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"African Americans’ concern for their children ranks among the strongest motivators for them to quit smoking."
"Racial/ethnic minority groups must be reached wherever they are and within the context of their daily lives."
"The rapid growth and relative youth of the Hispanic population presents numerous opportunities and challenges for tobacco use prevention education."
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Policymakers tread treacherous ground when addressing minority-related issues. It helps, when thinking about tobacco prevention, that addiction knows no color, no class, no creed. While preventing tobacco use is not a political/racial issue, it is a social/racial issue because various cultures respond differently to prevention messages. The issues policymakers should be familiar with recent research that includes factors influencing tobacco use, challenges to tobacco prevention efforts, and developing effective tobacco prevention materials and programs. Each area is discussed below. Factors Influencing Tobacco Use No single factor determines patterns of tobacco use among racial/ethnic minority groups. Tobacco use results from complex interactions of multiple factors such as individual and psychological characteristics; personal behavior; socioeconomic status; environmental and cultural characteristics; acculturation; marketing and advertising; price of tobacco products; increase in generic brands of cigarettes; lack of culturally relevant community education program materials; and limited public health resources to effectively develop, implement, and evaluate tobacco prevention and control initiatives (18,4,3). Complicating any broad scale tobacco prevention approach are the distinct differences in tobacco use among minority groups.
African American aHistorically, African-American adults have a higher prevalence of cigarette smoking than the general population. However, in recent years, the gap decreased dramatically. African Americans smoke fewer cigarettes per day than Whites, but are more likely to experience higher rates of heart disease, stroke, and cancers of the lungs and digestive tracts than Whites. They also die at a younger age and tend to have a worse disease prognosis than Whites. African-American men bear a great health burden, with death rates from lung cancer 50% higher than those for Whites (3). Though African Americans smoke fewer cigarettes per day than Whites, they show higher levels of nicotine dependence. A large percentage of African Americans are “wake-up” smokers, i.e., they need to smoke within 10 minutes of awakening (19). These dependency traits may occur because African Americans tend to smoke menthol cigarettes, which are higher in tar and nicotine (20,32). The preference for menthol cigarettes occurs consistently across education and income levels. They also are less likely to quit smoking or refrain from smoking for a year or more even when they are strongly motivated to do so (21,19). The practice among African-American youth of mixing tobacco with marijuana in hollowed out cigars or “blunts” to “make the high go higher” probably increases the attraction towards tobacco use (22,5). They begin smoking cigarettes later than their White counterparts; but they start using marijuana earlier, a difference yet to be explained (9,22). It remains unclear how much of the increase in smoking among African-American adolescents occurs due to use of cigarettes with marijuana. The marijuana-tobacco combination is especially notable because it represents a reverse of the more common progression from cigarette and alcohol use to illegal drugs (22). American Indians and Alaska Natives Because of the cultural and geographic diversity of American Indians and Alaska Natives, tobacco use varies widely by region or subgroup. The group includes 554 federally funded tribes, ranging in size from 20 to 250,000 people. Though many tribes use tobacco during religious ceremonies and as traditional medicine, the tobacco-related health problems they suffer are caused by chronic cigarette smoking and spit tobacco use. They have the highest prevalence of chewing tobacco and spit tobacco use in the nation. Since 1978, the prevalence of cigarette smoking declined for women in all ethnic groups except among American-Indian and Alaska Native women (3). Asian Americans and Pacific Islanders Asian Americans and Pacific Islanders have the lowest overall adult smoking prevalence of the four racial/ethnic groups. Much higher smoking rates occur among population groups from Southeast Asian countries such as Vietnam, Cambodia, and Laos than among population groups from other locations such as the Philippines, China, and Japan. Asian-American and Pacific-Islander men have smoking rates of 25.1% and 27.6%, respectively, comparable to the smoking rates of Whites. Asian-American and Pacific-Islander women smoke significantly less than White women, 5.8% and 24.4%, respectively. Unlike the general U.S. population, where smoking among women decreases with age, smoking rates among Asian-American and Pacific-Islander women increase with age. Research shows that there is an association between cigarette smoking and acculturation among Asian-American and Pacific-Islander adults from Southeast Asia. Those with higher English proficiency and those living in the United States longer were less likely to smoke (3). Hispanics Demographers project that by 2005, Hispanics will surpass African Americans as the nation’s second largest race/ethnic group, behind only non-Hispanic Whites. The Hispanic population has diverse national origins and cultures. The literature usually divides Hispanics into five subgroups: Mexican American, Puerto Rican, Cuban American, Central or South American, and other Hispanics. The rapid growth and relative youth of the Hispanic population presents numerous opportunities and challenges for tobacco use prevention education. According to the Hispanics Health and Nutrition Examination Survey (HHANES), 43.6% of adult Mexican Americans smoke compared with 41.3% of Puerto Rican men and 41.8% of Cuban men. Men who are less acculturated smoke more than their more acculturated counterparts. The opposite is true for Hispanic women, who smoke more as they become more acculturated (23). |
