An intersectional examination of early tobacco use among White and Black adolescents

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PROJECT SUMMARY Tobacco use is a prominent cause of preventable health disparities between White and Black individuals. Tobacco use is primarily established in adolescence. Although the lifetime prevalence of tobacco use is lower for Black than it is for White individuals, Black adolescents are less likely to quit tobacco once they initiate use. In the long run, Black individuals suffer disproportionately from tobacco-related death and disease. Significant progress has been made in identifying risk and protective factors for tobacco use in the general population. These factors are commonly addressed in standard tobacco control strategies. However, relative to Whites, Black individuals face diminished gains from standard tobacco control strategies. Our central hypothesis is that said diminished gains are explained by complex and dynamic interrelations between multi-level risk and protective factors for tobacco use that vary between White and Black adolescents. Current approaches for understanding tobacco use do not investigate these interrelations, which is a critical barrier for the development of targeted interventions that effectively mitigate tobacco use among Black adolescents. In this proposal we will employ a theoretically grounded and innovative conceptual model to examine Black-White differences in tobacco use across multiple intersecting domains and levels of influence. We will use adolescent data collected as part of the PATH study, the largest nationally representative longitudinal cohort study of tobacco product use in the US. Our aims include cross-sectional as well as longitudinal examinations across the four waves of PATH data. First, we will identify differences in the combination of risk and protective factors between Black and White adolescents. These analyses will explicate how unique risk factors among Black adolescents explain cross-sectional Black-White differences in tobacco use onset, types of products used, and frequency of use. Second, we will examine differences in the progression of risk and protective factors over time between White and Black adolescents. These analyses will elucidate unique patterns of risk and protective factors over time and their relation to tobacco use in the long run. This study’s findings will advance our understanding of diminished gains for Black individuals from standard tobacco control approaches. Further, this developmental study will identify new potential therapeutic targets for clinical and public health intervention development. Thus, findings from this project will have a sustained and powerful impact on the field of tobacco- related health disparities research.