Tobacco use trajectories and related mechanisms among US adults and youth representing minority and intersecting minority identities

SUMMARY/ABSTRACT Tobacco-related disparities are well-documented, particularly among racial/ethnic minorities, sexual/gender minorities (SGM), low socioeconomic status (SES; e.g., low income), and rural populations. However, the literature is limited by insufficient examination of: 1) such disparities among those with intersecting minority identities; 2) disparities in use of the diverse tobacco products in the current tobacco market; 3) mechanisms (e.g., marketing exposure, differing product perceptions) underlying such disparities among those with minority and intersecting minority identities; and 4) longitudinal associations, particularly using nationally-representative data. Regarding the former, groups disproportionately impacted are typically described by social identifiers that are visible and relatively static, like race. However, social determinants (e.g., industry marketing) impact individuals and may have multiplicative effects, thus requiring a more nuanced understanding of the mechanisms by which certain groups are impacted. Informed by social determinants of health (SDOH) and intersectionality perspectives, this study’s objective is to test our central hypothesis that US adults and youth representing intersecting minority identities will demonstrate distinct tobacco use behaviors (e.g., likelihood of use vs. no use of distinct products, polyproduct use profiles) and related mechanisms (e.g., marketing exposure and perceptions) over time. The rationale is that certain products may have specific characteristics (e.g., novelty, technology, flavors) that appeal to and/or are marketed toward different subgroups (i.e., minorities) and thus shape their perceptions (e.g., risk, social norms) and use behaviors. Moreover, individuals representing more than one targeted subgroup may be particularly impacted. We will use the Population Assessment of Tobacco and Health (PATH) study (both adult and youth survey data) – a nationally-representative longitudinal cohort study – to examine: 1) differences in tobacco use behaviors over time (i.e., trajectories in use of different products, any product, or multiple products; use of flavored products) among adults representing specific minority identities (i.e., racial/ethnic minorities, SGM, low-SES, rural) and explore the effects of intersecting minority identities (i.e., intersectionality) on use behaviors; 2) pathways underlying differential tobacco use behaviors over time among adults representing minority and intersecting minority identities, including tobacco marketing exposure and product perceptions (i.e., risks, social norms); and 3) differences in marketing exposure and product perceptions over time as outcomes – and as mechanisms of use to the extent possible (due to lower youth use prevalence) – in youth of minority and intersecting minority identities. This proposal will advance our long-term goal of informing research, interventions, and regulations to catalyze the reduction of tobacco-related disparities and the population impact of tobacco in the US.