Psychosocial Drivers of Racial/Ethnic Disparities in Tobacco and Cannabis Use Among Youth and Adults in the United States

Abstract

Racial/ethnic disparities in substance use, including tobacco and cannabis use, have persisted in the United States (US) for centuries. To fully understand these disparities, it is necessary for public health professionals and clinicians to move beyond attributing them to individual behaviors alone and to begin interrogating broader psychosocial factors that induce stress and psychological distress and potentially shape inequities in substance use and misuse. This dissertation investigated whether psychosocial determinants of health drive racial/ethnic disparities in tobacco and cannabis use, focusing on racially/ethnically salient determinants (e.g., discrimination) and among youth and adults, including emerging adults.

In Chapters 2 and 3, using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), I examined the relationship between racial/ethnic discrimination and tobacco and cannabis use and use disorders among adults living in the US and explored whether these associations were modified by race/ethnicity. I found that racial/ethnic discrimination was associated with patterns of tobacco and cannabis use (e.g., dual/poly tobacco and cannabis) and joint tobacco and cannabis use disorders. These associations were stronger for non-Hispanic (NH) White adults, followed by NH Black adults.

In Chapters 3 and 4, using data from the Population Assessment of Tobacco and Health (PATH) Study, I employed latent class analysis (LCA) to identify subgroups of tobacco and cannabis use, with consideration of various routes of administration (ROA), among US emerging adults and identified racial/ethnic differences. With this, I also estimated associations between mental health problems (i.e., internalizing/externalizing problems) and latent use classes overall and by race/ethnicity. I found that mental health problems were associated with tobacco and cannabis use and concurrent use (co-use) among youth and young adults (YAs), with associations varying by certain racial/ethnic groups.

Finally, in Chapter 5, I used data from the University of Southern California (USC) Happiness & Health (H&H) Study to conduct exploratory factor analysis (EFA) and determine whether nine indicators of concern, worry, and stress about societal discrimination, societal shootings/violence, and community police brutality (i.e., social problems) at baseline represented latent factors. I examined associations between each factor developed by the EFA and tobacco and cannabis use among a racially/ethnically-diverse cohort of YAs living in Los Angeles (LA), California. I found that factors representing concern, worry, and/or stress about social problems at baseline were associated with exclusive cannabis use and dual tobacco and cannabis use at follow up.

Using a racial/ethnic health equity lens, this dissertation examined potential drivers of racial/ethnic disparities in tobacco and cannabis use. My findings provide insight into the ways in which public health professionals, clinicians, and policymakers can intervene to prevent and reduce the prevalence of psychosocial determinants of health that will, in turn, mitigate inequities in tobacco and cannabis use.