Differences in time to onset of smoking and nicotine dependence by race/ethnicity in a Midwestern sample of adolescents and young adults from a high risk family study

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Abstract

Objective

The objective of this study was to determine whether race/ethnicity was associated with time to smoking initiation and time from first cigarette to onset of DSM-IV nicotine dependence (ND) after adjusting for familial and individual psychosocial risk factors.

Methods

Cox proportional hazards models with time-dependent covariates were used to analyze data from 1376 offspring aged 12–33 years from 532 families at high risk for substance use problems due to paternal alcohol problems and 235 low risk families. Fifty-six percent of the sample self-identified as African-American (AA) and 44% were mainly of European descent.

Results

Controlling for covariates, AAs began smoking at older ages (HR = 0.58; 95% CI: 0.48–0.70) and had longer times between smoking initiation and onset of ND compared to non-AAs (HR = 0.25, 95% CI: 0.16–0.39 for ND onset occurring <18 years and HR = 0.49, 95% CI: 0.30–0.80 for ND onsets ≥age 18). After additionally controlling for number of cigarettes smoked daily, the racial/ethnic effects for onset of ND were attenuated, but remained statistically significant for ND onset <18 (HR = 0.34, 95% CI: 0.19–0.61); however, the estimate was no longer significant for later ND onset (HR = 0.84, 95% CI: 0.50–1.41).

Conclusions

AA adolescents and young adults initiate smoking at older ages and have longer transition periods between initiation and onset of ND compared to non-AAs, even after controlling for many relevant psychiatric and psychosocial covariates; however, racial/ethnic differences in time to onset of nicotine dependence in late adolescence and young adulthood may be explained by differences in daily quantity smoked.

Introduction

Convergent results from published literature show that African American (AA) adolescents differ in their tobacco use behaviors from their non-AA counterparts. AA adolescents are less likely to initiate cigarette smoking (Bohnert et al., 2009, Dierker et al., 2008, Escobedo et al., 1990, Griesler et al., 2002, Gritz et al., 1998, Voorhees et al., 2011) and begin smoking at older ages (Gutman et al., 2011, Kandel et al., 2005). They are also less likely to become regular smokers and do so at older ages than non-AA youth (Choi et al., 2002, Griesler et al., 2002, Robinson et al., 2004, Voorhees et al., 2011). Among smokers, AA adolescents smoke fewer cigarettes per day (Gutman et al., 2011, Kandel et al., 2005) and increase the quantity they smoke more slowly after initiation (Gutman et al., 2011). In addition, AA adolescent smokers are less likely than non-AA smokers of the same age to meet criteria for DSM-IV nicotine dependence (Dierker et al., 2008, Kandel et al., 2005, Robinson et al., 2006, Schroeder and Moolchan, 2007), even after controlling for daily quantity smoked (Kandel et al., 2005). While racial/ethnic differences remain into young adulthood, with lower proportions of smokers among AAs compared to their EA counterparts, a “crossover effect” has been observed whereby the magnitude of between-group differences declines with age, and by middle age, smoking rates in AAs typically exceed those in EAs (e.g., Geronimus et al., 1993, Kandel et al., 2011).

Although racial/ethnic differences in smoking behaviors among adolescents and young adults are consistently observed, the reason for these differences has yet to be elucidated. Given that many sociodemographic risk factors for smoking are also positively associated with AA race/ethnicity, it would be expected that taking these other variables into account would explain the association, yet racial/ethnic differences in smoking behaviors persist despite controlling for variables such as friends’ smoking and indicators of socio-economic status (Bohnert et al., 2009, Escobedo et al., 1990, Gritz et al., 1998, Gutman et al., 2011, Voorhees et al., 2011). There are, however, racial/ethnic differences in other smoking-associated domains, such as individual psychopathology and parental substance use behaviors that have not yet or rarely been examined in the context of the relationship between race/ethnicity and smoking. In addition, although the literature consistently shows that AA adolescents have slower rates of transition to regular or daily smoking than non-AA adolescents (e.g., Flint et al., 1998) it is unknown whether these same group differences exist for transitioning to DSM-IV nicotine dependence.

The aims of the present study were to determine (a) whether AA race/ethnicity was associated with lower likelihood of transitioning from smoking initiation to DSM-IV nicotine dependence and (b) whether racial/ethnic differences in individual and parental alcohol use disorder and regular smoking explain the relationships between AA race/ethnicity and time smoking initiation and time from smoking initiation to onset of DSM-IV nicotine dependence. This investigation was conducted in a racially/ethnically diverse sample of adolescent and young adult participants in the Missouri Family Study (MOFAM), which is enriched for families at high risk for alcohol and other substance use problems. The MOFAM study features birth record ascertainment of families, over-sample of AA families, telephone screening interviews to determine family risk status, and detailed substance use and psychiatric histories from structured interviews administered to offspring and their parents.

Section snippets

Sample ascertainment

The Missouri Family Study (MOFAM) is a longitudinal, high risk family study designed to investigate the impact of paternal alcoholism on offspring outcomes over time in an ethnically diverse sample of youth identified from the general population. State birth records were used to randomly select families with children who would be aged 13, 15, 17 or 19 at the time of baseline interview, and with at least one additional child aged 13 or older born to the same parents, with oversampling of AA

Results

Fifty-six percent participants were from AA families and 44% were from non-AA families. Thirty-seven percent (37.45%) of the sample came from LRSK families, 28.01% came from HRSK families and 34.54% came from VHRSK families. As can be seen in Table 1, compared to AAs, non-AAs had higher rates of ever having smoked a cigarette (52.46% vs. 44.13%; p = 0.01) and nicotine dependence (32.81% vs. 18.51% p < 0.001) and earlier ages of onset for smoking initiation and for nicotine dependence (p = 0.017 and p <

Discussion

In this sample of adolescents and young adults, African-Americans were less likely to initiate smoking and to transition to nicotine dependence, particularly before age 18, even after controlling for familial and individual psychiatric and socio-demographic risk factors. The relationship between AA race/ethnicity and transition to nicotine dependence after age 18 was explained by racial/ethnic differences in quantity smoked. The effects of race/ethnicity on these outcomes did not differ by

Role of funding source

Funding for this study was provided by NIAAA Grants AA12640, AA11998, and AA017921 and NIDA DA027046 and DA014363. None of the funding sources had any further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

All authors contributed to and have approved the final manuscript. Dr. Bucholz designed, obtained funding for and collected data for the MOFAM study. Drs. Duncan, Lessov-Schlaggar and Bucholz planned the current study. Dr. Duncan conducted all data analysis (in consultation with Drs. Sartor, Lessov-Schlaggar and Bucholz) and wrote the preliminary draft of the manuscript with Dr. Lessov-Schlaggar. All of the authors interpreted the results and reviewed and edited all versions of the manuscript.

Conflict of interest

The authors have no conflicts of interest to report.

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