Differences Between African Americans And Whites In Theprogression From First Full Cigarette To Nicotine Dependence

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Public Health and Policy


Doctor of Public Health

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There are significant health disparities and social problems associated with nicotine dependence. While White adults have a higher prevalence of lifetime smoking, and current smoking than African Americans, African Americans suffer higher incidence rates from smoking-related health problems such as respiratory and cardiovascular problems, and cancer, than Whites. Research has shown racial/ethnic differences in the process of becoming nicotine dependent, with African Americans being more likely to become nicotine dependent than Whites. Data from Wave I of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used for this study (N=14,225). Nicotine dependence was operationally defined using DSM-IV criteria in the NESARC. The main independent variables for this analyses included race, gender, age at first nicotine use, and socioeconomic status (SES). Discrete time survival analyses and regression analyses were conducted using STATA version 10.0. Multivariate survival analyses showed African Americans had 17% lower hazards of becoming nicotine dependent than Whites (aHR=0.83; 95% CI=0.76-0.90; p< 0.001), adjusting for covariates and that Whites progressed to nicotine dependence faster than African Americans. The race by SES interaction showed that the race/nicotine dependence and SES/nicotine dependence associations seemed to be independent of each other which suggested that there may be a cultural component in the transition to nicotine dependence. African Americans suffer more adversely from smoking-related morbidity and mortality despite earlier smoking initiation and faster progression to nicotine dependence by Whites. The evidence from this study suggests that the origin of the tobacco-related health disparities is not rooted in differences in the incidence of nicotine dependence, but more likely derive from factors affecting the features and duration of nicotine dependence. This finding provides the platform for further research on factors associated with the duration of nicotine dependence. Based on the findings from this study, programs that reduce or delay the progression to nicotine dependence should be increased. Also, racial/ethnic-specific programs tailored to meet individuals' smoking prevention and cessation needs are important for the reduction of the impact of nicotine dependence health-related problems.&#8195;