Racial/ethnic discrimination and tobacco and cannabis use outcomes among US adults

Unpacking the complexities in racial and ethnic discrimination and tobacco use and cannabis co-use behaviors among young adults in the U.S

Introduction

There is a general paucity of research describing the relationship between racial and ethnic discrimination (RED) and coping strategies on use of little filtered cigars and cigarillos (LCCs) across racial and ethnic identities. This research sought to unravel some of the complex, multilayered experiences of RED and subsequent coping strategies to examine the impact on LCC use.

Methods

Data come from a cross-sectional survey conducted among a nationally representative sample of U.S. young adults (n = 1,178) in May 2022. Respondents were asked about their exposure to LCC marketing (systemic RED), interpersonal experiences of RED, coping strategies, and use of LCCs as-sold (tobacco only) or as a blunt (with marijuana). Multivariable logistic regression was used to examine odds of LCC use examining systemic and interpersonal RED and the relationship between emotion-focused and problem-focused coping strategies among those who have experienced RED.

Results

Exposure to systemic RED was associated with increased odds of blunt use. Interpersonal experiences of RED were associated with increased odds of LCC use as-sold and as blunts. Among those who experienced any RED, the impact of problem-focused and emotion-focused coping was differential across racial and ethnic identities in the impact on LCC use modality.

Conclusion

Systemic and interpersonal RED are independently associated with LCC use. There are considerable differences in how young adults cope with RED which necessitates additional research to further elucidate the complex pathways between RED and product use to more effectively inform strategies to address the undeniable racial and ethnic inequities in tobacco-related health outcomes.

Analyzing multiple types of discrimination using implicit and explicit measures, comparing target vs. Dominant groups, in a study of smoking/vaping among community health center members in Boston, Massachusetts (2020-2022)

BACKGROUND

In the United States (U.S.), the physical and mental health sequelae of diverse types of discrimination are far-reaching, severe, and contribute to population health inequities, with this work informing research on discrimination and health in both the Global North and Global South. To date, limited population health research has examined the joint impacts of discrimination measures that are explicit (i.e., self-report) and implicit (i.e., automatic mental representations), both singly and for multiple types of discrimination.

METHODS

Between May 28, 2020-August 4, 2022, we conducted Life + Health, a cross-sectional population-based study regarding six types of discrimination-racism, sexism, heterosexism, cissexism, ageism, and sizeism-with 699 participants (US-born, ages 25-64) from three community health centers in Boston, Massachusetts. Participants completed a Brief Implicit Association Test (B-IAT) and self-reported survey. Spearman's correlation coefficient was estimated to assess the strength and direction of discrimination types across target/dominant groups; logistic regression models were fit to assess the association of each type of discrimination with smoking/vaping following by random-effects meta-regression modeling to pool effects across discrimination types.

RESULTS

Mean age was 37.9 years (SD = 11.2 years). Overall, 31.6% were people of color; 31.8% identified as transgender or nonbinary/genderqueer; 68.6% were sexual minority. For education, 20.5% had some college/vocational school or no college. Current cigarette/vaping was reported by 15.4% of the study population. Implicit and explicit measures were generally correlated with one another, but associations varied across discrimination types and for target/dominant groups. In random-effects meta-regression modeling, explicit compared to implicit discrimination measures were associated with a 1.18 (95% CI = 1.00-1.39) greater odds of smoking/vaping among dominant group members, but no such difference was observed among target group members.

CONCLUSION

Implicit and explicit discrimination measures yielded distinct yet complementary insights, highlighting the importance of both. Meta-regression provided evidence of health impacts across discrimination types. Future research on discrimination and health, in diverse country contexts, should consider using both implicit and explicit measures to analyze health impacts across multiple types of discrimination.

Sociodemographic disparities in everyday discrimination among a national sample of adults in the United States, 2023

Objective

Discrimination is a social determinant contributing to health inequities in the United States (US). This study investigated the prevalence of, and sociodemographic disparities in, perceived everyday discrimination among a national sample of US adults.

Methods

We used data from the 2023 National Health Interview Survey (n = 27,538) and estimated the prevalence of three perceived everyday discrimination outcomes (1) any discrimination, (2) unique components of the discrimination experience, and (3) the Everyday Discrimination Scale (EDS) (range: 0-20) overall and by age, sex assigned at birth, race and ethnicity, sexual orientation, educational attainment, income-to-poverty ratio, and urban-rural status.

Results

Over half of US adults experienced any discrimination (55.8 %), and the most common form of perceived discrimination was being treated with less respect (45.2 %). Adults who were younger (aged 18-44), female, non-Hispanic Black, sexual minority, some college-educated, low income, or urban-living generally reported higher discrimination. For example, among the sample, non-Hispanic Black (vs. non-Hispanic White) (OR: 1.61, 95 % CI: 1.44-1.81) and sexual minority (vs. heterosexual) (OR: 2.48, 95 % CI: 2.12-2.90) adults had the highest odds of any discrimination and EDS scores (β: 1.38 (95 % CI: 1.17-1.59) and β: 1.65 (95 % CI: 1.35-1.94), respectively). The odds of perceived discrimination varied in magnitude by specific experience; for example, sexual minority adults had the highest odds of being threatened or harassed (OR: 2.93, 95 % CI: 2.52-3.42).

