Discrimination and Tobacco Use Outcomes Among US Adults: Effect Modification by Race/Ethnicity

Delvon T. Mattingly, Briana Mezuk, Michael R. Elliott, Nancy L. Fleischer

Research output: Contribution to journalArticlepeer-review


Introduction: Racial/ethnic discrimination (hereafter, discrimination) is associated with tobacco use. However, little is known about the relationship between discrimination and dual/polytobacco use and tobacco use disorder (TUD), including how these relationships vary by race/ethnicity. Methods: Data on adults 18 and older come from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 35,881). Past-year discrimination was measured using the Experiences of Discrimination scale. Past 30-day exclusive, dual, and polytobacco use was measured as the mutually exclusive use of any combination of four types of tobacco products: cigarettes, electronic nicotine delivery systems, other combustibles (i.e., cigars and pipe), and smokeless tobacco. Past-year TUD was defined according to DSM-5 criteria. Associations between discrimination and exclusive, dual, and polytobacco use and discrimination and TUD were estimated using multinomial logistic regression and logistic regression, respectively. Models were stratified by race/ethnicity (i.e., Hispanic, non-Hispanic (NH) White, NH Black, another race/ethnicity) to assess effect modification. Results: Adults who used tobacco and who had TUD was 24.2% and 19.2%, respectively. More discrimination was associated with higher odds of exclusive, dual, and polytobacco use as well as TUD. Models stratified by race/ethnicity suggest that discrimination was associated with dual/polytobacco use among NH Black adults (OR: 1.05, 95% CI: 1.002–1.11) and NH White adults (OR: 1.18, 95% CI: 1.13–1.22). While more discrimination was associated with TUD among all racial/ethnic groups, the relationship was the strongest for NH White adults. Conclusions: Discrimination was associated with more severe tobacco use outcomes among multiple racial/ethnic groups, but associations were the strongest for NH White adults.

Original languageEnglish
Pages (from-to)395-405
Number of pages11
JournalJournal of racial and ethnic health disparities
Issue number1
StatePublished - Feb 2024

Bibliographical note

Publisher Copyright:
© 2023, W. Montague Cobb-NMA Health Institute.


  • Discrimination
  • Health disparities
  • Polytobacco
  • Tobacco

ASJC Scopus subject areas

  • Health(social science)
  • Anthropology
  • Sociology and Political Science
  • Health Policy
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Discrimination and Tobacco Use Outcomes Among US Adults: Effect Modification by Race/Ethnicity'. Together they form a unique fingerprint.

Cite this