, but persistence under e-cigarette restrictions or their combination, (4) persistence of SES differences in e-cigarette purchases when all restrictions were enforced, and (5) waning of SES differences in NRT purchasing under all restrictions. Flavor restrictions differentially affected individuals based on SES. Within-group comparisons demonstrated restrictions significantly impacted lower SES, but not higher SES. Between-group comparisons showed SES differences in cigarette purchasing decreased under cigarette restrictions, but persisted under e-cigarette-restrictions or their combination. Additionally, SES differences in NRT substitution decreased under flavor restrictions. These findings highlight the utility of the ETM to investigate SES disparities. With increasing trends of socioeconomic differences in smoking prevalence and cessation rates, smoking-related health disparities are expected to continue to widen. Restricting menthol flavor in cigarettes while enhancing the availability and affordability of NRT have the potential to alleviate SES disparities in tobacco use, therefore, positively impacting health equity. However, this effect may depend on flavor availability in other tobacco products.

Racial Differences in Biopsychosocial Pathways to Tobacco and Marijuana Use Among Youth.

The influence of socioeconomic disparities and multidimensional stressors on youth tobacco and marijuana use is recognized; however, the extent of these effects varies among different racial groups. Understanding the racial differences in the factors influencing substance use is crucial for developing tailored interventions aimed at reducing disparities in tobacco and marijuana use among adolescents. This study aims to explore the differential effects of socioeconomic disparities and multidimensional stressors on tobacco and marijuana use between Black and White adolescents. Utilizing longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, this research includes a cohort of pre-youth, monitored from the age of 9-10years for a period of up to 36months. We examined the impact of various socioeconomic status (SES) indicators and multidimensional stressors, including trauma, financial stress, racial discrimination, and family stress, alongside baseline average cortical thickness and the subsequent initiation of tobacco and marijuana use over the 36-month follow-up. Overall, 10,777 participants entered our analysis. This included 8263 White and 2514 Black youth. Our findings indicate significant differences in the pathways from SES indicators through stress types to cortical thickness between Black and White youths. Notably, cortical thickness's impact on the future initiation of tobacco and marijuana use was present in both groups. The study suggests that compared to White adolescents, Black adolescents' substance use and associated cortical thickness are less influenced by stress and SES indicators. This discrepancy may be attributed to the compounded effects of racism, where psychosocial mechanisms might be more diminished for Black youth than White youth. These findings support the theory of Minorities' Diminished Returns rather than the cumulative disadvantage or double jeopardy hypothesis, highlighting the need for interventions that address the unique challenges faced by Black adolescents.

Examining the relationship of flavored tobacco product policy restrictions and flavored tobacco product use, among adolescents and young adults in the U.S.

ObjectiveThis work examines the relationship between local flavor policy exposure and any tobacco product use and flavored tobacco product use among U.S. youth and young adults, as well as the equity potential of these policies by race/ethnicity. MethodsParticipants were aged 15–36 (n = 10,893) surveyed from September–December 2019 using national, address- and probability-based sampling. Local flavor policies enacted before survey completion were linked to participant home address. Weighted cross-sectional multivariable logistic regression examined individual coverage by flavor policy vs. no flavor policy, with current any tobacco or flavored tobacco use, controlling for individual and county-level demographics, psychosocial variables, and other tobacco control policies. Interactions between race/ethnicity and any tobacco use and flavored tobacco use were assessed. ResultsThose covered by a flavor policy vs. no policy had lower odds of any tobacco use (aOR = 0.74, 95% CI = 0.55–1.00) and current flavored tobacco use (aOR = 0.67, 95% CI = 0.48–0.93). Compared with Non-Hispanic (NH)-White individuals, NH-Black individuals (aOR = 1.08, CI = 1.04–1.12) had higher odds of any tobacco use, and non-Hispanic Asian individuals had lower odds of any tobacco use (aOR = 0.67, CI = 0.53–0.85). Hispanic individuals exposed to policy had lower odds of flavored tobacco use compared to NH-White peers. ConclusionsExposure to flavor restriction policies is associated with lower odds of any tobacco and flavored use among youth and young adults. Flavor restrictions may be beneficial in reducing tobacco use in youth from diverse racial/ethnic backgrounds. However, passing policies covering NH-Black individuals is needed to mitigate disparities in tobacco use by flavor policy coverage over time.

