Racial Disparity in Smoking: Overcoming confounding of race with socioeconomic status and segregation

We examined the nature of racial disparities in smoking status within a sample that accounts for two major confounding factors in health disparities research—racial segregation and socioeconomic status. Data from the Exploring Health Disparities in Integrated Communities Study in southwest Baltimore, MD (EHDIC-SWB), and a subsample of respondents in the 2002 National Health Interview Survey (NHIS) were matched, providing a final matched dataset sample size was 2948 adults (1474 EHDIC-SWB; 1474 matched NHIS). Our outcome variables were lifetime and current smoking status, and number of cigarettes smoked daily. The prevalence rates for both lifetime and current smoking were substantially greater in the EHDIC-SWB sample, but in comparisons of blacks and whites across samples, we found that the magnitude of the difference between the samples was greatest for whites. After adjusting for age, sex, education, and income, blacks had lower odds than whites of current smoking(OR=0.71; 95% CI 0.56,0.90) and reported smoking (OR=0.68; 95% CI 0.61,0.75) more cigarettes per day in the EHDIC-SWB sample, but there was no race differences in current smoking status or in the number of cigarettes smoked per day in the NHIS. Unadjusted national estimates of race disparities as reported in national reports may be biased because of differential risk exposure among persons of different race groups. Race differences in social and environmental contexts partially account for racial differences in smoking patterns.