Smoking Trajectories Among Monoracial and Biracial Black Adolescents and Young Adults

Cross-sectional Associations of Multiracial Identity with Self-Reported Asthma and Poor Health Among American Indian and Alaska Native Adults

INTRODUCTION

American Indian and Alaska Native (AI/AN) multiracial subgroups are underrecognized in health outcomes research.

METHODS

We performed a cross-sectional analysis of Behavioral Risk Factor Surveillance System surveys (2013-2019), including adults who self-identified as AI/AN only (single race AI/AN, n = 60,413) or as AI/AN and at least one other race (multiracial AI/AN, (n = 6056)). We used log binomial regression to estimate the survey-weighted prevalence ratios (PR) and 95% confidence intervals (CI) of lifetime asthma, current asthma, and poor self-reported health among multiracial AI/AN adults compared to single race AI/AN adults, adjusting for age, obesity, and smoking status. We then examined whether associations differed by sex and by Latinx identity.

RESULTS

Lifetime asthma, current asthma, and poor health were reported by 25%, 18%, and 30% of multiracial AI/AN adults and 18%, 12%, and 28% single race AI/AN adults. Multiracial AI/AN was associated with a higher prevalence of lifetime (PR 1.30, 95% CI 1.18-1.43) and current asthma (PR 1.36, 95% CI 1.21-1.54), but not poor health. Associations did not differ by sex. The association of multiracial identity with current asthma was stronger among AI/AN adults who identified as Latinx (PR 1.77, 95% CI 1.08-2.94) than non-Latinx AI/AN (PR 1.18, 95% CI 1.04-1.33), p-value for interaction 0.03.

CONCLUSIONS

Multiracial AI/AN adults experience a higher prevalence of lifetime and current asthma compared to single race AI/AN adults. The association between multiracial identity and current asthma is stronger among AI/AN Latinx individuals. The mechanisms for these findings remain under-explored and merit further study.

Classification of Students by Race and Hispanic/Latino/a/x Ethnicity Impacts Estimates of the Prevalence of Substance Use

Multiracial and Hispanic/Latino/a/x youth are rapidly growing populations in the United States. When considered in substance use studies, they are often treated as homogeneous groups despite important demographic and cultural differences. The current study explores how substance use prevalence may differ depending on how precisely race and ethnicity groups are categorized. Data are from the 2018 High School Maryland Youth Risk Behavior Survey (n = 41,091, 48.4% female). We estimate prevalence of past 30-day substance use (i.e., alcohol, combustible tobacco, e-cigarettes, and marijuana) for all combinations of race and Hispanic/Latino/a/x ethnicity. Substance use prevalence across the specific Multiracial and Hispanic/Latino/a/x categories showed a wider range of estimates than within the traditional CDC racial and ethnic categories. Findings from this study suggest that state- and national-level surveillance of adolescent risk behavior should add further measures of race and ethnic identity to improve researchers' ability to increase precision of substance use prevalence estimates.

A Longitudinal Examination of Behavioral Transitions among Young Adult Menthol and Non-Menthol Cigarette Smokers Using a Three-State Markov Model

INTRODUCTION

Young adult cigarette smoking behaviors are complex and dynamic. Emerging research suggests a growing rate of switching from non-menthol to menthol cigarettes. Transitions across cigarette smoking states are not well understood. This research longitudinally explores transitions in cigarette smoking behaviors among 18-29 year olds.

METHODS

We applied a Markov model to data collected biannually for 1542 initially 18-29 year old young adults (mean age: 20.9 years; SD = 2.6) in Texas, who provided 7021 total observations from Fall 2014 to Spring 2017. All participants were past 30 day menthol or non-menthol cigarette smokers at first observation. We examined transitions across three states of cigarette smoking (menthol, non-menthol, and nonsmoking) and compared predictors of each transition, during young adulthood.

RESULTS

Descriptively, 22.2% of menthol and 14.3% of non-menthol smokers switched products while 25.6% of menthol and 26.0% of non-menthol smokers quit smoking. Among quitters, 20.0% relapsed via menthol and 28.2% relapsed via non-menthol cigarettes. Results from Markov model indicated that Hispanic/Latinos (Hazard Ratio [HR]: 3.69) and Asians (HR: 2.85) were significantly more likely to switch from non-menthol to menthol cigarettes, relative to non-Hispanic whites. Among recent quitters, the use of non-cigarette products was associated with increased risk of relapse via menthol (HR: 1.54) and non-menthol (HR: 1.85) cigarettes.

CONCLUSION

A substantial proportion of young adult cigarette smokers transitioned across cigarette smoking states over the course of 2.5 years. Other tobacco use and nicotine dependence were impediments to becoming and remaining a non-smoker. Hispanic/Latinos and Asians, relative to non-Hispanic whites, had greater odds of transitioning from non-menthol smoking to both non-smoking and to menthol smoking. Findings suggest racial/ethnic differences in cigarette smoking transitions during young adulthood.

