The optimal understanding of how ARBs develop requires considering a range of characteristics, preferably in a prospective study . The complex relationships with which multiple factors relate to ARB risks may indicate opportunities for more focused and efficient prevention by identifying subgroups most likely to experience ARBs and who are most likely to gain from programs aimed at decreasing heavy drinking. The larger study from which these data were extracted and a smaller investigation at another university indicated that active education about alcohol-related risk factors are associated with less intense future drinking. In the current study, the significant active education group vs. control group main effect in Table 4 supports the conclusion that decreases in maximum drinks seen with participation in the educational videos were also associated with lower levels of ARBs over time . Thus, universities and other institutions interested in decreasing the risk for ARBs and associated problems might consider developing similar education programs and focusing their efforts on subgroups of subjects with the highest ARB risk. As is true for all research, it is important to recognize caveats regarding the current work. The data were extracted from a larger study evaluating different ways of decreasing heavy drinking among students, and consistent with a prior report focusing on heavy drinking , exposure to active intervention affected ARB rates, a factor that complicates interpretation of results. However, as shown in Table 4, the current results remained robust when prevention group assignment was used as a covariate in the mixeddesign ANOVA. The relationships among ethnicity, LR and changes in drinking over time are the focus of several other papers and, due to space constraints, are not discussed in detail here . Also regarding the larger study,greenhouse benches the subjects were from a single California university, and the generalizability of results to other settings needs to be established, including gathering data on additional ethnic minorities as our analyses were limited to EA, Hispanic and Asian individuals.
Next, the data were gathered on-line rather than in person by research staff with whom students had no personal contact, a step that might have affected the veracity of the responses, but the level of impact or direction of effect cannot be determined. Also regarding the larger study from which these data were extracted, to maximize the number of students receiving educational videos only 13% of the subjects were controls, and differences in numbers of subjects across groups may have impacted on current results. While the time frame for the current study was 55 weeks and the proportion of subjects reporting ARBs during this interval approached 50% in females, ARBs occur over many years and longer term follow ups are needed. In addition, the short time frame of reporting for the prior month for each assessment resulted in relatively low numbers of ARBs per individual per evaluation.Additional caveats are worth noting. All information about ethnic identity and blackouts involved self-reports, which may underestimate ARBs because heavy drinking can interfere with accurate recognition of whether an ARB occurred. It is also important to recognize that while the SRE has proven to be a robust predictor of future heavy drinking and alcohol problems, the present analyses did not control for years of drinking, the type of beverage consumed or other covariates. However, prior studies demonstrated that the relationship of SRE scores to heavy drinking and related consequences remained robust even after controlling for sex, weight, marijuana use or smoking histories and operated similarly in 12- year-old subjects with recent drinking onsets and in young adults . Finally, there are important subgroups among EA, Asian and Hispanic populations, which, reflecting our sample size, could not be evaluated, and additional risk factors associated with ARBs were not included in analyses. These caveats aside, the present findings indicate that the propensity toward ARBs goes beyond the amount of alcohol consumed and is related to interrelationships among ethnicities, sex, and the sensitivity to alcohol. There are important differences among subgroups of students regarding how characteristics contribute to the ARB risk. Understanding how these interrelationships operate can be important in identifying who carries the highest risk and in creating focused and efficient prevention programs.
Adolescent use of electronic vapor products , including electronic cigarettes, vaporizers, and vape pens—with and without nicotine—is an emergent public health epidemic in the U.S.Vaping nicotine during adolescence is associated with increased risk for cigarette smoking initiation and co-use of alcohol, cannabis, and other substances.Vape products not containing nicotine may also have negative health effects, although these effects are not well understood.For example, evidence suggests that vape cartridges with THC may be related to recent outbreaks of severe lung injury in the U.S5 and flavored e-liquid found in vape products with and without THC contain health harming toxins.Since 2011, past 30-day prevalence of adolescent vaping has increased steadily, peaking in 2019 at approximately 30%.7,8 Although adolescent vaping prevalence dropped to approximately 20% in 2020, it remains high.Given the potential negative health consequences associated with vaping, adolescent vaping prevention must be a public health priority. Ideally, prevention efforts will target the most vulnerable, however, there is a limited evidence base regarding differences in vulnerability across adolescent groups. One group that may be at high risk for vaping is transgender adolescents. By transgender, we mean adolescents whose gender identity is not aligned with their sex assigned at birth, and by cisgender, we mean adolescents whose gender identity aligns with their sex assigned a birth. Although limited, research with nationally-representative and population-based surveys finds transgender adolescents are more likely to smoke combustible cigarettes and vape than their cisgender peers.The model posits that chronic exposure to multilevel gender minority-related prejudice and discrimination predisposes transgender and other gender minority people to excess stress and in turn, negative health outcomes and health disparities. Indeed, past research has found tobacco- and substance use related disparities among transgender adolescents may be related to violence and victimization, community norms favoring substance use, and targeting of LGBTQ people by tobacco and alcohol companies.
