Discrimination Distress and Current Combustible and Non-combustible Tobacco Product Use Among US Youth, 2023

Introduction Discrimination is the unfair treatment of people based on their identity. Youth who experience discrimination may cope with associated distress by using tobacco products, with amplified health consequences depending on the type of product. Methods We used data from the 2023 National Youth Tobacco Survey (n=22069) and derived an overall continuous measure from the 15-item Adolescent Discrimination Distress Index, as well as three continuous discrimination distress sub-indices: educational, institutional, and peer (range for each: 0–5). We defined current tobacco use as two outcomes: any past 30-day use of combustible (cigarettes, cigars, hookah, roll-your-own, pipe, bidis) and non-combustible (e-cigarettes, smokeless tobacco, snus, heated tobacco, nicotine pouches, oral nicotine) products. To estimate associations between discrimination measures and tobacco use outcomes, we conducted multivariable logistic regression. Results Youth experienced more educational (mean=0.56) than peer (mean=0.48) and institutional (mean=0.38) discrimination distress, and the prevalence of current combustible and non-combustible tobacco use was 3.89% and 9.67%. A single unit increase in overall discrimination distress was associated with increased odds of combustible (AOR: 1.26, 95% CI: 1.08 to 1.47) and non-combustible (AOR: 1.23, 95% CI: 1.09 to 1.39) tobacco use. For subindices, only a single unit increase in institutional discrimination distress was associated with current combustible tobacco use (AOR: 1.30, 95% CI: 1.06 to 1.59). Conclusion Overall discrimination distress was associated with current use of combustible and non-combustible tobacco products; however, only institutional discrimination distress was associated with combustible product use. These findings highlight the importance of considering discriminatory contexts as they relate to potential youth tobacco use as a distress-coping mechanism. Implications This study adds to the growing evidence that discrimination distress, particularly in institutional contexts, is associated with youth combustible tobacco use. By highlighting the unique role of institutional discrimination in tobacco use, our findings emphasize the need for targeted interventions to address discriminatory environments in these settings. These results underscore the importance of integrating anti-discrimination policies and support systems into tobacco prevention efforts to reduce maladaptive behaviors among youth. This research also suggests examining how differing discrimination contexts may shape nicotine use behavior, potentially revealing insights helpful in tailoring prevention strategies.