Differing patterns of smoking in African Americans and whites

I’ve written on a number occasions about menthol cigarettes being more harmful and addictive in certain circumstances. This is a factor that may have an impact on smoking rates among African Americans.But there are a number of interesting differences between white and AA smokers in addition to the later group’s preference for menthols (80%).

One of the most striking differences is in the pattern of initiation of cigarette smoking. Back in the mid 1970s, AAs, Latinos and whites had a similar teen smoking rates. For example in the mid 1970s, about 36% of high school seniors of each of the largest racial/ethnic groups (white non Hispanic, Hispanic and AA) had smoked a cigarette in the past 30 days. But from that point to the start of the 1990s there was a marked drop in the rates of African American adolescent cigarette smoking. By 1992 it was less than a third of that of whites (AAs under 10%, whites over 30%) and it has remained much lower for AA teens than for whites ever since. The strange part is that and we are not sure why! No-one has been able to fully explain what caused smoking rates to decline so rapidly within AA teens. Possibilities include increased supervision by AA parents, increased awareness of the health effects of tobacco within the AA community, increased religiosity in AA families (linked to lower substance use, including tobacco) and increased sensitivity to price increases.

But whatever the causes (and I’d love to hear your thoughts on what these might be, as no academics have figured it out yet!), the reduction in AA youth smoking should by now have fed into reduced adult smoking prevalence, relative to whites. But in fact that has not happened. AA adult smoking prevalence has only declined gradually, like that of whites, despite the rapid reduction in new initiates. This stable and similar smoking rate in adults masks both the reduced initiation, but also much lower quit rates among adult AA smokers. From the 1970s through 2006 the percentage of ever-smoking AAs who have quit is much lower than that for whites (36% vs 53% in 2006).

African American smokers smoke fewer cigarettes per day yet have higher blood cotinine levels (main metabolite of nicotine) indicating greater smoke intake per cigarette. This maybe part of the explanation for their lower quit rates: they are getting more nicotine per cigarette and consequently getting more addicted than do whites. As mentioned before, there is some evidence suggesting that the AA preference for mentholated cigarettes may play a role in this process.

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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.