Socioeconomic Status Partially Mediates the Effects of Structural Racism on Youth Tobacco Use Initiation.

Background: Recent research has identified structural racism-systemic policies and practices that perpetuate racial inequalities-as a significant social determinant of population health. Studies utilizing data from the Adolescent Brain Cognitive Development (ABCD) study have shown an association between higher levels of state-level structural racism and increased tobacco use among youth in the United States. However, there has been limited exploration of the psychosocial mediators of this relationship, particularly in the context of youth aged 10-16 years.

Objective: This study aimed to assess the roles of socioeconomic status (SES), tobacco susceptibility, and perceived discrimination as potential mediators in the relationship between state-level structural racism and youth tobacco initiation rates.

Methods: We analyzed data from the ABCD study, a nationally representative longitudinal survey of 11,698 youth followed from ages 9/10 to 15/16. These data were combined with state-level indicators of structural racism. We employed structural equation modeling (SEM) to investigate the mediators of the association between structural racism and self-reported initiation of tobacco use, while controlling for individual and state-level covariates.

Results: Our findings indicate that higher levels of structural racism were associated with increased rates of tobacco initiation among youth. This relationship was partially mediated by lower SES, but not by perceived discrimination or tobacco susceptibility.

Conclusion: The association between structural racism and youth tobacco initiation appears to be influenced in part by the lower SES prevalent in states with higher levels of racism. These results highlight the need for addressing both racism and SES inequalities as key strategies for reducing tobacco disparities among youth.