Impact of Hispanic Ethnicity on Adolescent Tobacco Use Estimates in the US.

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

Methods: 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 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 prevalence for each product between non-Hispanic and Hispanic youth; comparisons controlled for sex, grade, and year.

Results: 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 non-Hispanic Whites.

Conclusions: Systematically removing Hispanics from classification within each racial category results in underestimation of tobacco use among Asian and Black youth, 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 study of youth in the US.

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