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Eliseo J. Pérez-Stable, MD; Brenda Herrera, MS; Peyton Jacob III, PhD; Neal L. Benowitz, MD

JAMA. 1998;280:152-156.

Context.— Racial differences in tobacco-related diseases are not fully explained by cigarette-smoking behavior. Despite smoking fewer cigarettes per day, blacks have higher levels of serum cotinine, the proximate metabolite of nicotine.

Objective.— To compare the rates of metabolism and the daily intake of nicotine in black smokers and white smokers.

Design.— Participants received simultaneous infusions of deuterium-labeled nicotine and cotinine. Urine was collected for determination of total clearance of nicotine and cotinine, fractional conversion of nicotine to cotinine, and cotinine elimination rate. Using cotinine levels during ad libitum smoking and clearance data, the daily intake of nicotine from smoking was estimated.

Setting.— Metabolic ward of a university-affiliated public hospital.

Participants.— A total of 40 black and 39 white smokers, average consumption of 14 and 14.7 cigarettes per day, respectively, of similar age (mean, 32.5 and 32.3 years, respectively) and body weight (mean, 73.3 and 68.8 kg, respectively).

Main Outcome Measures.— Clearance (renal and nonrenal), half-life, and volume of distribution of nicotine and cotinine and the calculated daily intake of nicotine.

Results.— The total and nonrenal clearances of nicotine were not significantly different, respectively, in blacks (17.7 and 17.2 mL·min^-1·kg^-1) compared with whites (19.6 and 18.9 mL·min^-1·kg^-1) (P=.11 and .20). However, the total and nonrenal clearances of cotinine were significantly lower, respectively, in blacks (0.56 and 0.47 mL·min^-1·kg^-1) than in whites (0.68 vs 0.61 mL·min^-1·kg^-1; P =.009 for each comparison). The nicotine intake per cigarette was 30% greater in blacks compared with whites (1.41 vs 1.09 mg per cigarette, respectively; P =.02). Volume of distribution did not differ for the 2 groups, but cotinine half-life was higher in blacks than in whites (1064 vs 950 minutes, respectively; P =.07).

Conclusions.— Higher levels of cotinine per cigarette smoked by blacks compared with whites can be explained by both slower clearance of cotinine and higher intake of nicotine per cigarette in blacks. Greater nicotine and therefore greater tobacco smoke intake per cigarette could, in part, explain some of the ethnic differences in smoking-related disease risks.

From the Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations (Dr Pérez-Stable and Ms Herrera); Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, San Francisco General Hospital Medical Center (Drs Jacob and Benowitz); and Departments of Medicine and Psychiatry (Drs Jacob and Benowitz), University of California, San Francisco.

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