Tobacco use is a major risk factor for many preventable chronic conditions and subsequent complications (U.S. Department of Health and Human Services, 2014). While tobacco use has decreased over time among U.S. adults (Cornelius et al., 2022), trends remain stable among those with chronic conditions (Stanton et al., 2016). Over 1-in-4 U.S. adults with at least one chronic condition smoke cigarettes, with disproportionate rates of nearly 52% among those with more than one condition (Loretan et al., 2022). Additional tobacco use disparities persist with highest rates among those who identify as male, non-Hispanic Black or other race, of lower socioeconomic status, and who are publicly insured or uninsured (Cornelius et al., 2022). In 2020, non-Hispanic Black adults had the highest prevalence of combustible tobacco use (18%) compared to non-Hispanic White (16%) and Hispanic adults (10%) (Cornelius et al., 2022). However, tobacco use prevalence varies by Hispanic subgroups with rates up to 35% among Puerto Rican men (Kaplan et al., 2014). Additionally, Hispanic men can have high nicotine dependence and smoke a high number of cigarettes per day (Medina-Ramirez et al., 2022). Even though research has assessed the associations between tobacco use and the development and progression of chronic conditions (U.S. Department of Health and Human Services, 2014), there is a gap in the evidence base about the intersection between tobacco use patterns, healthcare utilization, and chronic conditions among U.S. adult men who are non-Hispanic Black and Hispanic. This research is of importance since non-Hispanic Black adults have an increased chronic disease burden including having multiple conditions, while Hispanic adults accumulate chronic conditions at a quicker rate when compared to non-Hispanic White adults (Quiñones et al., 2019).

Despite the high prevalence of chronic conditions among racially/ethnically diverse adults (Davis et al., 2017, Raghupathi and Raghupathi, 2018), healthcare utilization is especially limited among racially/ethnically diverse men who often prolong or delay preventive healthcare visits leading to undiagnosed chronic conditions (Kim et al., 2018). Further, while smokers are at risk for chronic conditions, and in turn, may need more healthcare, they are less likely to seek needed medical help for symptoms that may be harbingers of lung cancer such as cough or hoarseness (Friedemann Smith et al., 2016). Thus, research indicates that current cigarette smoking among adults with chronic conditions increases the likelihood of having one or more unplanned visits to an emergency department (ED) setting and one or more unplanned hospitalizations (Selya et al., 2020). Specific research is needed about the association between current tobacco use patterns and healthcare utilization among non-Hispanic Black and Hispanic men with chronic conditions to identify disparities as well as potential healthcare venues that can be used to reach this vulnerable population and provide them with tobacco cessation treatment.

The present study assessed current tobacco use patterns associated with past year healthcare utilization among non-Hispanic Black and Hispanic men ≥40 years old with ≥1 chronic condition. We hypothesized that when compared to nontobacco users, exclusive cigarette smokers, dualtobacco users (smoked combustible cigarettes + used one other tobacco product such as e-cigarettes or cigars), and polytobacco users (smoked combustible cigarettes + used two or more tobacco products) would be less likely to have a primary care visit, but they would be more likely to have an ED visit and overnight hospital stay. Further, we hypothesized that when compared to polytobacco users, exclusive cigarette smokers and dualtobacco users would be less likely to have an ED visit and overnight hospital stay, which are potential indicators of illness severity.