Understanding and reducing health disparities through social and behavioral research

National Institute On Minority Health And Health Disparities

Investigators

Linked publications & trials

Abstract

Narrative Understanding inter-relationships between social determinants and tobacco use We have furthered the understanding of the complex relationships between social determinant of health and commercial tobacco use. One line of this research focuses on how commercial tobacco use may influence socio-economic status and its precursors. Using data from a national longitudinal study of youth, we examined how cigarette and e-cigarette use initiation was related to subsequent academic performance. We found that compared to youth who did not initiate cigarette smoking, those who initiated cigarette smoking had subsequently lower academic performance. Similar association was observed for e-cigarette use initiation. Since academic performance is a precursor to higher educational attainment, we expect that those who use commercial tobacco during high school would be less likely to graduate from college. In a separate national cohort study, tested this hypothesis and found that compared to those who reported no cigarette smoking during high school, those who reported any cigarette smoking during high school was less likely to complete a 4-year college degree on time. Together, these studies suggest that youth commercial tobacco use can impact later socioeconomic status. Additionally, we have expanded our understanding of commercial tobacco use in populations that bear high burdens of commercial tobacco use. Among Black individuals, we conducted a series of qualitative analyses to explore the physical and sociocultural community-level factors that influenced smoking, experiences and perceptions of cigar craving, and addiction. We also used national surveillance data to examine the changes in age of cigar smoking initiation over time by racial/ethnicity and educational attainment. We found that among Black individuals, the gap in age of cigar smoking initiation by educational attainment has widened over time. Specifically, those with college education started cigar smoking later over time, but those with less than college education started cigar smoking at a younger age than those with college education and did not change over time. Moreover, in a nationally representative, diverse cohort of youth and young adult, we examined the correlates of tobacco product use initiation across a 5-year period. We found that compared to White young adults, Black young adults were more likely to initiate cigar and hookah use, while Hispanic young adults were more likely to initiate cigarette, e-cigarettes, and hookah use. Investigate mediating and moderating factors associated with tobacco use disparities We continue to document how traditional and new marketing strategies used by the tobacco industry influence use behaviors. In an online experiment, we tested how the tobacco-free nicotine claim influenced perceptions and intention to use e-cigarettes among young adults who did not use commercial tobacco. We found that those who were randomized to seeing the tobacco-free nicotine claim were more likely to be interested to start using e-cigarettes. In a second online study, we examined what features in e-cigarette advertisements appeal to non-tobacco-using young adults. We found that price discounts and mentioning of non-tobacco flavors was associated with interest in using these products. Additionally, Hispanic and Black young adult found price discount more appealing than White young adults. These findings suggest that limiting these marketing strategies can reduce commercial tobacco use and race/ethnicity-related disparities. Use marketing research perspective to reduce tobacco use disparities Changing product standard is a marketing strategy to reduce tobacco use disparities. One specific product standard modification is to eliminate non-tobacco flavors in commercial tobacco products. As the US FDA is poised to remove these flavors in cigars, we examined how young adults would react. In a qualitative study with Black young adult cigar smokers, we found that about a third of them would reduce or stop smoking cigars altogether. In a subsequent online study with flavored cigar users, we found that 15.1% of them would quit cigar smoking completely if non-tobacco flavors were eliminated. However, we found that racial/ethnic minority flavor cigar smokers were more likely than White flavor cigar smokers to substitute flavored cigars with cannabis. These findings indicate that while cigar flavor restriction could produce positive health impact among racial/ethnic minority individuals, addressing its potential unintended consequences (e.g., increase in cannabis use in these individuals) would be needed. Investigate the impact of tobacco use patterns and health outcomes Understanding of impact of e-cigarette use on health outcomes remains limited. One argument of the association between e-cigarette use and respiratory disorder we previously reported is the confounding relationship between e-cigarette and cigarette use, which the latter causes respiratory disorder. To this end, we tested that whether accounting for cigarette smoking is going to nullify the association between e-cigarette use and respiratory disorder. In a national sample of 214,945 adults, we found that the relationship between e-cigarette and cigarette use do not fully nullify the association between e-cigarette use and respiratory disorder. This finding provides further evidence to infer the health impact of e-cigarette use on population health. COVID-19 and Tobacco Use During the COVID-19 pandemic, anti-Asian sentiment and incidents increased dramatically. Much of this was because Asians were blamed for the pandemic. As many of these COVID-19-related discrimination incidents were reported in the news, we examined how concerns about experiencing these discrimination incidents varied between Asian and Asian American versus White commercial tobacco users, and how these concerns influence changes in cigarette consumption. We found that Asian and Asian American individuals expressed higher levels of concerns about experiencing COVID-19 discrimination than White individuals. We also found that higher levels of concerns were associated with increases in cigarette consumption during the pandemic. These findings indicate that the impact of COVID-19-related discrimination disproportionately affect Asian and Asian American individuals in term of its influence on cigarette smoking.