Margaret A.WinkerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor
To the Editor.—The recent documentation of ethnic differences in serum cotinine levels among non-Hispanic whites, Hispanics, and blacks1 raises the possibility that higher cotinine levels among black smokers may help explain the increased cardiovascular morbidity and mortality of black Americans. The data are also of interest because of lower serum cotinine levels in Hispanic or Mexican American smokers than those seen in non-Hispanic whites or blacks. Furthermore, smoking exposure in the home appears to be less for Mexican Americans who participated in the third National Health and Nutrition Examination Survey (NHANES III). Other data, albeit from small sample sizes, have indicated a lesser degree of tobacco smoke exposure among Hispanics in New Mexico (R. D. Lindeman, MD, New Mexico Elder Health Study, oral communication, April 15, 1998).2 On the other hand, Mexican Americans had the lowest socioeconomic status (SES) of all 3 ethnic groups, with lesser educational achievement, greater prevalence of poverty, and (of possible importance) a smaller proportion who live in the northeast or north central regions, which are all factors associated with increased heart disease rates.
Abrams J. Racial and Ethnic Differences in Serum Cotinine Levels. JAMA. 1998;280(24):2075-2076. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-24-jbk1223