African Americans and Smoking
At a Glance

• Smoking is responsible for one of every five deaths in the United States. Moreover, it is the single most important preventable cause of death in our society. (l,l0)

• More black Americans smoke cigarettes, over other tobacco products, than their white counterparts. Although the smoking rate for blacks is higher than for white smokers, black smokers smoke fewer cigarettes per day. Black smokers suffer from a higher incidence of smoking-related illnesses than white smokers.

• The following summarizes the most recent smoking information for African Americans in the United States

Smoking rates among black adults are higher than those for whites, even though the pattern of decline in smoking rates is similar for both groups.

• In 1988, more than 50 million Americans smoked cigarettes. Of those 50 million current smokers, about 6 million are black. (2)
• In 1987, 34.0% of black adults (aged 20+) smoked, compared with 29.0% of white adults (aged 20+); in 1966, 43.0% of black adults and 40.0% of white adults smoked.(1)
• Both black men and black women are more likely to smoke cigarettes, rather than other forms of tobacco, than their white counterparts. In 1987, 39.0% of black men (aged 18+) (30.5% of white men) and 28.0% of black women (aged 18+) (26.7% of white women) smoked cigarettes.(3)

Cigarette Smoking Behavior

Recent studies demonstrate that cigarette smoking behaviors vary by race and by sex.

• Black smokers (aged 17+ years) report smoking an average of 15 cigarettes per day; white men smoke nearly 24 cigarettes per day; and white women smoke an estimated 20 cigarettes per day. (4)
  
  
• Heavy smoking (25+ cigarettes per day) is much less common among blacks than among whites. (1)
  
  
• Black smokers are more likely to smoke higher tar and nicotine brands than are white smokers; and smoking higher tar brands is associated with higher lung cancer incidence and mortality rates.(1)
  
  
• Blacks also are more likely to smoke mentholated cigarettes. Of blacks who smoke, 75% of those aged 17 and over smoke mentholated cigarettes but only 23% of whites who smoke use mentholated brands.(1,5)
  
  
• The most popular mentholated brands are 1) Newport (Lorrilard, Inc.), 2) Kool (Brown & Williamson), and 3) Salem (R.J. Reynolds). These three brands represent 55% of the market among black smokers.(5)

Prevalence of Other Forms of Tobacco Use

Cigarettes are the most popular tobacco product among blacks, as they are among the general population. However, blacks do use other forms of tobacco. (3)

• The prevalence for pipe smoking is the same for black and white men (3.4%).

• More white men (5.6%) smoke cigars than do black men (4.0%).

Use of chewing tobacco and snuff varies significantly by race and sex.(3)

• Black men (3.4%) use chewing tobacco less than white men (4.2%).

• More black women (1.7%) chew tobacco than white women (0.1 %).

• White men use snuff at a rate of 3.3%, compared with a 1.1 % rate for black men.

• Among black women, 2.2% use snuff whereas only 0.3% of white women use this product.

In examining smoking and the workplace, researchers have found a link between smoking behavior and occupations.

 

• Smoking prevalence varies by occupational category. Smoking rates are generally higher in male and female blue-collar workers than in their white-collar counterparts. In 1987, 26.1 % of white collar men and 26.6% of white collar women smoked cigarettes. Among blue-collar workers, 42.1 % of men and 36.6% of women smoked during that year.(6) (Note: blacks of both sexes are more concentrated in blue-collar occupations.)
  
  

• The National Health Interview Survey 1978-1980 revealed a relationship between smoking behavior and occupations. Among men, blue-collar workers had considerably higher smoking rates than white-collar workers within each racial group, and black male blue-collar workers exhibited the highest smoking rate (52.1 %). Among black women, there was little difference in smoking prevalence between occupations. However, among white women, the expected white-collar, blue-collar, service worker differences prevailed; blue-collar and service workers were more likely to smoke (39.6% and 38.7%, respectively) than white collar workers (32.0%).(7)
  
  

• Black workers are considerably less likely than their white counterparts to be heavy smokers (smoke 20 or more cigarettes daily). This trend holds true for all categories of workers and for men and women.(7)

Health Consequences

Black Americans suffer from smoking-related diseases at a higher rate than whites.(8,9)

• Black men and women have a higher incidence of respiratory system cancers than do white men and women (Table 1).
  
