In the United States, African Americans develop a higher number of preventable diseases relative to white Americans. The three leading causes of death among the black population are heart disease, cancer and stroke. In addition, black Americans are at higher risk for a number of lung conditions, including asthma and infections. Smoking and tobacco use are major contributors to all of these conditions.
According to the most recent data from the Centers for Disease Control and Prevention (CDC), there were 44.5 million smokers in the United States in 2004. Among the black population, approximately 20 percent of adults smoked cigarettes as compared to 22 percent on all non-Hispanic whites.
In the 1990s, smoking rates were higher for black men than white men. By 2004, the smoking rate for black men dropped below the rate of white men. In addition, the incidence of smoking dropped significantly between 1999 and 2003 among black American middle and highs school students, according to the CDC Youth Risk Behavior Survey. Given the strikingly high rate of smoking among black American youth in the 1970s, this information is very encouraging.
Unfortunately, black American adults continue to be diagnosed with smoking-related diseases at a greater rate than other groups in the United States, often with greater associated mortality. Although black Americans are only 12 percent of the U.S. population, almost a quarter of all asthma deaths are among black Americans. According to figures compiled by the American Lung Association, in 2004, about 4.7 million black American adults smoked - roughly 11 percent of the total smokers in the United States.
Smoking tends to aggravate other known risk factors and diseases that are more common among black Americans. Smoking is a major risk factor for stroke, and recent research has suggested that black Americans are three to five times more likely to have a stroke than white Americans of the same age. This may be related to the fact that black Americans have significantly higher rates of high blood pressure and diabetes. Furthermore, black American women are struggling with greater rates of obesity.
As a result of this information, black Americans are urged to reduce these risk factors as much as possible by not smoking, controlling blood pressure, monitoring blood sugar, exercising and maintaining a healthy weight.
This article reviews the research that has been done on tobacco use in the black American community and programs that are available to help educate the public about this issue.
Youth tobacco use in black Americans
A recent survey by the Centers for Disease Control and Prevention revealed encouraging information on smoking and black Americans. The 2004 National Youth Tobacco Survey determined that, in contrast with white students, black American students were less likely to have a regular smoking habit in either middle school or high school, and those who did smoke were more likely to have participated in a smoking cessation program.
These statistics are very encouraging because they reflect how much smoking rates have dropped among black American youths since the 1970s, when rates were strikingly high. However, recent surveys also show a leveling off in the decline of smoking rates among black American high school students. Specific findings include:
Overall, 11.8 percent of middle school students reported use of tobacco of any kind, a decline of slightly more than 1 percent since 2002. Cigarettes and cigars were the most common
In both high school and middle school, students reported a significant decline in media exposure to cigarettes and tobacco products. However, tobacco advertising on the Internet increased significantly and represents an area of possible improvement.
At the high school level, white and Hispanic students were much more likely than black American students to smoke cigarettes and almost three times as likely to use chewing tobacco. Overall, 27.4 percent of high school studies reported use of any tobacco product. Cigarettes and cigars were the most common. Use of any tobacco product among black American high school students dropped from 21.7 percent to 16.8 percent.
At both the middle- and high-school levels, black American students were more likely than white students to have participated in a structured smoking cessation program.
Youth attitudes toward smoking
Unfortunately, positive social perceptions about smoking and smokers continue. Among middle-school black American students who had never smoked, slightly over 20 percent surveyed thought that smokers have more friends; among current smokers, roughly 45 percent. Among high-school black American students who had never smoked, 21 percent thought that smokers have more friends; among current smokers, almost 38 percent. In all cases these numbers were higher than white, Hispanic and Asian students, except for the 39 percent of Asian high-school current smokers who thought that smokers have more friends.
Among middle schoolers, black American nonsmoking children were significantly less likely than nonsmoking white children to know that smoking is addictive, that smoking at least a pack a day carries health risks or that passive smoke (from other people's smoking) can be dangerous. However, black American nonsmoking students were more likely to have participated in community anti-tobacco events.
Among nonsmoking high school students, black American teens were less likely than white teens to know that passive, “secondhand” smoke (from other people’s smoking) can be dangerous. They were also less likely than white teens to have seen/heard antismoking messages on T.V. or the radio. Black American high school students who had never smoked were more likely than Hispanic, Asian or white students to have participated in community anti-tobacco events.
As smoking has declined, tobacco companies have targeted this population with advertising and merchandising, including billboards and media geared toward these groups. One tobacco company utilizes hip-hop characters while another incorporates rap music into their campaigns. In addition, tobacco companies have become visible at athletic and entertainment events that cater to the youth population. The American Lung Association reports that in 2003, the five major tobacco companies spent a record $15.5 billion on advertising and promotion of their products.