IJCM_135A: Tobacco Burden, Legal Awareness, and Attitudes toward Control Measures among Healthcare Students, Professionals, and Staffs: Insights of an Online Survey in Bihar &amp; Jharkhand, India

Background: Healthcare professionals, students, and workers are vital change agents in the global battle against tobacco. Yet, it’s important to note a concerning trend: there’s a high prevalence of tobacco use among them in India, although data on this is limited. Objective: This study aimed to assess tobacco use prevalence, awareness of related laws, and attitudes among healthcare professionals, students, and staff in Bihar and Jharkhand, India. Methodology: In July and August 2023, we conducted an extensive cross sectional, online survey across 24 tertiary healthcare institutions. Participants included a diverse group of medical, dental, and nursing students, faculty, resident physicians, nursing professionals, and support staff. The survey covered sociodemographic factors, tobacco use, awareness of laws (26 items) [a: 0.924), compliance practices (9 items) (a: 0.929), and perceptions of tobacco control (10 items) (a: 0.728). Results: Our research revealed a significant prevalence of tobacco use: 15.9% reported current use, with 9.6% as daily users. Notably, awareness levels differed noticeably between users and non-users, with non-users displaying deeper knowledge of tobacco-related laws in 61.5% of cases. Our multifactor logistic regression models for current (R2: 0.184, PAR: 84.1%) and daily tobacco use (R2: 0.203, PAR: 90.4%) highlighted various associated factors, including age, gender, marital status, occupation, family income, and native state. Importantly, insufficient awareness emerged as a key factor, correlating with higher chances of current and daily tobacco use. Regional differences were evident, with lower prevalence in southern states. A majority of faculty (90.0%) and students (93.6%) expressed the need for increased emphasis on tobacco control in healthcare curricula. Conclusion: Our research highlights disparities in healthcare tobacco use, influenced by age, gender, marital status, occupation, income, and location. Awareness plays a crucial role, emphasizing the need for integrating tobacco education into curricula and sustaining awareness campaigns to address this issue effectively

Opportunities to Improve Tobacco Control for State Agency Employees.

The aim of the study is to explore tobacco-related knowledge and perceptions at Washington State (WA) agencies. The study used a cross-sectional employee survey and qualitative focus groups with managers/supervisors. We produced descriptive statistics to examine differences in awareness and perceptions of tobacco-control efforts among employees and conducted a rapid thematic analysis of focus group data. Of employees, only 18% with a history of tobacco use had used their agency's cessation benefits. Employees who did not use tobacco and who had higher education had more favorable attitudes toward tobacco-control efforts. In the focus groups, manager/supervisors described limited tobacco cessation promotion at their agency, barriers to tobacco control implementation, and concerns about the perceived effectiveness of additional tobacco-control efforts. State agencies should increase promotion of tobacco control policies and programs to increase awareness and reduce disparities in tobacco use.

Oropharyngeal Squamous Cell Carcinoma Outcomes by p16INK4a Antigen Status in a Veteran Population.

The correlation between head and neck squamous cell carcinoma (SCC) and human papillomavirus (HPV) has been of great interest. We aimed to study immunoexpression of the p16INK4a (p16) antigen, a surrogate marker for high-risk HPV infection, in oropharyngeal SCC among veterans to estimate HPV-related cancer and survival. Secondary aims included stratification of race and ethnicity, degree of tobacco and alcohol use, tumor location, stage, and age at diagnosis. A retrospective electronic health record review was performed between January 1, 2000, and December 31, 2008, at a tertiary-level US Department of Veterans Affairs (VA) medical center for veterans who were treated for oropharyngeal SCC, had follow-up for a minimum of 2 years, and for whom paraffin-embedded tissue was available. Paraffin-embedded tissue was analyzed for p16 expression. We identified 66 veterans who met the inclusion criteria. p16 expression was observed in 29% of the patients. All patients were male with no difference in age at diagnosis between the groups. Among patients with p16-negative status, 60% were African American, whereas among patients with p16-postive status, 32% were African American (P = .04). Among patients with p16-postive status, 22% were tobacco-naïve, and 18% were alcohol-naïve vs 0% and 4%, respectively, of patients with p16-negative status (P = .005 and P = .12, respectively). Two-year survival was the same for both groups (P = .52). We observed p16 expression in 29% of VA patients with oropharnygeal SCC, which was less than observed in non-VA populations. At presentation, both groups demonstrated a predilection for tonsil location and late stage without significant difference in age or disease-specific survival. Disparities in racial distribution and tobacco use between patients with and without p16-positive status appear like that reported in non-VA populations; however, the frequently reported younger age at presentation, lower stage, and improved prognosis were not observed.

