Poly-Tobacco Use and Minority Health: Differential Risks, Transitions, and Socio-Environmental Context

Project Summary Racial and ethnic minorities and individuals of low SES disproportionately experience tobacco-related health inequities, including chronic illness and premature death. Poly-tobacco use—operationalized as the concurrent use of three or more different tobacco products, including electronic nicotine delivery systems (ENDS)—has seen an uptick among emerging adult tobacco users in recent years, notably minorities. The study premise is based the persistent tobacco-related health disparities among minorities and inadequate knowledge of factors that contribute poly-tobacco use or the relative harm. Bearing implications for NIH’s stated need (PAR-17-473 ) for comprehensive socio-environmental investigation as means to advance our knowledge, the study will apply a novel socio-spatial approach to uncover the unique contributions of individual, neighborhood-, county-, and state-level contexts associated with poly use among US emerging adults. The specific aims will shed new light on differential risks (Aim 1), transitions (Aim 2), and the moderating effects of context (Aim 3) of poly- tobacco use across race, ethnicity and low SES. The overriding hypothesis is that minority differences in poly- tobacco use are not explained solely through individual factors but are influenced by the interplay of environments in which emerging adults live, work, study, and play. Through Aim 1, we expect to uncover new information about the relative individual risks or harm among different categories of tobacco users and products, across minority groups—potentially informing both new biological and behavioral studies. Per Aim 2, we will determine factors that influence the transitions from single to dual or poly use over time, which in turn may inform how to prevent escalation to certain tobacco products, especially the most harmful combustible products. Pursuant of Aim 3, because we expect that poly-tobacco use will be best explained by a combination of personal and socio- environmental factors, we expect to uncover rich, new knowledge about contextual influences. We will undoubtedly uncover that individual demographic and behavioral factors explain a significant percentage of the variance in single, dual, and poly use outcomes. Imagine, however, the advancements in tobacco control if we could uncover not only the contributing socio-environmental domains, but also the factors within those domains that explain the remaining percentage—and across diverse racial, ethnic, and low SES populations. The potential impact of such knowledge on tobacco-related health disparities is high.