The present study found no statistically or clinically significant differences to support the hypotheses of early ethnic differences in acute physiological responses to menthol cigarette smoking and puff topography measures among teenage smokers seeking cessation treatment. Adolescent puff volumes found in the current study were similar to those reported by others. Higher CO in our population seeking cessation treatment may reflect heavier dependence-related smoking. Alternatively, while higher CO in this group of all menthol smokers did not appear to be due to higher puff volume than in previous studies, anesthetizing and cooling effects of menthol may have influenced other puff topography variables (e.g., depth of inhalation) to allow greater smoke exposure.
Ethnic differences in smoking topography and physiological response to smoking can be obscured by ethnic differences in preference for menthol cigarettes. This study of all menthol smokers clarified these relationships by controlling for menthol preference. The overwhelmingly high prevalence of menthol smoking in both ethnic groups of adolescents is consistent with other data that report targeted marketing of mentholated cigarettes. Given the resurgence of menthol smoking among both African-American and European-American teenagers and the higher-than-average mean nicotine content of menthol cigarettes in the current study, we suggest that future research extend these findings by evaluating ethnic differences in smoking topography and physiological responses to smoking in a 2-x-2 factorial experimental design that includes adolescents who smoke both menthol and nonmenthol cigarettes on a regular basis. canadian pharmacy viagra
However, these findings are preliminary and suffer limitations of generalizability. By studying a self-selected, treatment-seeking sample of highly addicted menthol smokers, we may have minimized differences observable in a larger, more diverse sample of adolescent smokers. The use of data from a single smoking session in this sample of convenience may also have led to less generalizable results, although a recent study among adult smokers in our laboratory supports it validity. Influenced by degree of nicotine delivery, which was not measured in the current study; however, the lack of differences in puff topography and CO measures suggests similar exposure to nicotine by both groups. Finally, teenagers may smoke differently in naturalistic settings outside the laboratory where physiological measures were recorded, thus, these findings may not reflect ethnic differences operating in daily life. Further study is warranted to replicate and extend these findings to adolescent smokers who are not treatment-seeking and not physically dependent on tobacco.
While not examined in the current study, the possibility remains that factors other than acute physiological responses to smoking contribute to ethnic differences in population-based, tobacco-attributable mortality. Indirect rather than direct factors, such as the impact of the social and societal stress of ethnic discrimination and its resulting effects (e.g., immune and neuroendocrine responses) that mediate the development of disease entities may be more relevant than acute responses to longer-term consequences of decades of exposure to tobacco. Alternatively, for as-yet undocumented reasons, African-American smokers may not be accessing effective quitting aids, such as over-the-counter nicotine replacement therapy products (i.e., nicotine patch and gum) at the same rate, resulting in less successful quit attempts and longer exposure to tobacco. As such, longitudinal, population-based, and laboratory studies in a broader sample of young smokers are needed to better understand the mechanisms underlying ethnic differences in tobacco-related health outcomes.