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 9.6% 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, CDC, Health, United States, 2008; SEER Cancer Statistics Review,

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

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Inner City Menthol Marketing Blitz Yerger, Przewoznik, & Malone (2007)

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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)

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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.