TOBACCO USE in DIVERSE POPULATIONS

PREVALENCE of ADULT SMOKING, by RACE/ETHNICITY—U.S., 2007

Centers for Disease Control and Prevention. (2008). MMWR 57:1221–1226.

* non-Hispanic

0 10 20 30 409.6% Asian*

36.4% American Indian/Alaska Native*

19.8% Black*

21.4% White*

13.3% Hispanic

HEALTH DISPARITY/INEQUALITY

Health disparities are potentially avoidable differences in health between groups of people who are more and less advantaged socially

Used to describe unequal health conditions or indicators (e.g., tobacco use initiation, current use, ETS, CPD, quitting, treatment access, relapse, cancer).

Fagan et al (2007); Braveman (2006)

Lung Cancer Incidence and Cardiovascular-Related Mortality for US Adults, 2002-2006

0

50

100

150

200

250

300

Heart Disease Stroke Lung & Bronchus Cancer

Smoking-related diseases

Ag

e-ad

just

ed d

eath

s p

er 1

00,0

00

Whites

Blacks

Hispanic

American Indian/Alaska Native

Asian/Pacific Islander

CDC, Health, United States, 2008; SEER Cancer Statistics Review, 1975-2006

ETHNIC DIFFERENCES in SMOKING BEHAVIORS

Initiation Middle/high school: Latinos/Hispanics Middle school: Native Americans,

Pacific Islanders High school: Asian Americans

(experimentation) After 18: African Americans

(experimentation/regular use) & Asian-Americans (regular use)

Fagan et al., 2007 ; Kandel et al., 2004; Trinidad et al., 2004

75% of African Americans smoke menthol cigarettes

≤ 10 cigarettes per day Latinos: 59% men, 75% women African Americans: 42.9% men, 59.7% women 53% Japanese American women; 22% men

≤ 15 cigarettes per day 70% Pacific Islanders 50% American Indians/Alaska Natives

Fagan et al., 2007; Haiman et al., 2006; Eichner et al., 2005; U.S.DHHS, 1998

ETHNIC DIFFERENCES in SMOKING BEHAVIORS

SECONDHAND TOBACCO SMOKE

Youth: 10% Mexicans, 16% other Latin countries, 35.5% Puerto Ricans

African American youth: 46% youth exposed to secondhand smoke (highest of any ethnic group) Higher serum cotinine levels compared to

white and Latino youth

Data needed for Asian and Native Americans Home exposure is likely high for American

Indians 31% of Vietnamese American women exposed

daily

Fagan et al., 2007; Freeman et al., 2003; Stamatakis et al., 2002

SMOKING CESSATION

Quit 1+ days in past 12 months

Blacks (47%) > Whites (42%)

45-46%: Hispanics, Asians, American Indians

No ethnic differences in lifetime quit attempts or desire to quit

National Health Interview Survey Results, 2007

AFRICAN-AMERICANS

Nicotine accumulates in tissue containing melanin Higher serum and hair cotinine levels

in black youth compared to white and Latino youth

Tobacco industry has a 70 year relationship with African American organizations

Yerger et al., 2007; Yerger & Malone, 2006; Yerger & Malone, 2002; Tang et al., 1999

Yerger & Malone (2002)

MARKETING DEATH

Bates # 507137655

Inner City Menthol Marketing Blitz

Yerger, Przewoznik, & Malone (2007)

Bates # 85625435

SALEM’S (1989) MARKETING RESEARCH REPORT

Bates #

TEENS & MENTHOL

Newport is the second most popular brand (21% in 2006) of middle & high school smokers (MMWR, 2009)

93% (n=551) inner-city Baltimore youth (54% white) calling a study line for cessation smoked menthol cigarettes (Moolchan, 2003)

Bates # 501244549

SUMMARY

Ethnic differences exist in smoking rates and level of use, types of tobacco smoked (menthol), and secondhand smoke exposure.

The cause of the disparity in the prevalence of tobacco-related diseases among African Americans is unknown.

The tobacco industry has a long history of targeting ethnic minorities with their products.