Question

1. In a survey of population 18 years and older conducted in 2004, 24.1 % of white men and 23.9 % of black men were current smokers of tobacco. Irrespective of race, the prevalence of tobacco smoking differed little by age, except for a sharp drop in men 65 years and older. The small difference in current smoking (0.2 % ) between white and black men noted above does not take into account the fact that in 2004 the average age of white men was somewhat higher. After age adjustment, would you expect the interracial difference to be larger, smaller (or reversed), or unchanged? Why?

Answer 1

Answer-

​​​​​​I think it's "larger"

- Although a smaller proportion of black parents in control practices smoked than white, black parents were more likely to be asked by pediatrismokedcians about smoking. The CEASE intervention was associated with higher levels of screening for smoking for both black and white parents.

• For years, national US surveys have found a lower prevalence of cigarette smoking among non-Hispanic (NH) black adolescents and young adults than their NH white counterparts while finding either similar or higher prevalence in NH blacks among older adults. We present results from four US surveys, including one supplemented by cotinine data, to determine if a race-gender-age crossover effect exists between NH black and NH white current cigarette smokers.

• which the authors assessed NH black and NH white smoking prevalence for women aged 18–44 years using data from the 1987 NHIS Cancer Supplement, the authors concluded that there was an age crossover effect by age 30. 5 The age crossover effect is described as an age-related reversal in prevalence of current smoking among NH blacks and NH whites where the prevalence is higher among NH whites than NH blacks in adolescence but lower in adulthood. In a more recent publication by Kandel, Schaffran, Hu, and Thomas, 6 the authors, using the 2006–2008 NSDUH cross-sectional surveys found a crossover age of 29 years old. Even though Geronimus and colleagues’ study was specific to women of reproductive age living in the United States and Kandel and colleagues’ study included all adults in the United States aged 12–49 years, the ages of the crossover are strikingly similar and also point to the fact that this phenomena of a possible age crossover between NH blacks and NH whites may have been going on at least from the 1980’s. This age crossover effect between NH blacks and NH whites may not be unique to cigarette smoking prevalence. Similar observations have been found for illicit drug use and prescription drugs for non-medical purposes, 7 and for heavy drinking. 7 , 8 To help explain the specific age of the crossover between NH blacks and NH whites, Kandel and colleagues assessed in their study various sociodemographic factors that may help explain it. Those factors were gender, education, marital status, and work status. They found that education had the greatest effect on the specific age of the crossover. Kandel and colleagues’ study, even though it controlled for gender, did not specifically separate analyses for males and females nor used a survey with a biomarker of cigarette smoking that could capture under-reported smoking. Our study adds to the potential age crossover smoking prevalence literature by specifically looking at results from several surveys, including one that uses a biomarker to detect cigarette smoking under-reporting. Our study only intends to determine if there is an age crossover effect in smoking prevalence between NH blacks and NH whites by gender, not to identify the specific age of the crossover.

Even though national surveys have traditionally estimated smoking prevalence using self-reports, which are considered generally accurate, 2 still, self-reported smoking information are based on retrospective recall for a behavior viewed by many as socially undesirable, which may result in providing less than accurate smoking status information, and resulting in variation in current smoking prevalence estimates across surveys. 9–17 Furthermore, several national surveys use differing definitions of smoking status, interview settings, mode of survey administration, time of the year when the survey is administered, which, along with other differences, may contribute to varying prevalence estimates. 18–20 For example, school interviews, especially those that are anonymous, provide higher smoking prevalence estimates among youth than household interviews. 21 A number of additional factors have been offered to explain the lower smoking prevalence in NH black youth, including later age of smoking onset, parental and peer influence not to smoke, sports involvement, attendance at religious services, and the cost of cigarettes. 1 , 6 , 10 , 22–27

Analyses were restricted to NH white and NH black persons only, thus, estimates presented in this manuscript are not identical to previously reported current smoking estimates for the whole US non-institutionalized population from each survey (these surveys include other races as well in their reports). We compared current cigarette smoking prevalence between NH whites and NH blacks by gender and age groups. We defined age groups as 12–17, 18–25, and 26 years or older.

• All data analyses were performed in SUDAAN using procedures appropriate for each survey’s sample design. Multiple years of data were combined for each survey and weighted according to each survey’s analytical guidelines. Records with missing data were excluded from the analyses. We have estimated weighted prevalence of current cigarette smoking, 95% CIs and statistical significance of the estimate differences ( P value).