Racial and ethnic differences in serum cotinine levels of cigarette smokers: Third National Health and Nutrition Examination Survey, 1988-1991

JAMA. 1998 Jul 8;280(2):135-9. doi: 10.1001/jama.280.2.135.


Context: Cotinine, a metabolite of nicotine, is a marker of exposure to tobacco smoke. Previous studies suggest that non-Hispanic blacks have higher levels of serum cotinine than non-Hispanic whites who report similar levels of cigarette smoking.

Objective: To investigate differences in levels of serum cotinine in black, white, and Mexican American cigarette smokers in the US adult population.

Design: Third National Health and Nutrition Examination Survey, 1988-1991.

Participants: A nationally representative sample of persons aged 17 years or older who participated in the survey.

Outcome measures: Serum cotinine levels by reported number of cigarettes smoked per day and by race and ethnicity.

Results: A total of 7182 subjects were involved in the study; 2136 subjects reported smoking at least 1 cigarette in the last 5 days. Black smokers had cotinine concentrations substantially higher at all levels of cigarette smoking than did white or Mexican American smokers (P<.001). Serum cotinine levels for blacks were 125 nmol/L (22 ng/mL) (95% confidence interval [CI], 79-176 nmol/L [14-31 ng/mL]) to 539 nmol/L (95 ng/mL) (95% CI, 289-630 nmol/L [51-111 ng/mL]) higher than for whites and 136 nmol/L (24 ng/mL) (95% CI, 85-182 nmol/L [15-32 ng/mL]) to 641 nmol/L (113 ng/mL) (95% CI, 386-897 nmol/L [68-158 ng/mL]) higher than for Mexican Americans. These differences do not appear to be attributable to differences in environmental tobacco smoke exposure or in number of cigarettes smoked.

Conclusions: To our knowledge, this study provides the first evidence from a national study that serum cotinine levels are higher among black smokers than among white or Mexican American smokers. If higher cotinine levels among blacks indicate higher nicotine intake or differential pharmacokinetics and possibly serve as a marker of higher exposure to cigarette carcinogenic components, they may help explain why blacks find it harder to quit and are more likely to experience higher rates of lung cancer than white smokers.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Black People*
  • Black or African American
  • Cotinine / blood*
  • Female
  • Health Surveys
  • Humans
  • Male
  • Mexican Americans
  • Middle Aged
  • Models, Statistical
  • Regression Analysis
  • Smoking / blood*
  • Smoking / ethnology*
  • Tobacco Smoke Pollution
  • United States / epidemiology
  • White People


  • Tobacco Smoke Pollution
  • Cotinine