Abstract
INTRODUCTION: Racism and discrimination are a public health problem. This study aims to examine the association of racially-motivated discrimination distress using the Adolescent Discrimination Distress Index (ADDI) and its subscales - institutional, educational, and peer - with tobacco use outcomes. METHODS: Weighted logistic regression was used to model the effect of discrimination on past 30-day tobacco use, poly-tobacco use, use frequency, tobacco dependence, intention to quit, and history of quit attempt using data from the 2023 National Youth Tobacco Survey. RESULTS: Approximately 53.9% (> 12 million) of adolescents reported discrimination. Higher ADDI scores were associated with higher odds of tobacco dependence (AOR = 1.04, 95% CI = 1.02-1.07, p < 0.05). Higher scores on each of the three subscales were associated with higher odds of tobacco dependence: institutional (1.09, 1.04-1.16), educational (1.10, 1.03-1.17), and peer (1.08, 1.04-1.13) (p < 0.05 for all). Moreover, the peer subscale was associated with lower odds of intention to quit (0.93, 0.88-0.99) and history of quit attempt (0.93, 0.87-0.99) (p < 0.05 for both). CONCLUSIONS: Scores of ADDI and each of the three subscales were independently associated with tobacco dependence. Scores of the peer subscale were also associated with lower intention to quit and quit attempt. Prevention interventions may consider strategies to increase resilience against discrimination and screening for discrimination when treating young people with tobacco dependence.