Journal supplement points out disparities among African-American, white smokers

BUFFALO, N.Y. – The percentage of African-American high school seniors who smoke has changed very little over the past two decades. In fact, the percentages in 2014 and 1992 are statistically the same.

That’s among the findings presented in a supplement to the April issue of the journal Nicotine & Tobacco Research.

Smoking among African-American high schoolers had been on a downward trend before stagnating in 1992, when 8.7 percent of African-American high school seniors smoked; the figure in 2014 was 9 percent.

“That the decline has stalled in the last 22 years is, to me, very sad news. I think it’s about the industry working really hard to keep this market,” said Gary A. Giovino, a University at Buffalo professor of community health and health behavior who served as co-editor of the supplement with Phillip Gardiner of the Tobacco Related Disease Research Program, University of California Office of the President.

Bridgette E. Garrett, associate director for health equity, and Italia V. Rolle, lead epidemiologist, from the Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health, which sponsored this special supplement, also contributed to the editorial process.

Giovino previously served as guest editor for an issue of the journal Preventive Medicine, and contributed to the Surgeon General’s 1998 report on tobacco use among racial and ethnic minority groups.

The supplement — titled “Critical Examination of Factors Related to the Smoking Trajectory among African-American Youth and Young Adults” — also presents new findings on smoking among African-American inmates.

“We always knew that could be an issue, but this is the first time we’ve ever had data on it,” said Giovino, PhD, MS, who also chairs the Department of Community Health and Health Behavior in UB’s School of Public Health and Health Professions.

The major surveys that measure tobacco use are not distributed in prisons.

“When you factor in the number of African-American inmates, the smoking prevalence estimate for adults goes up by one percentage point – not one percent, but one percentage point, which is a big deal,” said Giovino, who previously worked for the Office on Smoking and Health at the CDC.

Papers in the supplement also address these issues:

• African-American adult smokers are less likely than white smokers to quit as they get older.
• African-Americans who started smoking as young adults are less likely to quit than African-Americans who started at younger ages, and are less likely to quit than whites in general.
• African-American young adults are more likely to take up smoking than white young adults, but they still smoke at lower rates than white young adults because their rates of smoking as adolescents were so much lower than among whites.
• African-American teens are less likely than their white peers to begin smoking as adolescents in part because of protective factors such as parental opposition and differential price sensitivity. African-American youth appear to be more responsive to price increases than whites.
• Among African-Americans, smoking deaths occur at the same rate among those who started smoking early and those who began when they were older. However, in whites, those who take up smoking later in life experience lower mortality than those who started earlier.

The findings point to the need for better efforts to prevent African-Americans from taking up smoking at an older age.

“Even though African-Americans start smoking later in life, they still die disproportionately from tobacco related diseases compared to their white counterparts,” said Gardiner. “This information has been known for some time and calls upon all of us to redouble our efforts to allocate greater resources for prevention and cessation in the African-American community.”

Giovino and Gardiner co-authored a commentary in the supplement that, among other points, outlines a need for the FDA to ban menthol cigarettes, which are favored by blacks and marketed more heavily in African-American neighborhoods.

“The predatory marketing of menthol and other candy flavored tobacco products to African-Americans over the past 50 years is a tragedy,” adds Gardiner. “More than 80 percent of black smokers use these products. A major step in fighting smoking health disparities would be for the FDA to ban the use of menthol in tobacco products.”

The supplement includes a literature review on smoking cessation among African-American and white smokers authored by Jessica A. Kulak, MPH, MS, a PhD student in UB’s Department of Community Health and Health Behavior.