• This trend also is present for incidences of esophagus and oral cavity cancer.

Blacks experience excessive mortality for many tobacco-related cancers.

 
• The average (annual age-adjusted) mortality is higher among black men than among white men for cancers of the respiratory system, heart disease, and stroke (Table 2).
• The death rates for black women are higher than for white women for cancers of the respiratory system, heart disease, and stroke.(8.9)

In 1988, nearly 48,000 black Americans died from smoking-attributable causes-these are deaths that could have been prevented.(10) (Table 3)

 
• Smoking-attributable deaths among black men are double those among black women. This ratio is not as high among white men and women.

The rate of smoking-attributable deaths is higher among blacks than among whites (Table 4) .

 
• The death rate due to smoking for black men is triple that for black women; and 1.3 times higher than the death rate for white men. The death rate from smoking for white men is double that for white women.
  
  
• The death rates for white women are higher relative to those of black women.

Studies conducted by the Centers for Disease Control report that black Americans have not only a higher death rate from cigarette smoking than do whites, but have a greater loss of productive years of life.

Blacks tend to become ill from smoking at younger ages than do whites.(11)

In 1988, blacks lost an estimated 268,437 years of potential life to age 65 due to smoking. Whites lost an estimated 913,943 years.(10) (Note: The U.S. Census reported that black Americans comprised 12% of the total population in 1990).

Although whites lost more years in total, the rate of smoking attributable YPLL (before age 65 per 100,000 persons is greater than or equal to 35 years age) for blacks (2,472) was twice that for whites (1,225). (10)

Smoking and Pregnancy

• In general, women in the lowest age and socioeconomic categories are most likely to smoke during pregnancy.(1)
  
  
• Among pregnant teenagers, smoking rates between 1967-1980 remained constant at about 38% among whites and 27% among blacks.(13)
  
  
• Among all pregnant women over age 20, decreases in smoking prevalence between 1967-1980 varied considerably by race. Smoking prevalence among pregnant white women over age 20, declined from 40% in 1967 to 25% in 1980; among pregnant black women (aged 20+ years), it declined from 33% to 23%. (13)
  
  
• Older black women (25 to 44 years of age) are less likely to smoke during pregnancy than white women (43% versus 53%). Among pregnant women who smoke, blacks smoke fewer cigarettes per day than whites.(12)
  
  
• Among white women over age 20, the proportion who quit smoking during pregnancy increased from 1 1 % to 16%; among blacks (aged 20+ years) the proportion who quit decreased from 17% to 11%.(13)

Every day more than 3,000 American teenagers become regular smokers-that's more than 1 million annually. Most regular smokers start in their teens.(1) However, this trend is more dominant among white teenagers.

 
• According to the National Institute on Drug Abuse (NIDA) National High School Senior Survey, the prevalence of daily smoking has fallen substantially among black high school seniors, from 26% in 1976 to 6% in 1989. During the same period, prevalence among white high school seniors declined from 29% to 22%.(14)
  
  
• Another indirect measure of smoking initiation is the prevalence of smoking among persons aged 20 to 24 years. Ninety percent of persons who will become regular smokers have begun smoking by age 20. Among blacks, the prevalence among 20 to 24 year olds declined by one-third between 1983 and 1987 (from 38.7% to 25.6%).I.6 Among whites, the prevalence of smoking for persons in this age group declined by only 17% (from 36.8% to 30.5%).' (Note: the age of initiation for blacks is somewhat older than that for whites).(4)

References

1. Office On Smoking and Health. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1989. DHHS publication no. (CDC)89-8411.

