Race differences in factors relating to smoking initiation

Abstract

To investigate race differences in retrospectively-reported early smoking experiences, we studied African-American (n = 48) and Caucasian (n = 155) current smokers who participated in a study designed to identify phenotypic and genotypic factors associated with smoking. Compared with Caucasian smokers, African-American smokers were less educated (mean ± s.e.m.: 13.3 ± 0.25 vs. 14.3 ± 0.16; p < .01), had higher BMI (28.9 ± 1.06 vs. 26.7 ± 0.52; p < .05), and smoked significantly fewer cigarettes/day (14.1 ± 1.00 vs. 18.4 ± 0.74; p < .01). Ninety percent of African-American smokers consumed menthol cigarettes, as opposed to 25% of Caucasian smokers. African-American smokers were significantly older than Caucasian smokers upon initial smoking experimentation (17.4 ± 1.1 vs. 14.7 ± 0.3; p < .05) and onset of regular smoking (19.7 ± 0.9 vs. 17.4 ± 0.4; p < .05). African-American smokers were significantly more likely than Caucasian smokers to endorse global pleasurable sensations (48% vs. 30%; p < .05), “pleasurable rush or buzz” (62% vs. 43%; p < .05), and “relaxing” (45% vs. 27%; p < .05) as early experiences with smoking, whereas Caucasian smokers were marginally more likely to report dizziness and difficulty inhaling (61% vs. 45%; p < .10 and 48% vs. 31%; p < .10, respectively). Caucasian smokers were significantly more likely to endorse friends (6.9 ± 0.2 vs. 4.8 ± 0.4; p < .0001) and “perk me up” (4.2 ± 0.3 vs. 3.1 ± 0.4; p < .05) and marginally more likely to endorse buzz (4.2 ± 0.2 vs. 3.4 ± 0.5; p < .10) as reasons for starting to smoke. Further research is needed to determine the relative contributions of genetic, developmental, and socio-cultural factors to these findings.

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.