It's Not Just Black and White: Identifying the Combined Influence of Multilevel Determinants of Tobacco Use Among Black Adolescents.

Abstract

Objective: Black individuals are disproportionately affected by tobacco-related illnesses. Although tobacco use is often initiated in adolescence and risk factors thereof originate from multiple domains of influence, investigations of tobacco use among Black adolescents seldom consider these domains simultaneously. These examinations are needed to identify the impact of co-occurring risk factors on tobacco use and inform comprehensive tobacco prevention and treatment programs. Our study sought to identify the combined influence of factors across multiple domains on tobacco use among Black adolescents.

Method: Participants were non-Hispanic Black (N = 1,801) adolescent (ages 12 to 17 years) respondents from Wave 1 of the Population Assessment of Tobacco and Health Study. Latent class analysis identified unique response patterns to items assessing the risk of tobacco use across sociocultural, environmental, psychological, and behavioral (e.g., alcohol use) domains. Subsequent logistic regressions compared the odds of ever and current tobacco use between the classes.

Results: Four latent classes were identified. According to item response probabilities, they were named low risk (LR; 36.5%), low psychological (LP; 19.0%), high psychological (HP; 30.4%), and high social, psychological, and behavioral (HSPB; 14.1%) risk. The odds of ever and current tobacco use were highest among adolescents in the HSPB latent class compared with the other latent classes (odds ratio = 6.5 to 42.1).

Conclusions: Adolescents with the highest odds of tobacco use endorse multiple risks including feeling distress, perceiving tobacco as beneficial for handling stress, and using substances, and may prioritize the management of negative emotions over perceived health consequences from tobacco use. Multilevel interventions that incorporate the development of coping strategies for effectively handling negative affect may prove highly effective in preventing tobacco use among Black adolescents.