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Discrimination and Tobacco Use Outcomes Among US Adults: Effect Modification by Race/Ethnicity



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.


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.


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.


Discrimination was associated with more severe tobacco use outcomes among multiple racial/ethnic groups, but associations were the strongest for NH White adults.

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Data Availability

The NESARC-III data are limited access and must be requested from the US National Institute on Alcohol Abuse and Alcoholism (NIAAA) at


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The data used in this manuscript were limited access and obtained from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).


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.

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All authors contributed to the study conception and design. Material preparation and data analysis were performed by Delvon T. Mattingly. The first draft of the manuscript was written by Delvon T. Mattingly, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Delvon T. Mattingly.

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Mattingly, D.T., Mezuk, B., Elliott, M.R. et al. Discrimination and Tobacco Use Outcomes Among US Adults: Effect Modification by Race/Ethnicity. J. Racial and Ethnic Health Disparities (2023).

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  • Discrimination
  • Health disparities
  • Tobacco
  • Polytobacco