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Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.

Structurally racist policies and practices of the past are likely to be a driving factor in current day differences in exposure to air pollution and may contribute to observed racial and ethnic disparities in adverse birth outcomes in the United States (U.S.). Non-Hispanic Black women in the U.S. experience poorer health outcomes during pregnancy and throughout the life course compared to non-Hispanic White women. This disparity holds even among non-Hispanic Black women with higher socioeconomic status. Reasons for this finding remain unclear, but long-term environmental exposure, either historical exposure or both historical and ongoing exposure, may contribute. Structural racism likely contributes to differences in social and environmental exposures by race in the U.S. context, and these differences can affect health and wellbeing across multiple generations. In this paper, we briefly review current knowledge and recommendations on the study of race and structural racism in environmental epidemiology, specifically focused on air pollution. We describe a conceptual framework and opportunities to use existing historical data from multiple sources to evaluate multi-generational influences of air pollution and structurally racist policies on birth and other relevant health outcomes. Increased analysis of this kind of data is critical for our understanding of structural racism's impact on multiple factors, including environmental exposures and adverse health outcomes, and identifying how past policies can have enduring legacies in shaping health and well-being in the present day. The intended purpose of this manuscript is to provide an overview of the widespread reach of structural racism, its potential association with health disparities and a comprehensive approach in environmental health research that may be required to study and address these problems in the U.S. The collaborative and methodological approaches we highlight have the potential to identify modifiable factors that can lead to effective interventions for health equity.

To examine whether Tobacco 21 (T21) law coverage moderated associations between cigarette prices and adolescent smoking and associated disparities. We used nationally representative, repeated cross-sectional 2014–2020 Monitoring the Future study data (n = 20,547–96,083) to examine associations between state-level average cigarette price per pack and county-level T21 coverage (100% vs. < 100%) on past 30-day smoking participation, first and daily cigarette smoking initiation, and smoking intentions in US adolescents in eighth, 10th, and 12th grade. We implemented weighted, grade-stratified, modified Poisson regression models to test for interactions between price and T21 coverage for each outcome. We also tested for disparities by sex, race and ethnicity, parental education, and college educational expectations. Higher cigarette prices were associated with a lower probability of past 30-day smoking participation among eighth graders in counties with < 100% T21 coverage (average marginal effect = −0.003, 95% confidence interval = −0.006, 0.000) but not among eighth graders in counties with 100% T21 coverage (average marginal effect = 0.001, 95% confidence interval = −0.001, 0.004) (p for interaction = 0.005). There were no associations with other smoking outcomes or grades or evidence of differential associations by sociodemographic factors. Our findings suggested that higher cigarette prices were associated with lower adolescent smoking among eighth graders living in counties with < 100% T21 coverage. However, no such association was observed in other grades or smoking outcomes. Further investigation is necessary to determine the best combination of policies to reduce adolescent smoking, related sociodemographic disparities, and the use of other tobacco products in areas with fewer tobacco control policies. [ABSTRACT FROM AUTHOR]

Purpose: To (1) assess whether residential rurality/urbanicity was associated with the prevalence of 30‐ or 90‐day long COVID, and (2) evaluate whether differences in long COVID risk factors might explain this potential disparity. Methods: We used data from the Michigan COVID‐19 Recovery Surveillance Study, a population‐based probability sample of adults with COVID‐19 (n = 4,937). We measured residential rurality/urbanicity using dichotomized Rural‐Urban Commuting Area codes (metropolitan, nonmetropolitan). We considered outcomes of 30‐day long COVID (illness duration ≥30 days) and 90‐day long COVID (illness duration ≥90 days). Using Poisson regression, we estimated unadjusted prevalence ratios (PRs) to compare 30‐ and 90‐day long COVID between metropolitan and nonmetropolitan respondents. Then, we adjusted our model to account for differences between groups in long COVID risk factors (age, sex, acute COVID‐19 severity, vaccination status, race and ethnicity, socioeconomic status, health care access, SARS‐CoV‐2 variant, and pre‐existing conditions). We estimated associations for the full study period (Jan 1, 2020‐May 31, 2022), the pre‐vaccine era (before April 5, 2021), and the vaccine era (after April 5, 2021). Findings: Compared to metropolitan adults, the prevalence of 30‐day long COVID was 15% higher (PR = 1.15 [95% CI: 1.03, 1.29]), and the prevalence of 90‐day long COVID was 27% higher (PR = 1.27 [95% CI: 1.09, 1.49]) among nonmetropolitan adults. Adjusting for long COVID risk factors did not reduce disparity estimates in the pre‐vaccine era but halved estimates in the vaccine era. Conclusions: Our findings provide evidence of a rural‐urban disparity in long COVID and suggest that the factors contributing to this disparity changed over time as the sociopolitical context of the pandemic evolved and COVID‐19 vaccines were introduced. [ABSTRACT FROM AUTHOR]

