Tobacco product use at the intersection of racial/ethnic and sexual orientation discrimination among California adults, 2022–2023: an observational study

Discrimination related to race/ethnicity and sexual orientation are associated with tobacco product use, but less is known about how experiencing both types of discrimination may affect likelihood of tobacco product use. The purpose of this study was to examine the associations between intersectional discrimination (experiencing racial-ethnic and/or sexual orientation discrimination) frequency and tobacco product use among a representative sample of California adults ages 18–64. Pooled data ( n = 10332) from the 2022–2023 Online California Adult Tobacco Survey were weighed and analyzed to estimate the association between the type (none, other discrimination, racial-ethnic only, sexual orientation only, and joint racial-ethnic and sexual orientation only) and reported frequency of discrimination experienced, as measured by the Everyday Discrimination Scale, with current cigarette use and current vaping. Estimates were calculated using logistic regression with standardized discrimination scores adjusting for demographic and socioeconomic factors. Discrimination type and frequency had different, but positive associations, with both cigarette and vape use. Adjusted odds ratios (aOR) of smoking relative to no discrimination experienced varied by type and increasing frequency of discrimination experienced: other discrimination (aOR: 1.32, 95%CI: 1.11–1.57), sexual orientation discrimination only (aOR: 2.05, 95%CI: 1.47–2.85), and joint discrimination (aOR: 1.26, 95%CI: 1.10–1.45). These patterns were similar for current vaping (other discrimination aOR: 1.37, 95%CI: 1.18–1.59; racial-ethnic discrimination only aOR: 1.53, 95%CI: 1.18–1.99; and joint only aOR: 1.31, 95%CI: 1.08–1.58). Type and frequency of discrimination experienced were differentially associated with increased odds of tobacco product use, demonstrating the utility of using discrimination type and chronicity to examine factors associated tobacco product use beyond just demographic categories. Future research and interventions should account for factors that can be modified, such as discrimination, as opposed to immutable demographic characteristic to examine health disparities.