Background: Early initiation of tobacco use among adolescents is a significant public health concern. While there is extensive research on overall tobacco use, much of it focuses on initiation in late adolescence, uses cross-sectional designs, and lacks specific exploration of electronic versus conventional cigarette use. This study aims to investigate social determinants influencing the early initiation of electronic and conventional cigarette use among U.S. adolescents. Methods: We utilized data from the Adolescent Brain Cognitive Development (ABCD) study, which follows a cohort of tobacco-naïve children from age nine through age 16. The social determinants examined included household income, parental education, financial difficulties, racial/ethnic minority status, family structure, neighborhood income, and gender minority status. Structural equation models were employed to assess associations between these determinants and early initiation of electronic and conventional cigarette use. Results: Male gender was associated with a higher likelihood of conventional cigarette use, while the risk of early initiation of electronic cigarette use was similar across genders. White adolescents were at a higher risk of conventional cigarette use; however, the risk for electronic cigarette use was comparable across White and non-White groups. Financial difficulties were linked to an increased likelihood of early initiation of conventional cigarette use but not electronic cigarette use. Higher household income was associated with a reduced risk of initiating conventional cigarettes but did not significantly impact electronic cigarette use. Adolescents from married families were less likely to initiate electronic cigarette use. No significant effects were found for parental education or neighborhood income on the initiation of either type of cigarette use. Age did not significantly affect the initiation of either cigarette type, and gender minority status was marginally associated with early initiation of conventional cigarette use. Conclusions: The social patterning of electronic cigarette use differs from that of conventional cigarette use, suggesting that distinct tobacco products do not pose a uniform risk across all adolescents. This study underscores the importance of tailored prevention efforts that address the unique challenges associated with early initiation of electronic and conventional cigarette use among adolescents. The differential risk factors identified suggest targeted prevention strategies for conventional cigarette use, focusing on financial difficulties, household income, and gender-specific interventions. In contrast, prevention efforts for electronic cigarette use may require broader, more inclusive approaches that address all adolescents, regardless of their background. Comprehensive universal screening for electronic cigarette use and targeted screening for conventional cigarette use among adolescents are recommended.

Background: Social determinants of health (SDOH) significantly influence health behaviors, including tobacco use among youth. Adversities such as perceived discrimination, perceived neighborhood stress, life trauma, and financial strain are stressors that may mediate the relationship between various SDOH and youth tobacco use. This study aims to investigate whether multidimensional adversities mediate the effects of SDOH on tobacco use among youth. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study were used to test our hypotheses. The sample included a diverse cohort of youth aged 9-10 years old followed until they were 15-16 years old. We examined the effects of baseline parental education, household income, neighborhood income, and family structure on subsequent youth tobacco use. Structural equation models were used to test if adversities (perceived discrimination, life trauma, financial strain) operate as potential mediators. Results: All ABCD participants were eligible for our analysis, regardless of race, ethnicity, or SDOHs (n = 11,878). The findings indicated that the effects of parental education, household income, neighborhood income, and family structure on youth tobacco use were partially mediated by adversities. Higher levels of parental education and household income were associated with lower tobacco use, and this relationship was weakened when accounting for adversities. Similarly, stable family structures and higher neighborhood income were linked to reduced tobacco use, with adversities playing a mediating role. Conclusions: Multidimensional adversities partially mediate the relationship between SDOH at baseline and subsequent youth tobacco use. Interventions aimed at reducing youth tobacco use should address both the social determinants and multiple adversities experienced by adolescents. Policies to improve the educational and economic situations of families, enhance neighborhood environments, and support stable family structures all reduce youth tobacco use, with lower exposure to adversities explaining this effect.

Background: Minorities’ Diminished Returns (MDRs) theory posits that socioeconomic resources have weaker protective effects on health and behavior for racial and ethnic minorities compared to Whites. This study examines whether tobacco susceptibility, defined as curiosity, intention, and openness to future tobacco use, mediates the diminished returns of family income on tobacco initiation among Black adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed. Participants were followed from age 9 to 16. All participants were tobacco naïve at baseline. Tobacco susceptibility was assessed through self-reported measures of curiosity, intention, and openness to future tobacco use. Structural equation modeling (SEM) was used to examine the relationship between family income, tobacco susceptibility, and tobacco initiation. Results: Overall, 10,653 Black or White youth entered our analysis. The analysis revealed that higher family income was less effective in preventing tobacco initiation among Black adolescents. Tobacco susceptibility significantly predicted tobacco initiation and partially mediated the relationship between family income and tobacco initiation. Conclusions: Tobacco susceptibility explains some of the diminished returns of family income on tobacco initiation among Black adolescents. Interventions aimed at reducing tobacco susceptibility may enhance the protective effects of family income and help mitigate health disparities.

Background: Socioeconomic status (SES) is traditionally viewed as a protective factor against impulsivity and subsequent tobacco use in youth. The prevailing model suggests that higher SES is associated with lower impulsivity, which in turn reduces the likelihood of future tobacco use. However, this pathway may not hold uniformly across racial groups due to differences in impulsivity and the phenomenon of Minorities' Diminished Returns (MDRs), where the protective effects of SES, such as educational attainment, tend to be weaker or even reversed for Black youth compared to their White counterparts. Objectives: This study aims to examine the racial heterogeneity in the pathway from childhood SES to impulsivity and subsequent tobacco use initiation during adolescence, focusing on differences between Black and White youth. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) Study, which includes a diverse sample of youth aged 9 to 16 years. The analysis examined the relationship between baseline family SES (age 9), impulsivity (age 9), and subsequent tobacco use (ages 9 to 16). Impulsivity was measured using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, and Positive Urgency Impulsive Behavior Scale (UPPS-P). Structural equation modeling (SEM) was employed, with analyses stratified by race to explore potential differences in these associations. Results: Overall, 6,161 non-Latino White and 1,775 non-Latino Black adolescents entered our analysis. In the full sample, higher family SES was linked to lower childhood impulsivity and, consequently, less tobacco uses in adolescence. However, racial differences emerged upon stratification. Among White youth, higher SES was associated with lower impulsivity, leading to reduced tobacco use, consistent with the expected model. In contrast, among Black youth, higher SES was not associated with lower impulsivity, thereby disrupting the protective effect of SES on tobacco use through this pathway. These findings suggest that racial heterogeneity exists in the SES-impulsivity-tobacco use pathway, aligning with the MDRs framework, which highlights how structural factors may weaken the protective effects of high SES among Black youth. Conclusions: These findings underscore the importance of considering racial heterogeneity in the relationships between SES, impulsivity, and tobacco use. The observed disparities suggest a need for targeted interventions that address the unique challenges faced by Black youth, who may not experience the same protective benefits of high SES as their White peers. These results carry significant implications for public health strategies aimed at reducing tobacco use in racially diverse populations.