Examining how social class discrimination is associated with combustible tobacco use, nicotine vaping, and dual use among adolescents in California.

Adolescents who are disadvantaged in social class are twice as likely to use tobacco than their counterparts. Despite extensive research showing how social class is associated with using tobacco products, there is limited knowledge about the association between the discrimination that adolescents experience because they are disadvantaged in social class and their use of tobacco products. To provide new knowledge, this cross-sectional study examined the association between social class discrimination and tobacco use among 1,678 adolescents at two public high schools in California. Social class discrimination was measured by assessing adolescents' experiences based on their social class. Tobacco use was measured with lifetime and past month use of combustible tobacco and nicotine vaping products, categorized into groups: no use, combustible tobacco use only, nicotine vaping use only, and dual use of combustible tobacco and nicotine vaping products. Multinomial logistic regression indicated that social class discrimination was positively associated with lifetime combustible tobacco use (RRR = 1.61), lifetime dual use (RRR = 1.42), and past month dual use (RRR = 1.81) compared to no use. Race/ethnicity modified these associations. Findings underscore the need for interventions addressing social class discrimination as a key social determinant of health to reduce tobacco use and mitigate health disparities among adolescents.