Background. The prevalence of smoking is higher among sexual minority (SM) individuals compared with heterosexuals. The impact of televised anti-tobacco mass media campaigns on smoking outcomes among SMs is not known. Aims. We examined whether televised anti-tobacco advertising was differentially associated with current smoking and smoking intensity for SM and heterosexual adults. Method. We combined county-level anti-tobacco advertising data (gross rating points) with restricted, geocoded individual-level National Health Interview Survey data on smoking (20'3-20'5). We estimated associations between advertising and smoking outcomes, including potential effect modification by SM status. Results. Greater anti-tobacco advertising exposure was associated with lower smoking prevalence (prevalence ratio [PR] = 0.97; 95% confidence interval [CI] = [0.94, '.00]). Although the direction of the association differed for heterosexual and SM adults, differences were not statistically significant. No significant associations were observed with regard to smoking intensity. Conclusion. Associations between anti-tobacco advertising and smoking were not significantly different for heterosexual and SM adults. [ABSTRACT FROM AUTHOR]

Background and Aims: Tobacco control policies may differentially impact smoking initiation among socio-demographic groups. We measured longitudinal associations between exposure to smoke-free laws in grade 12 (modal age 18 years) and patterns of smoking initiation in the United States. Design: Prospective longitudinal analysis. Setting and Participants: We used data on US young adults sampled at modal age 18 years from the Monitoring the Future Survey. Baseline data were collected between 2000 and 2017, with the last year of follow-up in 2018. The sample number varied by outcome and time-point, ranging from 7314 to 17 702. Measurements: Smoke-free law coverage in work-places and hospitality venues (restaurants/bars) was measured as the percentage of the county population covered by each type of law. We examined associations with any past 30-day smoking initiation and daily smoking initiation at modal ages 19/20, 21/22 and 23/24, using Poisson regression and calculating average marginal effects. We explored effect modification by sex, race/ethnicity and parental education by testing the significance of interaction terms. Findings: Work-place law coverage at modal age 18 was associated with a lower probability of daily smoking initiation at modal ages 21/22 [-2.4 percentage points (p.p.); 95% confidence interval (CI) = -3.9, -0.9] and 23/24 (-2.0 p.p.; 95% CI = -3.9, -0.2). Hospitality law coverage was associated with a lower probability of daily smoking initiation at modal ages 19/20 (-1.6 p.p.; 95% CI = -2.8, -0.4), 21/22 (-2.3 p.p.; 95% CI = -3.7, -0.9) and 23/24 (-1.8 p.p.; 95% CI = -3.6, -0.0). Findings were inconclusive with regard to associations with any past 30-day smoking initiation and with regard to effect modification, after adjusting for multiple testing. Conclusions: Exposure to smoke-free laws at age 18 appears to be prospectively associated with reduced daily smoking initiation 1-6 years later. [ABSTRACT FROM AUTHOR]

Purpose: To describe patterns of menthol/non-menthol cigarettes with flavored e-cigarettes (tobacco, menthol, sweet/spicy, and other flavorings) use. Design: We used cross-sectional data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Setting: United States. Subjects: Adults over 18 years old. Sample: A nationally representative sample (n = 135 329). Measures: We generated a 15-category variable of all combinations of cigarette and e-cigarette flavoring use. Analysis: We estimated population prevalence (PP) for the 15-category flavored cigarette and e-cigarette use variable and proportion of flavored cigarette and e-cigarette use among adults who used cigarettes or e-cigarettes (PAU) by age, sex, race/ethnicity, and income. Results: Exclusive menthol cigarette use was higher among NH Black (PP = 8.79%, PAU = 68.96%) and low-income (PP = 4.86%, PAU = 29.09%) compared to NH White (PP = 2.63%, PAU = 18.83%) and high-income participants (PP = 1.25%, PAU = 19.02%). Exclusive sweet/spicy e-cigarette use (PP = 1.32%, PAU = 10.22%) and exclusive menthol e-cigarette use (PP =.95%, PAU = 7.40%) was higher in younger (18-34) vs older (35+) adults (PP =.34% and PAU = 2.76%, and PP =.14%, PAU = 1.11%, respectively). Older dual users tended to combine the same flavor in both products (eg, menthol cigarettes + menthol e-cigarettes), while younger adults were more likely to combine menthol and non-menthol cigarettes with sweet/spicy e-cigarettes. Conclusion: Findings suggest that a menthol cigarette ban might be most effective in conjunction with sweet/spicy e-cigarette flavor restrictions, given these flavors are attractive for younger adults. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate sociodemographic differences in the relationship between state and national anti-smoking media campaigns and cessation behaviors among adult smokers in the U.S. Design: Repeated cross-sectional analysis. Setting: U.S. nationally representative survey of adults ages 18 and older, 2001-2015. Subjects: 76,278 year-ago smokers from the 2001-2015 Tobacco Use Supplement to the Current Population Survey. Measures: Area-level exposure to State-sponsored and "Tips from former smokers" anti-tobacco media campaigns was the primary predictor of this study. Outcome variables included: quit attempt in the past 12 months, past 30-day smoking cessation, and past 90-day smoking cessation among year-ago smokers. Analysis: We conducted modified Poisson regression models to examine the association between media campaign exposure and cessation behaviors. We also examined effect modification on the additive scale by sex, race/ethnicity, income, and education using average marginal effects. Results: Year-ago smokers with greater exposure to media campaigns were more likely to report 30-day (Prevalence Ratio [PR]: 1.18, CI: 1.03, 1.36) and 90-day cessation (PR: 1.18, CI: 1.00, 1.41) compared to respondents with less campaign exposure. We found no evidence of effect modification by sociodemographic variables. Conclusion: Exposure to anti-smoking media campaigns were associated with year-ago smokers' cessation behaviors. However, there were no differences in the association by sex, race/ethnicity, income, or education, indicating that broadly focused media campaigns may be insufficient to reduce smoking cessation among priority populations, and thus health disparities generally. [ABSTRACT FROM AUTHOR]

