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

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 (۱) the effects of race, ethnicity, educational attainment, and poverty status on first cigarette flavor in a national sample of American adult smokers, and (۲) racial and ethnic differences in the effects of educational attainment and poverty status on first cigarette flavor.Methods: This cross-sectional study entered ۲۲,۱۴۴ ever-smoker adults who had participated in the Population Assessment of Tobacco and Health (PATH; ۲۰۱۳), 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 = ۳.۸۶, ۹۵% CI = ۳.۵۵-۴.۲۰), and Hispanics had higher odds of initiating smoking using candy/fruit-flavored cigarettes (OR = ۱.۷۹, ۹۵% CI = ۱.۴۴-۲.۲۱). Overall, individuals with higher education had lower odds of initiating smoking using menthol/mint-flavored cigarettes (OR = ۰.۹۴, ۹۵% CI = ۰.۹۲-۰.۹۶), but higher odds of candy/fruit-flavored cigarettes (OR = ۱.۳۵, ۹۵% CI = ۱.۲۶-۱.۴۵). 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.