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
JournalJournal of racial and ethnic health disparities
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
This work was supported by the National Cancer Institute of the National Institutes of Health and the Food and Drug Administration's Center for Tobacco Products (grant number U54CA229974 to N.L.F.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Food and Drug Administration.

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


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