COMPARISON OF GLOBAL YOUTH TOBACCO SURVEY (GYTS) – 4 TAMIL NADU WITH INDIA

The Global Youth Tobacco Survey (GYTS) is a worldwide survey of students in grades 13 through 15 that is conducted in schools and is nationally representative. The worldwide youth tobacco survey is a component of the global tobacco surveillance system.This paper evaluates the gender disparities in tobacco use across the populations of Tamil Nadu and India using data from the GYTS 2019 survey.The 2019 GYTS objectives were determining the level of tobacco usage, indicated age, exposure to secondhand smoke, and tobacco advertising. A total of 34 schools from Tamil Nadu were chosen for the survey among the 987 schools in India.The questionnaire included details about tobacco use prevalence, quitting, secondhand smoke, the media's influence on tobacco use, the availability of tobacco to young people, and knowledge and attitudes about smoking in paper products among girls and boys between the ages of 13 and 15. Prevalence of ever tobacco users and current tobacco users (both smoking and smokeless form) in Tamil Nadu is lower than Indian average.This Youth Tobacco Survey data is used by health and education professionals to improve national and state programs aimed at preventing and reducing youth tobacco use

Racial and Ethnic Differences in Initiation of Menthol Tobacco Smoking and Subsequent Tobacco Use in the Population Assessment of Tobacco and Health Study, Waves 1-4 (2013-2018).

Certain subpopulations in the United States are highly vulnerable to tobacco initiation and addiction, and elimination of disparities among those groups is crucial to reducing the burden of tobacco use. This study evaluated the racial and ethnic differences in smoking initiation of menthol flavored cigarettes and cigars among never-users, and in subsequent tobacco use among new users of menthol-flavored products, using longitudinal data from waves 1-4 of the Population Assessment of Tobacco and Health Study. The outcomes of interest were new use of menthol-flavored products, and subsequent past 30-day and past 12-month cigarette and cigar smoking, irrespective of flavors, after initiation. The percentages of new users of menthol-flavored cigarettes and cigars at waves 2-4 were disproportionately higher in non-Hispanic black and Hispanic than in non-Hispanic white people. Adjusting for age and sex, black people who first used any menthol cigars had higher risk of past 30-day use of the same cigar category at the subsequent wave (adjusted risk ratio, aRR 1.48; 95% confidence interval [CI] 1.11 to 1.96) and past 12 months (aRR 1.74; 95% CI 1.55 to 2.63) compared to non-Hispanic white smokers. Black people who first used menthol-flavored cigarettes had marginally higher risk of subsequent past 30-day cigarette use (aRR 1.44; 95% CI 0.99 to 2.10) compared with their non-Hispanic white counterparts. This study shows that racial and ethnic differences exist in both initiation of menthol-flavored tobacco products and product-specific subsequent use after first using menthol-flavored products; black and Hispanic people have higher rates of initiation; black people also have higher rates of subsequent use. Use of menthol flavors in tobacco products is confirmed to be a contributor to large disparities in tobacco use; black and Hispanic people are more likely to maintain smoking through use of mentholated products than non-Hispanic white people. The findings suggest educational and regulatory actions on menthol-flavored tobacco products including restricting the selective marketing to vulnerable communities and banning characterizing flavors in cigarettes and cigars may reduce tobacco-related disparities and inform the Food And Drug Administration's evidence-based rulemaking process.

