Hunger and housing: Economic disparities in current and daily tobacco use among high school students in the United States in 2021.

Introduction: Economic disparities in tobacco use and dependence are well-documented among adults but not adolescents. This study aims to examine economic disparities in patterns of tobacco use among a nationally representative sample of high school students in Spring 2021.

Methods: We analyzed data from n = 6750 US high school student via the 2021 Adolescent Behaviors and Experiences Survey (ABES). We estimated the association between experiencing homelessness and food insecurity (analyzed independently) and current (past 30-day) and daily (all 30 days) use of four tobacco products (e-cigarettes; cigarettes; cigars; smokeless). Models controlled for sex, race/ethnicity, age, and sexual identity.

Results: Overall, ∼1.8 % experienced homelessness and 23.7 % experienced food insecurity. Experiencing homeless was significantly associated with greater odds of current use for e-cigarette (aOR: 3.43), cigarettes (aOR: 5.58), cigars (aOR: 10.47), and smokeless tobacco (aOR: 4.41) as well as greater risk for daily use of e-cigarettes (aOR: 2.66), cigarettes (aOR: 10.94), and cigars (aOR: 5.23) but not smokeless tobacco (aOR: 2.48; 95 %CI: 0.51-12.16). Food insecurity was significantly associated with greater odds of current use of e-cigarettes (aOR: 2.00), cigarettes (aOR: 2.15), and cigars (aOR: 2.44) but not smokeless (aOR: 1.04; 95 % CI: 0.56-1.93). No association was observed between food insecurity and daily tobacco use.

Conclusion: Substantial economic disparities in tobacco use were observed in a nationally representative sample of high school students. Interventions should consider prioritizing economic determinants of health during adolescence, including a focus on preventing youth tobacco use as well as addressing upstream determinants of homelessness and food insecurity.