2. Alcohol, Drug Abuse, and Mental Health Administration. National Institute on Drug Abuse, National house-hold survey on drug abuse: population estimates 1988. Washington, D.C.:U.S. Department Of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1989. DHHS publication no. (ADM)89-1636.

3. Schoenborn CA, Boyd G. Smoking and other tobacco use: United States, 1987. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, National Center for Health Statistics, 1987. DHHS publication no. (PHS)89-1591. (Vital and health statistics, series 10, no. 169).

4. Office On Smoking and Health. Adult use of tobacco, 1986. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1989. DHHS publication no. (OM)90-2004.

5. Centers for Disease Control. Cigarette brand use among adult smokers-United States, 1986. Morbidity and Mortality Weekly Report 1990; 9:665, 671-673. 

6. National Health Interview Survey, 287, Office on Smoking and Health, unpublished data.

7. Office On Smoking and Health. The health consequences of smoking: cancer and chronic lung disease in the workplace. A report of the Surgeon General. Washington, D.C.: U.S. apartment of Health and Human Services, Public Health Service, Office on Smoking and Health, 1985. HHS publication no. (PHS)85-50207.

8. National Center for Health Statistics. Health, United States, prevention profile 1989. Hyattsville, Maryland: U.S. Department of Health and Human Services, Public Health Service, 1990. DHHS publication no. (PHS)90-1232.

9. National Institutes of Health. Cancer statistics review 1973-87, surveillance, epidemiology, and end results report (SEER), 1978-81. Washington, D.C.: U. S. Department of Health and Human Services, Public Health Service, National Cancer Institute, 1990. NIH publication no. (NIH)90-2789.

10. Centers for Disease Control. Smoking-attributable mortality and years of potential life lost-United States, 1988. Morbidity and Mortality Weekly Report 1990; 40:62-71.

11. Centers for Disease Control. Smoking-attributable mortality and years of potential life lost-United States, 1984. Morbidity and Mortality Weekly Report 1987; 36:693-697.

12. Niswander KR, Gordon M. The women and their pregnancies. The collaborative perinatal study of the National Institute of Neurological Diseases and Stroke. Washington, D.C.: U.S. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, 1972. DHEW publication no. (NIH)73-379.

13. Mosher WD, Pratt, WF. Fecundity, infertility, and reproductive health in the United States, 1982. Washington, D.C.: Public Health Service, Government Printing Office, 1988. National Center for Health Statistics, 1988. DHHS publication no. (PHS)88-1591. (Vital and Health Statistics, series 2, no. 106).

14. National Institute on Drug Abuse. Monitoring the Future Project, 1989, Office On Smoking and Health, unpublished data.

15. Office On Smoking and Health. The health benefits of smoking cessation. Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1990. DHHS publication no.(CDC)90-8416.

16. Fiore MC, Novotny TE, Pierce JP, Hatziandrea EJ, Patel KM, Davis RM Trends in cigarette smoking in the United States: the changing influence of gender and race. Journal of the American Medical Association 1989; 261:49-55.

17. Davis, RM. Current trends in cigarette advertising and marketing. New England Journal of Medicine 1987; 316:725-732.

18. Cummings KM, Giovino G, Mendicino AJ. Cigarette advertising and racial differences in cigarette brand preference. Public Health Reports 1987; 102:698-701.

19. Federal Trade Commission. Report to Congress for 1987 pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, D.C.: U.S. Federal Trade Commission, 1989.

20. McMahon ET, Taylor PA. Citizens' action handbook on alcohol and tobacco billboard advertising. Washington, D.C.: Center for Science in the Public Interest, 1990.

21. Ramirez A. A cigarette campaign under fire. New York Times. 1990 Jan 12: Dl,D4.

22. California Department of Health Services. Tobacco use in California 1990: preliminary report documenting the decline of tobacco use. San Diego: University of California, 1990.

23. Marcus M, Glick D, Lewis SD. Fighting ads in the inner city: a grassroots baffle against 'minority marketing'. Newsweek. 1990 Feb 5:46.