Race, Ethnicity, Education, Poverty, and First Cigarette Flavor

Shervin Assari

doi:10.34172/ijtmgh.2021.22

Abstract

Introduction: Research shows that race, ethnicity, and socioeconomic status (SES) have multiplicative rather than additive effects on the risk of cigarette smoking. In a national sample of American adult smokers, this study tested (1) the effects of race, ethnicity, educational attainment, and poverty status on first cigarette flavor in a national sample of American adult smokers, and (2) racial and ethnic differences in the effects of educational attainment and poverty status on first cigarette flavor. Methods: This cross-sectional study entered 22,144 ever-smoker adults who had participated in the Population Assessment of Tobacco and Health (PATH; 2013), a nationally representative study in the US. Independent variables were race, ethnicity, educational attainment, and poverty status. There were three dependent variables: initiating smoking using any, menthol/mint, and candy/fruit-flavored cigarettes. Age, sex, and region were the covariates. Results: Black individuals had higher odds of initiating smoking using menthol/mint-flavored cigarettes (OR=3.86, 95% CI=3.55-4.20), and Hispanics had higher odds of initiating smoking using candy/fruit-flavored cigarettes (OR=1.79, 95% CI=1.44-2.21). Overall, individuals with higher education had lower odds of initiating smoking using menthol/mint-flavored cigarettes (OR=0.94, 95% CI=0.92- 0.96), but higher odds of candy/fruit-flavored cigarettes (OR=1.35, 95% CI=1.26-1.45). Living out of poverty was not associated with initiating smoking using flavored cigarettes. Conclusion: In the US, race, ethnicity, and SES show multiplicative rather than additive effects on first cigarette flavor.

Highlights

Research shows that race, ethnicity, and socioeconomic status (SES) have multiplicative rather than additive effects on the risk of cigarette smoking
Most smokers’ (60.7%) first cigarette was non-flavored, most of the flavored cigarettes were mint/menthol (39.3% of total), which was considerably higher than people who had started their first smoke with a candy/fruit-flavored product (4.5% only)
Blacks had a higher tendency to initiate with menthol/mint-flavored cigarettes, whereas Hispanics more frequently initiated with candy/fruit-flavored cigarettes

Summary

Introduction

Ethnicity, and socioeconomic status (SES) have multiplicative rather than additive effects on the risk of cigarette smoking. There were three dependent variables: initiating smoking using any, menthol/mint, and candy/fruit-flavored cigarettes. Individuals with higher education had lower odds of initiating smoking using menthol/mint-flavored cigarettes (OR = 0.94, 95% CI = 0.920.96), but higher odds of candy/fruit-flavored cigarettes (OR = 1.35, 95% CI = 1.26-1.45). Tobacco use remains the leading preventable cause of morbidity and mortality in the US, especially for populations with a low socioeconomic status (SES).[9,10,11] Each year, tobacco takes 480,000 lives in the US and causes 16 million tobacco-related chronic diseases.[12] in the US, tobacco imposes 300 billion dollars each year for combined direct and indirect costs.[13]

Methods

Results

Conclusion