Ethnic differences in tobacco use and cessation

Background: African Americans experience an unequal burden of tobacco-related disease and mortality, including disparate rates of tobacco-caused cancers, cardiovascular disease, cerebrovascular disease, and infant mortality, when compared with Caucasians. Studies suggest a relationship between these disparities and differences in tobacco consumption and exposure, nicotine dependence, and cessation effectiveness.

Purpose: To determine differences in tobacco initiation, cessation attempts and methods used, tobacco use and dependence, secondhand smoke exposure, and readiness to quit smoking between African American and Caucasian smokers.

Design: A cross-sectional analysis of baseline data from 942 tobacco users, including 54 African Americans and 888 Caucasian smokers in a population-based cessation intervention study. Half of the participants were in the treatment group, recruited from Quit and Win cessation contest enrollees. Remaining participants were recruited using random-digit dialing in communities not exposed to the Contest.

Findings: Compared to Caucasians, African Americans smoked their first cigarette at a younger age; yet they smoked fewer cigarettes per day and reported less nicotine dependence. African American smokers were less likely than Caucasians to report smoking in their cars and more likely than Caucasians to have used ‘cold turkey' as their only quit method on previous attempt(s). The two ethnic groups did not differ on readiness to quit smoking.

Conclusions: African American smokers were less dependent on nicotine, smoked less, and less exposed to secondhand smoke in automobiles. While just as ready to quit smoking, African American smokers may be less likely to use medication and/or counseling for quitting, compared with Caucasians.

Implications for practice: Making effective tobacco dependence treatment modalities widely available and affordable to African American smokers will reduce the enormous disease and economic burden associated with tobacco use.