IMPLICATIONS

This paper examined multidirectional transitions across cigarette smoking, including switching between menthol and non-menthol cigarettes, among young adults. Results indicate that Hispanic/Latino and Asian young adults are at increased risk of transition to menthol cigarette smoking compared with non-Hispanic white young adults. Findings highlight need for further study of Hispanic/Latino and Asian young adult smoking behaviors.

Unpacking the Non-Hispanic Other Category: Differences in Patterns of Tobacco Product Use Among Youth and Adults in the United States, 2009-2018

Studies investigating patterns of tobacco use by race often aggregate non-Black and non-Hispanic racial minorities into the "Other" category, masking important differences. Pooling 10 years (2009-2018) of National Survey on Drug Use and Health data (n = 52,424), we estimated the prevalence and proportion of individual tobacco product use and patterns of single, dual, and polytobacco use overall and by sex for youth (12-17) and adult (18 +) non-Hispanic Asian, American Indian/Alaska Native (AI/AN), Native Hawaiian/other Pacific Islander (NH/PI), and multiracial respondents. Cigarette prevalence was highest among AI/AN youth (8.6%) and adults (37.3%). For youth and adults, the AI/AN subgroup had the highest prevalence of single (9.2% youth, 35.8% adults) and dual (2.8% youth, 6.6% adults) use, followed by multiracial respondents. Furthermore, among tobacco users, AI/AN and multiracial youth and adults had the highest proportions of dual and poly use compared to other races. Appropriate tobacco prevention and cessation interventions should consider variation in tobacco use among non-Hispanic "Other" subgroups.

Examining Arrest and Cigarette Smoking in Emerging Adulthood

Background:

Despite prior studies, transitions in smoking patterns are not fully understood. Getting arrested may alter an individual’s smoking pattern through processes proscribed by the criminological labeling theory. This study examined how arrest during emerging adulthood altered smoking behavior during subsequent years and whether there were differential effects by race/ethnicity and gender.

Methods:

We analyzed 15 waves of data from the National Longitudinal Survey of Youth 1997. Multinomial logistic regressions were performed using Stata software version 14.

Results:

For both genders, arrested black men and women had the most distinct smoking transitions (both increases and decreases) as compared with their non-arrested counterparts. Among men, particularly black males, arrest in early adulthood was associated with the men transitioning to both increased and decreased smoking. Patterns in smoking transitions for women were less clear, suggesting that women’s smoking may be influenced by factors not in the models. Women had a low probability of starting to smoke or increasing smoking if they were never arrested between 18 and 21 years of age.

Conclusions:

The results for transitioning into increased smoking offer some support for labeling theory processes. Other findings suggest that arrest may lead to some men reducing or quitting smoking. Early adulthood arrest may serve to “shock the system” and contribute to males altering their prior smoking behavior.

Implications:

Tobacco use over the life course, particularly across different racial and ethnic groups, remains understudied. This study contributes to the literature using a nationally representative sample to examine the effect of getting arrested in emerging adulthood on cigarette use during subsequent years. In conducting the study, investigators combined theories and methodological approaches from 2 complementary disciplines: public health and criminal justice. Because criminal justice policymakers tend to focus on issues like ex-offender unemployment, public health officials can provide guidance regarding the effect of justice system involvement on smoking, particularly given the adverse health outcomes of using cigarettes.

The biracial Asian population in California: an examination of health profiles and chronic conditions

OBJECTIVES

To examine health outcomes and chronic conditions for the biracial Asian population in California. We hypothesized that the biracial population will display intermediate (or an average of) outcomes in comparison to their monoracial counterparts.

DESIGN

The study was cross-sectional. After adjusting for sociodemographic variables, multivariable regression models predicted health outcomes (ie, diabetes, heart disease, high blood pressure, disability status, BMI, and general health) and compared health outcomes among various (mono- and bi-) racial and ethnic groups.

PARTICIPANTS

Data were collected from 238,897 adult (aged ≥ 18 years) respondents after merging iterations of the California Health Interview Survey (CHIS) administered in 2001, 2003, 2005, 2007, and 2009.

RESULTS

Multivariate results revealed that Whites reported better health overall than biracial Asians and other monoracial groups. Biracial Asians displayed BMI ranges that were intermediate between their monoracial constituents.

CONCLUSIONS

BMI is a more proximal health outcome and is more sensitive to lifestyles and behaviors. As a result, BMI may be a better indicator than chronic diseases in showing that biracial Asians have adopted health behaviors and practices that fall between their mono-racial counterparts. Future epidemiological research should examine the prevalence of more proximal health outcomes among biracial Asians and assess how it differs by developmental age.