Association of Race-Ethnicity Intersection With Disparities in Cigarette Smoking in U.S. Adults

Introduction: Detailed estimates of disparities in cigarette smoking across single- and multi-race groups and their intersections with ethnicity are lacking. This study estimates the prevalence of self-reported current smoking among intersecting adult race-ethnicity groups in the United States. Aims and Methods: The analysis uses 2018–2019 data from the Tobacco Use Supplement—Current Population Supplement (TUS-CPS; n = 137 471). Self-reported Hispanic origin and race were recoded into 19 mutually exclusive race-by-ethnicity intersecting groups. Weighted race-ethnicity group smoking prevalence were compared to the overall population prevalence and one another. Results: Compared to the U.S. population current smoking prevalence (11.4% [95% CI = 11.2% to 11.6%]), smoking was particularly higher in non-Hispanic American Indian/Alaska Native (AI/AN) groups (20.7% [95% CI = 17.8% to 24.0%]) and non-Hispanic multiracial AI/AN/White (24.4% [95% CI = 20.3% to 29.1%]) and AI/AN/Black (22.4% [95% CI = 14.4% to 33.2%]) groups. Non-Hispanic single-race Asian (5.0% [95% CI = 4.4% to 5.6%]) and Hispanic single-race White (7.2% [95% CI = 6.7% to 7.7%]) smoking prevalence undercut the overall U.S. population prevalence. In pairwise comparisons, smoking prevalence was higher in various non-Hispanic single- and multi-race AI/AN groups than non-AI/ AN groups and was lower in various Hispanic groups than non-Hispanic groups. Conclusions: Smoking prevalence disparities are not monolithic across complex diversity of race and ethnicity in the United States. Accurate identification of priority populations in need of targeted tobacco control efforts may benefit by acknowledging multinomial heterogeneity across intersecting racial and ethnic identities. Implications: Understanding racial and ethnic disparities in cigarette smoking can inform national strategies for reducing health inequities. This study examines cigarette smoking disparities among 19 adult intersecting race-ethnicity groups in the United States using the 2018–2019 TUS-CPS data. Results show higher smoking rates in some non-Hispanic American Indian/Alaska Native and Black groups, while lower rates are seen in Asian and Hispanic individuals. These findings emphasize the need for disaggregated data to tackle smoking disparities and guide targeted prevention efforts.