Purpose: To provide tobacco product use patterns for US adults by sociodemographic group. Design: A secondary analysis of Tobacco Use Supplement to the Current Population Survey (2014-15), National Health Interview Survey (2015), and Population Assessment of Tobacco and Health (2015-16). Setting: United States. Sample: Three nationally representative samples of adults (N = 28,070-155,067). Measures: All possible combinations of cigarette, Electronic Nicotine Delivery Systems (ENDS), other combustible product, and smokeless tobacco use, defined as current use every day or some days. Analysis: Weighted population prevalence and proportion among tobacco users of exclusive, dual, and polyuse patterns by sex, race/ethnicity, education, income, and age. Results: Exclusive cigarette use was the most prevalent pattern (10.9-12.8% of US population). Dual and polyuse were less prevalent at the population level (2.6-5.2% and 0.3-1.3%, respectively) but represented 16.7-25.5% of product use among tobacco users. Cigarette plus ENDS use was similar by sex, but men were more likely to be dual users of cigarettes plus other combustibles or smokeless tobacco. Among race/ethnic subgroups, non-Hispanic (NH) Whites were most likely to use cigarettes plus ENDS, while NH Blacks were most likely to use cigarettes plus other combustibles. Dual and polyuse were generally less common among adults with higher education, income, and age. Conclusion: Differences in product use patterns by sociodemographic group likely represent different risk profiles with important implications for resulting health disparities. [ABSTRACT FROM AUTHOR]

Racial/ethnic discrimination (hereafter, discrimination) is associated with use of individual tobacco and cannabis products. However, we know little about how discrimination affects dual/polytobacco and cannabis use and associated use disorders. We used cross-sectional data on adults (18+) from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 35,744). We defined past-year discrimination as a summary scale (range: 0–24) based on six scenarios. We created a mutually exclusive six-category use variable: noncurrent, individual tobacco and noncannabis, individual tobacco and cannabis, individual cannabis and nontobacco, dual/polytobacco and noncannabis, and dual/polytobacco and cannabis based on past 30-day tobacco use of four products (i.e., cigarettes, electronic nicotine delivery systems, other combustibles (cigars, pipe), smokeless tobacco) and cannabis use. We also examined past-year tobacco use disorder (TUD) and cannabis use disorder (CUD) as a four-level variable: no disorders, TUD only, CUD only, and TUD and CUD. We estimated associations between discrimination and each outcome using adjusted multinomial logistic regression and assessed effect modification by stratifying adjusted models by race/ethnicity (i.e., Hispanic, non-Hispanic (NH) White, NH Black, and another race/ethnicity). Experiencing more discrimination was associated with each outcome but was most strongly associated with dual/polytobacco and cannabis use (OR: 1.13, 95 % CI: 1.07–1.19) and joint TUD and CUD (OR: 1.16, 95 % CI: 1.12–1.20). Models stratified by race/ethnicity showed that discrimination was associated with dual/polytobacco and cannabis only among NH White adults, and with joint TUD and CUD only among NH Black and NH White adults. Discrimination was associated with tobacco and cannabis use outcomes among multiple adult racial/ethnic populations, but associations were more profound for NH White and NH Black adults than adults from other racial/ethnic populations. • Experiencing more discrimination was linked to dual/polytobacco and cannabis use. • Discrimination was also associated with joint tobacco and cannabis use disorders. • For each race/ethnicity, discrimination was linked to at least one use outcome. • Associations with more severe outcomes were stronger for White and Black adults. [ABSTRACT FROM AUTHOR]