Motives of Tobacco Use Among Young Adults in the United States Air Force.

Research has focused on cigarette use motives and have not included military personnel. The current study assessed tobacco use motives for different products, and differences within males and females and those with different racial identities given historical disparities in tobacco use. A cross-sectional survey about tobacco use was administered from October 2019 to February 2022. Four Technical Training bases in the US. Air Force Airmen who used tobacco (N = 3243). Questions were about sociodemographic characteristics, tobacco use, and the Tobacco Motives Inventory (representing affect regulation, boredom, enhancement, and social motives). Linear regressions assessed associations between overall tobacco use and motives. Stratified analyses assessed associations between tobacco use and motives among males and females, and individuals from different racial backgrounds. Logistic regressions assessed differences in motives and use of different tobacco products between "some day" and "everyday" users. Overall, boredom (B = .09, SE = .01) and affect regulation (B = .05, SE = .00) motives were associated with higher tobacco use. Males and females and individuals from different racial backgrounds endorsed different motives, but all endorsed boredom as a motive for higher tobacco use. Individuals who used cigarettes, e-cigarettes, or smokeless tobacco "some days" endorsed higher social motives than everyday users, but everyday users endorsed different motives across products. There are motives differentiating between "some day" and "everyday" users of tobacco products, which may need to be differentially targeted in intervention programs. Additionally, there are some overlapping motives (affect regulation, boredom) that may be beneficial to address with all tobacco users.

Psychosocial Drivers of Racial/Ethnic Disparities in Tobacco and Cannabis Use Among Youth and Adults in the United States

Psychosocial Drivers of Racial/Ethnic Disparities in Tobacco and Cannabis Use Among Youth and Adults in the United States

Disparities in Cigarette, E-cigarette, Cigar, and Smokeless Tobacco Use at the Intersection of Multiple Social Identities in the US Adult Population. Results From the Tobacco Use Supplement to the Current Population Survey 2018-2019 Survey.

Sociodemographic disparities in tobacco use are prevalent and persistent in the United States. Nevertheless, few studies have examined disparities in tobacco use from an intersectionality perspective. We developed a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of multiple social identities. We used the 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to estimate the prevalence of tobacco product use at the intersection of age (18-34, 35-54, ≥55 years), sex (male, female), race/ethnicity (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other), and annual household income (<$50 000, $50 000-$99 999, and ≥$100 000). Estimates accounted for the complex survey design. For cigarettes, the most defining characteristic was income, with the highest prevalence among low-income NH White male adults aged 35-54 years (30.7%) and low-income NH White female adults aged 35-54 years (29.7%). For e-cigarettes, the most defining characteristic was age, with adults 18-34 years old having the highest prevalence. High prevalence groups for cigars included young- and middle-aged NH Black and NH White males, while NH White males had the highest prevalence of smokeless tobacco use. Our intersectionality visualization tool is helpful to uncover complex patterns of tobacco use, facilitating the identification of high-risk groups. We created a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of age, sex, race/ethnicity, and income. Our visualization tool helps uncover complex patterns of tobacco use, facilitating the identification of high-risk population groups that would otherwise be masked. These results can be used to implement tobacco control policies targeted at factors that promote or sustain tobacco use disparities.

Disparities in Tobacco Use by Disability and Type: Findings From the 2019 National Health Interview Survey

People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use. Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type. Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95). People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities.

The effect of race/ethnicity and adversities on smoking cessation among U.S. adult smokers