The 1998 Master Settlement agreement prohibited tobacco companies from advertising their products in markets geared toward individuals less than 18 years of age. However, the agreement has not been totally successful in limiting the promotion of tobacco products to children and adolescents. A recent study found that children between the ages of 10 and 15 who watched five or more hours of television per day were six times more likely to start smoking than those who watched two hours or less per day.
According to the CDC, if current trends continue, an estimated 1.6 million black Americans who are currently under the age of 18 will become regular smokers. They estimate that about 500,000 of these individuals will die from a smoking-related disease.
Adult tobacco use in African Americans
Despite the positive trend among black Americans youths, smoking among black American adults continues to be a problem with serious and often fatal consequences. Specific research findings are listed below:
In 2004, 20.2 percent of black Americans reported as being smokers. This rate was slightly below the estimated national average of 20.9 percent of adults. There are fewer smokers among black Americans that white (22.2 percent) but more than Hispanics (15 percent).
According to the American Lung Association, in 2004, 23.9 percent of black American men smoked as compared to 24.1 percent of white men. In women, blacks tended to smoke less than whites, however, rates were very similar. Furthermore, black Americans are more likely to be diagnosed with smoking-related diseases than white Americans.
According to data reviewed in the U.S. Surgeon General’s 1998 report on Tobacco Use Among U.S. Racial/Ethnic Minority Groups (updated in July 2000), black American men are at least 50 percent more likely than white men to develop lung cancer, and have higher mortality rates from lung cancer. Of black American smokers, more than 70 percent indicated they wanted to quit smoking completely. During 2002, about 33 percent of black adult smokers indicated they quit for at least one day, compared to 43 percent of white adult smokers. Overall, black American smokers were much more likely to succeed in quitting the habit.
As with other U.S. populations, the rate of smoking decreases as the level of education increases. In 2003, smoking rates were over three times higher (37.4 percent) among black adult males with less than a high school education than those with a college education (10.3 percent). The same prevalence was true for black American women.
Menthol cigarettes are popular among black American smokers (75 percent), whereas about 25 percent of white smokers state a preference for menthol cigarettes. Research suggests that menthol enhances the absorption of carcinogens present in cigarette smoke.
Studies show that, cigarette-for-cigarette, urinary levels of cotinine (the metabolized product of nicotine) is higher in black American smokers than in white or Hispanic smokers.
Among women who quit smoking while pregnant, research found that black American women were more likely than white women to pick up the habit again after delivering their baby.
Strategies to lessen impact
History has shown that individuals can make a difference in relieving some of the burden that tobacco places on the black American community. Backed by groups such as the National Black Leadership Initiative on Cancer, the Association of Black Cardiologists and the National Association of African Americans for Positive Imagery, community-organized efforts successfully prevented two brands of cigarettes from being marketed specifically to the black American community. The first brand was “Uptown” (introduced in 1989 and never test-marketed) and the second was “X” (withdrawn in 1995).
Here are some strategies that individuals can use to help turn the tide against the harmful effects of smoking on the black American community:
Strengthen efforts to quit smoking and support others who are trying. For tips on how to quit, see Smoking Cessation. Encourage youth to avoid peer pressure tactics and engage in healthy, active lifestyles instead of choosing harmful behaviors.
Be aware of who is selling what. As smoking rates have dropped nationally, tobacco companies have launched aggressive marketing campaigns aimed at the black American community. These campaigns include magazine and billboard advertising, as well as sponsorship of scholarships and entertainment and athletic events. Research has suggested that three black American publications receive proportionally higher profits from cigarette advertising than do more mainstream magazines.
Help antismoking groups at the state and national level to spread the word. For example, the National Association of African Americans for Positive Imagery (NAAAPI) offers public service announcements and research aimed at countering the extensive marketing campaigns mounted by tobacco companies.
Learn and practice healthy stress management techniques instead of reaching for a cigarette.
The Tobacco Consensus Panel of the National Medical Association also called for actions such as:
Continued prevention efforts for black American youths.
Additional training for physicians in roles as advocates and leaders in tobacco control movements.
More “culturally competent” educational campaigns about smoking in black American communities.
Further research on the impact of smoking on black Americans.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful conversations with their physicians about their conditions. Patients or parents may wish to ask healthcare professionals the following questions about smoking and black Americans:
Why is it important for me to quit smoking?
As a black American, am I at a greater risk from cardiovascular diseases if I smoke?
What other health risks associated with tobacco use?
Does my family history place me at higher risk for problems from smoking?
How urgently do I need to quit smoking? Can't I just cut back?
How will smokeless tobacco products affect my health?
Am I a candidate for using smoking cessation aids, such as a nicotine patch?
Can you suggest any programs or groups that can help me to quit smoking?
How quickly will I see improvement in my health if I quit smoking?
What can I do to prevent my child from using tobacco?