While examinations of gender identity disparities in adolescent tobacco use—vaping in particular—are uncommon,grower equipment even less is known about how these disparities vary by race/ethnicity, i.e., disparities at the intersection of gender identity and race/ethnicity. Indeed, vaping among transgender adolescents of color may differ significantly from their non-Latinx white peers given exposure to multiple and intersecting individual, interpersonal, and structural level forms of racism and cisgenderism. These intersecting, multiplicative experiences of racism and cisgenderism, and resultant stress and coping can be understood through the lens of intersectionality. A theoretical framework rooted in Black feminist thought, intersectionality examines relationships between macro-level interlocking systems of power and individual-level experiences and behaviors across multiple social positions .As a tool, intersectionality provides a lens through which researchers can elucidate and explain population health disparities across multiple axes of social positions, centering the notion that “social categories are not independent and unidimensional but rather multiple, interdependent, and mutually constitutive” .Given a dearth of evidence on vaping and vaping disparities among transgender adolescents of color, the present study examines the prevalence of adolescent vaping at the intersections of gender identity and race/ethnicity in a population-based sample of adolescents in California secondary schools. We tested the hypothesis that gender identity and race/ethnicity interact such that transgender adolescents of color would evidence greater frequency of vaping compared to cisgender white adolescents . This information may provide a starting point for advancing understanding of vaping disparities among transgender adolescents of diverse races/ethnicities and informing vaping prevention and control initiatives. Data for this study come from the California Healthy Kids Survey collected in 2017-2018 and 2018-2019. One of the largest of its kind in the U.S., the CHKS is administered via paper/pencil or electronically to adolescents in California schools on a variety of health domains, including tobacco and substance use, and sociodemographics, including gender identity, ethnicity, and race. School districts receiving subsidies from the California Department of Education are required to administer the CHKS at least biennially in 7th and 9th grades and strongly encouraged to administer it in 5th and 11th grades. Districts not receiving subsidies participate voluntarily. Parents/guardians provide active, written consent for children in 5th grade and passive consent for children in 7th grade and above to participate. Student participation is voluntary and anonymous.For years 2017-2018 and 2018-2019, approximately 75% of California school districts administered the survey at least once , 39% of which administered it twice .Our main independent variables were gender identity and race/ethnicity. Gender identity was measured with the question, “Some people describe themselves as transgender when their sex at birth does not match the way they think or feel about their gender. Are you transgender?”. We categorized participants into three gender identity categories based on their response to the question: Cisgender , Transgender , and Unsure of Gender Identity . We categorized race/ethnicity based on participant responses to two separate questions: “Are you of Hispanic or Latino origin” , and “What is your race?” . Participants who indicated a Hispanic or Latino ethnicity were categorized as “Latinx” regardless of the race they endorsed. Participants who did not indicate a Latinx identity were categorized as non-Latinx white , non-Latinx Black or African American , non-Latinx Asian , non-Latinx American Indian or Alaskan Native , non-Latinx Native Hawaiian or Pacific Islander , and non-Latinx multiracial .
Our outcome variable was number of days vaped in the past 30-days, i.e., vaping frequency, measured with the item: “During the past 30 days, on how many days did you use electronic cigarettes, e-cigarettes, or other vaping device such as juul, e-hookah, hookah pens, or vape pens? ”. Past research on adolescent vaping has tended to examine vaping as a binary outcome . To allow for greater detail in modeling frequency, we re-categorized this variable on an integer ordinal scale of 0 days , 1 day , 2-9 days , and 10 or more days vaping in the past 30-days. Based on prior research finding differential patterns in vaping or other tobacco product use among adolescents by specific sociodemographic factors,we included the following potential confounders in analyses: grade, parental education, and sexual orientation. We coded grade into four categories to capture typical groupings in the U.S. context and aid model convergence: 6th -8 th , 9th -10th , 11th -12th , and other/non-traditional. Of note, the majority of adolescents participating in the CHKS are in grades 7th, 9th, and 11th; however a small proportion of students participating in the 2017-18 or 2018-19 survey indicated that they were in 6th, 8th, 10th, or 12th grade which may mean they completed the survey during a class that is primarily open to students in grades 7th, 9th , or 11th, or that their school administered the survey to all grades. We coded parental education into five categories: did not graduate from high school, graduated from high school, attended some college, graduate college, or “don’t know”, and sexual orientation into six categories: heterosexual/straight, gay/lesbian, bisexual, not sure, other , or declined to answer. Our analytical goal was to test the hypothesis that disparities in vaping frequency would be magnified among transgender adolescents of color relative to cisgender white adolescents. We pooled data from the CHKS 2017-2018 and 2018-2019 waves to increase sample size in smaller racial/ethnic and gender identity subcategories and to ensure that the maximum number of schools across the state could be included in the analysis given most schools participate biennially as opposed to annually. We restricted analyses to data from adolescents in grades 6th and above , as the 5th grade survey does not ask about gender identity or substance use . We excluded data from 26 schools that did not collect gender identity . Compared to adolescents attending schools that collected gender identity, adolescents attending schools that did not collect gender identity were less likely to report any past 30-day vaping , and more likely to identify as white and report their parents graduated from college . We further excluded observations collected via a shortened version of the survey which lacked items on substance use . Per recommendations from the survey administrator WestEd, we then excluded observations considered implausible or impossible responses and/or endorsement of an item indicating that some or all survey items were answered dishonestly .