Racial/ethnic discrimination and tobacco and cannabis use outcomes among US adults

Delvon T Mattingly; Harold W Neighbors; Briana Mezuk; Michael R Elliott; Nancy L Fleischer

doi:10.1016/j.josat.2023.208958

Racial/ethnic discrimination and tobacco and cannabis use outcomes among US adults

J Subst Use Addict Treat. 2023 May:148:208958. doi: 10.1016/j.josat.2023.208958. Epub 2023 Jan 14.

Authors

Delvon T Mattingly¹, Harold W Neighbors², Briana Mezuk³, Michael R Elliott⁴, Nancy L Fleischer³

Affiliations

¹ Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. Electronic address: delvon@umich.edu.
² Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
³ Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
⁴ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA.

PMID: 37102192
DOI: 10.1016/j.josat.2023.208958

Abstract

Introduction: Racial/ethnic discrimination (hereafter, discrimination) is associated with use of individual tobacco and cannabis products. However, we know little about how discrimination affects dual/polytobacco and cannabis use and associated use disorders.

Methods: We used cross-sectional data on adults (18+) from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 35,744). We defined past-year discrimination as a summary scale (range: 0-24) based on six scenarios. We created a mutually exclusive six-category use variable: noncurrent, individual tobacco and noncannabis, individual tobacco and cannabis, individual cannabis and nontobacco, dual/polytobacco and noncannabis, and dual/polytobacco and cannabis based on past 30-day tobacco use of four products (i.e., cigarettes, electronic nicotine delivery systems, other combustibles (cigars, pipe), smokeless tobacco) and cannabis use. We also examined past-year tobacco use disorder (TUD) and cannabis use disorder (CUD) as a four-level variable: no disorders, TUD only, CUD only, and TUD and CUD. We estimated associations between discrimination and each outcome using adjusted multinomial logistic regression and assessed effect modification by stratifying adjusted models by race/ethnicity (i.e., Hispanic, non-Hispanic (NH) White, NH Black, and another race/ethnicity).

Results: Experiencing more discrimination was associated with each outcome but was most strongly associated with dual/polytobacco and cannabis use (OR: 1.13, 95 % CI: 1.07-1.19) and joint TUD and CUD (OR: 1.16, 95 % CI: 1.12-1.20). Models stratified by race/ethnicity showed that discrimination was associated with dual/polytobacco and cannabis only among NH White adults, and with joint TUD and CUD only among NH Black and NH White adults.

Conclusions: Discrimination was associated with tobacco and cannabis use outcomes among multiple adult racial/ethnic populations, but associations were more profound for NH White and NH Black adults than adults from other racial/ethnic populations.

Keywords: Cannabis; Health disparities; Polytobacco; Racial discrimination; Substance use disorder; Tobacco.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Cannabis*
Cross-Sectional Studies
Humans
Tobacco Products*
Tobacco Use Disorder* / epidemiology

Grants and funding

U54 CA229974/CA/NCI NIH HHS/United States