IntroductionBlack and Hispanic individuals in the US experience more socioeconomic adversities that are associated with disparities in tobacco use and cessation than White individuals. This study examined if racial/ethnic differences in smoking abstinence were mediated by socioeconomic (SES) adversities. MethodsData from 7,101 established smokers were identified in Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) and followed to Wave 4 (2016–2018). The study outcome was cigarette abstinence at Wave 4. The main independent variable was race/ethnicity (Non-Hispanic White [White], Non-Hispanic Black [Black] and Hispanic). The mediators were five measures of SES adversities (unemployment, poverty, difficulty with money, lower education level, lack of health insurance). A weighted Generalized Structural Equation Model (GSEM) was used to estimate the total, direct, and indirect effect of race/ethnicity on the odds of quitting mediated by the five SES adversities. This model was adjusted by study covariates, including health and smoking characteristics. ResultsThe indirect effect of race/ethnicity on cessation showed that differences in quitting between Black and White individuals as well as Hispanic and White individuals were mediated by SES adversities. However, the differences in quitting between Hispanic and Black individuals were not mediated by SES adversities. Black and Hispanic individuals were less likely to quit than White individuals, but Hispanic individuals were more likely to quit than Black individuals. There were no direct effects between Black or Hispanic individuals compared to White individuals. Those with higher SES were more likely to quit compared to those with lower SES. DiscussionSmoking abstinence is higher in White individuals compared to Black and Hispanic individuals and is mediated by SES adversities. However, smoking abstinence is higher among Hispanic individuals compared to Black individuals and it is not mediated by SES adversities. Future studies should consider the role of other factors, such as psychosocial support, racism, discrimination, and stress over the life course in explaining differences in smoking abstinence between Black and Hispanic individuals.

Disparities in traditional and alternative tobacco product use across sexual orientation groups of young adult men and women in the US

Background: Despite literature documenting disparities in tobacco use among sexual minority young adults, research is just emerging regarding alternative tobacco product (ATP) use among specific sexual minority men versus women. The current study examined associations between sexual orientation and traditional and ATP use among young adult men and women. Methods: We analyzed survey data (September–December 2018) from 2,809 young adults (ages 18–34) recruited via social media. Multivariable regression models were used to examine the binary outcomes of any past 30-day use of cigarettes, e-cigarettes, cigars, hookah, and any tobacco product (logistic regression), and the continuous outcome of number of categories of tobacco products used (linear regression), in relation to sexual orientation (bisexual, gay/lesbian, heterosexual) among men versus women, controlling for age and race/ethnicity. Results: In this sample (M age = 24.60, SD = 4.73; 56.0% women, 71.5% White, 5.4% Black, 12.6% Asian, 11.5% Hispanic), 9.3% of participants identified as gay/lesbian (13.1% of men, 6.2% of women) and 17.6% bisexual (8.3% of men, 25.0% of women). Gay men were less likely to use e-cigarettes, cigars, and any tobacco product, and used fewer products relative to heterosexual men. Bisexual women were more likely to use each tobacco product and any tobacco product, and used more categories of products relative to heterosexual women. Conclusions: Specific tobacco use disparities differ with respect to type of product, gender, and sexual orientation, underscoring the need to better understand the underlying mechanisms of these differences (e.g., marketing, social influences) and developing interventions to address them.

Associations between disparities in tobacco retailer density and disparities in tobacco use

Research has separately established that there are disparities in tobacco use, that greater tobacco retailer density (TRD) is positively associated with tobacco use, and that TRD is greater in high poverty and high racial/ethnic minority neighborhoods. Connecting these topics, this study examined the association between disparities in TRD and disparities in the prevalence of tobacco use among adults and youth. We obtained Ohio data on tobacco use from two statewide adult surveys and two sub-state regional youth surveys (2017–2019). Licensed tobacco retailers in Ohio were geocoded within census tracts. Disparity in TRD within regions across the state was defined as the ratio of TRD in high vs. low poverty (and in high vs. low racial/ethnic minority) census tracts per region. Disparity in cigarette smoking (adults) and any tobacco use (youth) was defined as the ratio of use prevalence among socioeconomically disadvantaged vs. non-disadvantaged (and racial/ethnic minority vs. non-minority) individuals. We estimated Pearson correlation coefficients to assess the linear relationship between the TRD disparity ratios and tobacco use disparity ratios. Poverty-based and race/ethnicity-based TRD disparities were positively associated with smoking disparities among adults. Negative associations between TRD disparities and tobacco use disparities were found among youth. To our knowledge, this is the first analysis directly linking TRD disparities and tobacco use disparities. Different adult and youth findings may be due to trends by age and product preferences. For adults in particular, this analysis suggests a detrimental effect of the tobacco retail environment on disadvantaged populations.