Short communicationRace differences in factors relating to smoking initiation
Introduction
Smoking remains the leading preventable cause of morbidity and mortality in the United States (CDC, 2005), making it imperative to improve our understanding of factors influencing smoking initiation and its trajectory. Racial differences exist in smoking behavior and have been well documented, with previous research showing that African-Americans begin smoking at a later age, smoke fewer cigarettes per day, are more likely to smoke high nicotine and tar containing cigarettes, prefer mentholated cigarettes, inhale more deeply, and metabolize nicotine at a much slower rate than Caucasian smokers (Benowitz, 1996, Clark et al., 1996, Fiore et al., 1989, Kabat et al., 1991, Okuyemi et al., 2006). African-American smokers also have lower rates of successful quitting (Fiore et al., 1989, Giovino et al., 1994), and suffer a disproportionately high rate of deleterious health consequences due to smoking (Harris, Zang, & Anderson, 1993). The reasons for these differences remain to be adequately explained.
A growing body of literature suggests that initial experiences with nicotine, by activating a series of biochemical events in the reward and craving areas of the brain (Littleton, 2001, Quick and Lester, 2002) may be critical in determining whether or not an individual goes on to become a smoker (Chen et al., 2003, DiFranza et al., 2004, DiFranza and Wellman, 2005, Friedman et al., 1985, Gurling et al., 1985, Poulos and Cappell, 1991, Pomerleau et al., 1999, Pomerleau et al., 1998, Pomerleau et al., 2005a). Although those who persist in smoking may experience unpleasant as well as pleasant sensations upon smoking their first cigarette, they may be constitutionally more sensitive to the reinforcing and/or rewarding effects of nicotine (Pomerleau, Collins, Shiffman, & Pomerleau, 1993) and possibly more susceptible to the development of tolerance, leading to greater self-administration (Pomerleau, 1995).
To investigate possible race differences in early smoking experiences that might modulate the transition to smoking, we studied African-American and Caucasian current smokers who participated in a study designed to identify phenotypic and genotypic factors associated with smoking. Age of initial experimentation with smoking and transition to regular smoking, avidity of uptake, reactions to early experiences with nicotine, and reasons for initiation of regular smoking were compared.
Section snippets
Participants
Participants were 203 regular daily smokers (155 Caucasian, 48 African-American) recruited from the local community to participate in a study designed to identify phenotypic and genotypic factors associated with smoking. To be included in the study, candidates had to be between age 25 and 65 years old, to have smoked at least 5 cigarettes/day of ≥ 0.5 mg nicotine for ≥ 5 years, and to have smoked at their current rate for the past 6 months. They also had to meet the following exclusion criteria:
Sample characteristics
African-American smokers had fewer years of education and higher BMI than their Caucasian counterparts. They smoked significantly fewer cigarettes per day. Ninety percent of the African-American sample smoked mentholated cigarettes as compared to 25% of the Caucasian sample population. No other significant differences in baseline or variables related to current smoking emerged. Sample characteristics are shown in Table 1.
Race differences in age of experimentation and transition to regular smoking
African-American smokers were significantly older than Caucasian smokers
Discussion
African-American smokers were less educated than their Caucasian counterparts and had a higher BMI. Consistent with previous reports (Kabat et al., 1991), they currently smoked fewer cigarettes per day and were more likely to smoke mentholated cigarettes.
African-American smokers were significantly older than Caucasian smokers when they first experimented and when they transitioned to regular smoking, in accord with previously reported findings (Trinidad, Gilpin, Lee, & Pierce, 2004). No
Acknowledgments
A preliminary version of this report was presented at the 14th Annual Meeting of the Society for Research on Nicotine and Tobacco in Portland, OR, February, 2008. Preparation of the manuscript was supported by grants DA017640 and R01 DA006529 to the last author.
References (30)
- et al.
Effect of menthol cigarettes on biochemical markers of smoke exposure among black and white smokers
Chest
(1996) - et al.
Recollections and repercussions of the first inhaled cigarette
Addictive Behaviors
(2004) - et al.
Smoking onset among teens: An empirical analysis of initial situations
Addictive Behaviors
(1985) - et al.
Adolescent vs. adult-onset nicotine self-administration in male rats: Duration of effect and differential nicotinic receptor correlates
Neurotoxicology and Teratology
(2007) - et al.
