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 (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.