Conclusions

Perceived everyday discrimination is prevalent and differentially affects adults, especially members of marginalized and underserved populations. Understanding discrimination patterns will benefit public health and medical efforts aimed at mitigating exposure and deleterious health consequences.

Situations and roles of cannabis versus cigarette use: Integrating ecological momentary assessment with qualitative mapping interviews

Use of both cannabis and tobacco has surpassed use of tobacco alone among young adults in California. To better understand why, we collected data with 32 young adults ages 18-30 in Northern California who regularly used cigarettes and cannabis and had diverse sexual, gender, racial, and ethnic identities. Geographically-explicit ecological momentary assessment (EMA; 30 days) was integrated with qualitative mapping interviews. We found contrasting situations of use for cannabis (e.g., around other people) versus cigarettes (e.g., recent discrimination) and different reasons for why participants chose one substance over the other (e.g., enhancing experiences vs. stepping away). Understanding when and why diverse young adults choose cannabis versus cigarettes as they navigate everyday environments helps explain how cannabis and tobacco retail markets shape substance use disparities over time.

Patterns of Tobacco and Cannabis Use Among Sexual Minority Females and Males From PATH Wave 5: The Role of Sociodemographic and Psychosocial Correlates

INTRODUCTION

Although sexual minority (SM; vs heterosexual) individuals display higher rates of tobacco and cannabis use, limited research has examined sociodemographic and psychosocial correlates of single and co-use among this population.

METHODS

Participants were SM-identifying female (N = 2419; Mage = 27.80; 50.0% racial/ethnic minority) and male (N = 1142; Mage = 30.34; 46.1% racial/ethnic minority) adults from Wave 5 of the Population Assessment of Tobacco and Health study. Multinomial logistic regressions examined sociodemographic (ie, sexual identity, age, race/ethnicity, education, income) and psychosocial (ie, alcohol use, mental health, substance use) correlates of single and co-use (ie, no use [referent], tobacco-only, cannabis-only, co-use), controlling for state cannabis legalization, among SM females and males, separately.

RESULTS

The proportions of SM females reporting no use, tobacco-only, cannabis-only, and co-use were 37.9%, 24.0%, 10.5%, and 27.6%, respectively. Among males, 40.6%, 27.8%, 10.1%, and 21.5% reported no use, tobacco-only, cannabis-only, and co-use, respectively. Among females and males, substance use problems were associated with all 3 use groups (vs no use); past-month alcohol use was associated with cannabis-only and co-use; and mental health symptoms were associated with co-use (and cannabis-only in males). Sociodemographic correlates among females were: tobacco-only-identifying as bisexual (vs lesbian), White (vs Black), older, lower education, and lower income; cannabis-only-bisexual, other race (vs White); and co-use-White (vs Hispanic), lower education, and lower income. Among males, sociodemographic correlates were: tobacco-only-older, lower education, and lower income; cannabis-only-Black (vs White) and higher income.

CONCLUSIONS

Public health efforts to reduce tobacco and cannabis use among SM adults should target single versus co-use patterns and their corresponding sociodemographic, mental health, and substance use profiles.

Race/ethnic differences in the association of anxiety, depression, and discrimination with subsequent nicotine and cannabis use among young adults: A prospective longitudinal study

INTRODUCTION

The shifting patterns in nicotine and cannabis use among young adults is taking place at a time when there is also increased reports of psychosocial stressors such as anxiety, depression, and everyday discrimination. Although race/ethnicity has been found to moderate the impact of psychosocial stressors, there is limited research examining the association of anxiety, depression, and discrimination with patterns of nicotine and/or cannabis product use among diverse young adults.

METHODS

Data were from a longitudinal study of 2478 US young adults surveyed between 2019 and 2021. General estimating equation models were used to examine associations of self-reported psychological symptoms (depression, anxiety) and social stressors (discrimination) with substance use (any nicotine and cannabis product use; nicotine and cannabis vaping).

RESULTS

Young adults from different racial/ethnic groups differed significantly in their depression and discrimination scores with young adults of color having higher mean scores. Overall, higher depression and everyday discrimination score was associated with increased odds of past 6-month use of any nicotine/tobacco and cannabis products. Higher generalized anxiety score increased odds of any nicotine/tobacco and dual nicotine and cannabis product use. Higher everyday discrimination score was associated with increased odds nicotine and cannabis vaping overall. Stratified models showed variation in associations among different racial/ethnic groups.

CONCLUSIONS

Psychosocial stressors are associated with increased substance use odds among young adults. However, these stressors have a differential impact on substance use odds among young adults from different racial/ethnic contexts.