Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

118 III. SUBSTANCES OF ABUSEadult cigarette use. Native Americans/Alaska Natives had the highest prevalence(36.0%). The smoking rates for whites and blacks were 24.1% and 23.2%,respectively, and the rates of smoking among adult men and women were similar(white: 25.9% and 22.4%, respectively; black: 26.1% and 20.9%, respectively).For Hispanics and Asians, adult men smoked at considerably higherrates than adult women (24.0%, Hispanic men; 13.3%, Hispanic women;21.0%, Asian men; 7.6%, Asian women). For Native Americans/AlaskaNatives, the opposite relationship held (29.1%, men; 42.5%, women; Centersfor Disease Control and Prevention, 2002).Adults who had earned a General Educational Development (GED)diploma had the highest prevalence of smoking (47.2%). Persons with master’s,professional, and doctoral degrees had the lowest prevalence (8.4%). The prevalenceof current smoking was higher among adults living below the povertylevel (31.7%) than those at or above the poverty level (22.9%) (CDC, 2002).In 2000, an estimated 44.3 million adults (22.2%) were former smokers,representing 24 million men and 19.7 million women (Centers for DiseaseControl and Prevention, 2002). Among smokers, 70.0% reported that theywanted to quit smoking completely; an estimated 15.7 million (41.0%) hadstopped smoking for one or more days during the preceding months becausethey were trying to quit; and 4.7% of smokers who had smoked every day orsome days during the preceding year quit and maintained abstinence for 3–12months in 2000. The percentage of ever smokers who had quit varied sharplyby demographic group. By race/ethnicity, the percentage of persons who hadever smoked and had quit was highest for whites (51.0%) and lowest for non-Hispanic blacks (37.3%; Centers for Disease Control and Prevention, 2002).Although blacks have not quit smoking at the same rate as the generalpopulation (cf. Fiore, Novotny, Pierce, et al., 1990), data from large smokingintervention studies (e.g., Multiple Risk Factor Intervention Trial [MRFIT];Hymowitz, Sexton, Ockene, & Grandits, 1991; Community Intervention Trialfor Smoking Cessation [COMMIT]; Hymowitz et al., 1995) revealed comparablequit rates for blacks and whites. Variables that emerged as significant predictorsof smoking cessation in these studies were older age, higher income, lessfrequent alcohol intake, lower levels of daily cigarette consumption, longertime to first cigarette in the morning, initiation of smoking after age 20, morethan one previous quit attempt, a strong desire to stop smoking, absence ofother smokers in the household, and male gender.PHARMACOLOGYNicotine is a tertiary amine composed of a pyridine and a pyrolidine ring(DHHS, 1988). Absorption of nicotine across biological membranes dependson pH. Modern cigarettes produce smoke that is suitably flavored and suffi-