Impact of Hispanic Ethnicity on Adolescent Tobacco Use Estimates in the United States

National estimates of tobacco use are reported by racial category after excluding all individuals who identify as Hispanic (e.g., non-Hispanic [NH], Black, and NH-White). In this study, we assess the impact of excluding Hispanics from racial categories on national estimates of youth tobacco use in the United States.

We pooled four years of Youth Risk Behavioral Surveillance Survey (YRBSS) data (2015-2021). Participants were n = 60 327 high school students (9-12th grade). We report the prevalence of past 30-day (current) use of cigarettes, cigars, smokeless tobacco, and electronic cigarettes, stratified by racial category: (1) American Indian/Alaskan Native (AI/AN); (2) Asian; (3) Black; (4) Native Hawaiian/Other Pacific Islander (NHOPI); (5) White; (6) multiracial; and (7) unspecific. Within racial category, we compared the prevalence for each product between NH and Hispanic youth; comparisons controlled for sex, grade, and year.

Descriptively, the majority of AI/ANs (75.6%) and Pacific Islanders (58.9%) identified as Hispanics, as did a minority of multiracial (20.6%), White (14.6%), Black (8.2%), and Asian (7.9%) youth. Prevalence estimates were significantly greater for all four tobacco products among Hispanic-Asian and Hispanic-Black youth, relative to their NH counterparts. Conversely, tobacco use was lower among Hispanic-White youth relative to NH-Whites.

Systematically removing Hispanics from classification within each racial category results in an underestimation of tobacco use among Asian and Black youth, an overestimation of tobacco use among White youth, and unstable estimates among AI/AN and NHOPI youth. These findings challenge the utility of the "race/ethnicity" variable in the study of youth in the United States.

Findings highlight the need to reconsider the operationalization of "race/ethnicity" which currently excludes Hispanics from each racial category. Hispanic ethnicity appears to function as a "within-group" difference; the study of these within-group differences may provide unique insights into tobacco use disparities.