Disparities in Personal, Familial, and Social Effects on Cigarette Smoking Behavior between African-American and Caucasian Adolescents in the United States

Background and Purpose: Limited information on cigarette smoking in racial minority groups hinders development of effective and cultural competent treatment and prevention strategies. We know surprisingly little about how the differential predictors of smoking behavior among African-American and Caucasian adolescents. According to the 2005 National Survey on Drug Use and Health (NSDUH, 2006), a substantially greater proportion of Caucasian adolescents aged 12-17 reported past 30-day cigarette smoking compared to their African-American counterparts (14.9% vs. 6.5%); but a greater proportion of African-American adolescents experimented with smoking than Caucasian adolescents (23.0% vs. 20.8%). Given the differences in prevalence rates of smoking status, this study examines disparities in the etiology of adolescent smoking behavior (experimental and regular smoking) between these two racial groups.

Methods: Using data from the 2004 National Youth Tobacco Survey, 5,100 African-American adolescents (female, 52.6%; male, 47.4%) and 12,555 Caucasian adolescents (female, 49.9%; male, 50.1%) in grades 6 through 12 were selected. The nationally representative self-administered mailing survey data are well-suited for this study because they include personal, familial and social factors for smoking-related behaviors. Multiple logistic regression analysis was employed to identify specific predictors of experimental smoking (less than 100 lifetime use occasions and not smoked in the past 30 days) and regular smoking (greater than 100 lifetime use occasions and smoked in the past 30 days) for each racial group.

Results: Consistent with results from the 2005 NSDUH (2006), significantly more African-American than Caucasian adolescents experimented with cigarettes (27.9% vs. 19.3%, p=.000); but Caucasian adolescents had significantly higher rates of regular smoking than their counterparts (9.5% vs. 2.5%, p=.000). Multivariate analyses revealed that, age, weekly income, smoking intention, family members' cigarette use, best friends who smoke, exposure to smoking advertising, and usage of tobacco company products positively predicted adolescent experimental smoking (vs. nonsmoking), whereas an in-house smoking ban negatively predicted such behavior in both groups. Missing school classes was positively significant only among Caucasian experimenters. Perceptions about the harmful effects of cigarette smoking on health negatively predicted regular smoking (vs. nonsmoking) in both racial groups. Weekly income, family members' cigarette use and missing classes were positively significant only among Caucasian regular smokers. Further, significantly more regular than experimenting smokers had best friends who smoke in both groups. Finally, regular smokers reported significantly lower perceptions regarding the harmful effects of cigarette smoking on health compared to experimenters.

Conclusions and Implications: Our findings emphasize that different predictors of adolescent cigarette smoking between the two racial groups should be incorporated into the design of future smoking treatment and prevention programs. In particular, reducing smoking intention and promoting cigarette refusal skills may be selectively effective for African-American smokers as well as Caucasian smokers. In addition, increasing perceptions about the harmful effects of cigarette smoking on health and reducing/eliminating other negative familial and social environments may be useful for Caucasian smokers. Policies aimed at curbing racially targeting advertising campaigns may reduce the initiation and experimental use of cigarette smoking among African-American youth.