Validation of retrospective reports of early experiences with smoking
Addictive Behaviors
(2005) - et al.
Do the majority of Asian-American and African-American smokers start as adults?
American Journal of Preventive Medicine
(2004) - et al.
Racial differences in trajectories of cigarette use
Drug and Alcohol Dependence
(2004) Cotinine as a biomarker of environmental tobacco smoke exposure
Epidemiological Review
(1996)- et al.
Reliability of adult retrospective recall of lifetime tobacco use
Nicotine & Tobacco Research
(2008) Annual smoking–attributable mortality, years of potential life lost, and productivity losses–United States, 1997–2001
Morbidity and Mortality Weekly Report Serial Online
(2005)
Sensations from initial exposure to nicotine predicting adolescent smoking in China: A potential measure of vulnerability to nicotine
Nicotine & Tobacco Research
A sensitization-homeostasis model of nicotine craving, withdrawal, and tolerance: Integrating the clinical and basic science literature
Nicotine & Tobacco Research
Trends in cigarette smoking in the U.S.—The changing influence of gender and race
Journal of the American Medical Association
Surveillance for selected tobacco-use behaviors—United States, 1900–1994
MMWR Surveillance Summaries
The genetic and cultural transmission of alcohol use, alcoholism, cigarette smoking and coffee drinking: A review and example using a log-linear cultural transmission model
British Journal of Addiction
Cited by (25)
Effectiveness of an Opt-Out Electronic Heath Record-Based Tobacco Treatment Consult Service at an Urban Safety Net Hospital
2020, ChestCitation Excerpt :For both the primary (receipt of inpatient and outpatient NRT) and secondary (self-reported 7-d smoking abstinence at 6 months) outcomes, we first performed unadjusted analyses comparing outcomes between smokers seen and not seen by the TTC service, using χ2 analysis, and then by multivariable logistic regression to control for potentially confounding variables. The four demographic (age, sex, race, insurance plan type) and four comorbid illness (COPD, CHF, SUD, mental health disorders) variables shown in Table 1 were selected for inclusion in the multivariable models because they have been demonstrated in prior research to have an association with smoking cessation.5,29-35 Adjusted odds ratios (AORs) with 95% CIs are reported.
Circulating Inflammation Proteins Associated With Lung Cancer in African Americans
2019, Journal of Thoracic OncologyCitation Excerpt :As the lung cancer–associated inflammation profile was different to that previously observed in EAs, we assessed genetic and nongenetic host factors that could drive the relationship.16,18,20,32 Specifically, as menthol cigarette use is higher among AAs, we compared the effect of menthol cigarette use on circulating inflammation proteins.33-35 Using healthy population control current smokers to negate any effects of cancer on inflammation protein expression levels, we found that use of menthol cigarettes did not modulate expression of inflammation proteins (Fig. 2).
Critical Role for Brain Stress Systems in the Negative Affective State Associated With Nicotine Withdrawal
2017, Negative Affective States and Cognitive Impairments in Nicotine DependenceAdolescent nicotine or cigarette smoke exposure changes subsequent response to nicotine conditioned place preference and self-administration
2014, Behavioural Brain ResearchCitation Excerpt :Considering this, it is important to understand the consequences of such early cigarette smoking initiation. Similar to other abused substances, cigarettes are taken because it makes the user “feel good” [6]. The main substance implicated in the euphorigenic effect of cigarettes/tobacco is nicotine [7–9].
Mentholated cigarettes and smoking-related cancers revisited: An ecologic examination
2012, Regulatory Toxicology and PharmacologyCitation Excerpt :Because of the large racial disparities that exist in rates of tobacco-related cancers (Chu et al., 2007; Gadgeel and Kalemkerian, 2003; Ward et al., 2004) we sought to identify sources of data on tobacco use that specify race. We used “Black” (or African American) or “White” (or European American) as the main categories of interest, which are the self-reported race categories reported to vital status and other registries (Finkenauer et al., 2009; Jemal et al., 2008; Kant et al., 2007; Rock et al., 2010). Age-adjusted incidence rates per 100,000 population/year were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute for the following cancer sites: lung, ESCC, oropharyngeal cancer, and laryngeal cancer.