Ethnic Groups

Ethnic and cultural considerations are important components for any prevention or intervention programs as diverse groups use tobacco in different ways and at different rates.

• Concerns
• Needs

Concerns

Prevalence rates among ethnic groups differ when it comes to smoking and tobacco product use:

• Native Americans tend to have high rates of tobacco use. In 2006, 32% American Indians/Alaska Natives smoked.¹ However, smoking rates in these groups often fail to differentiate between ceremonial and recreational use of tobacco products, so this should be considered when interpreting data.
• Lung cancer is the leading cause of cancer death among Native Americans and Alaska Natives.
• Non-Hispanic Blacks smoke at rates (21.5%) similar to non-Hispanic Whites (21.9%). However, white men tend to smoke 30-40% more cigarettes than black men. Black women tend to have lower smoking rates than white women, though the difference is not statistically significant.²
• Hispanic and Latino groups tend to smoke less than other ethnic groups (16.2% in 2006). The low rate is due primarily attributable to low usage among Hispanic and Latino women (10.8%).¹
• Asian Americans tend to have the lowest rates of tobacco use (10.4% in 2006). However, when gender is considered, it seems that Asian American men have comparable rates of use to other ethnic groups (16.8%); it is actually Asian American women who smoke less (4.6%).³

TABLE 1: National Health Interview Survey, United States 2006
Cigarette Smoking Rates by Ethnicity⁵

• While rates are often reported for major ethnic groups, it is important to consider rates for subgroups within these major ethnic groups. For instance, Alaskan Natives and American Indian tribes that live in the Northern Plain areas smoke much more than the general population, while those that live in the Southwestern region tend to smoke much less.¹ A similar geographic influence exists for Asian American and Pacific Islander groups. For instance, Southeast Asians tend to smoke the most compared to other subgroups of Asians. Length of time in the US can also affect smoking rates. Chinese men tend to smoke more as they continue to live in the US, while Southeast Asians tend to smoke less.³ Among Hispanic and Latino groups, Puerto Ricans smoke much more than other subgroups.⁴
• Some have suggested that African American women are almost 4 times more likely than White women to use tobacco products while they are pregnant.⁶ However, other statistics have suggested American Indian women have the highest rates of use during pregnancy, followed by non-Hispanic white women. Non-Hispanic black women use tobacco during pregnancy even less than either of those two groups.¹ Other than Hawaiian women, Asian American women tend to have lower rates of smoking during pregnancy than other ethnic groups.³ Hispanic and Latino women also tend to have lower rates of smoking during pregnancy than other groups, though the rates vary by subgroup, with Puerto Rican mothers smoking at the highest rates.⁴

The health effects of tobacco products differ among ethnic groups:

• Asian American groups tend to have the lowest lung cancer and heart disease rates across ethnic groups. In fact, there is evidence that Chinese-Americans may actually take in less nicotine in each cigarette they smoke and may metabolize nicotine less quickly than other ethnicities.³
• On the other hand, African Americans seem to be at greater risk for the negative effects of cigarettes. Even though Blacks tend to smoke fewer cigarettes in a day than Whites, Black men and women are more likely to get lung cancer and die from it than White men and women. There is some evidence that African Americans absorb more toxins and nicotine than Whites absorb, and may also clear cotinine slower than Whites. Another theory for the difference in lung cancer risk is the higher rate of menthol cigarettes used by Blacks as compared to Whites (75% vs. 25%). Menthol cigarettes may increase nicotine and toxin absorption as smokers often take in more smoke and hold it in longer due to the numbing effect of menthol.²
• In addition to lung cancer, African Americans seem to be at greater risk of death from other cancers, such as stomach, cervix, esophagus, and oral cavity cancers. They are also at heightened risk (almost twice the risk) compared to white smokers for cerebrovascular disease.⁷

Culture must be considered when working with patients who smoke:

• For some cultures, tobacco is a major part of the economy and smoking is a way of demonstrating maturity. Sharing tobacco is a way of showing hospitality.⁸
• Arab American cultures often use narghile, as well as smoke cigarettes. The narghile is a vessel of water that has a platform. On the platform, charcoal is burned under a ball of tobacco, which may be mixed with other items for flavor. The tobacco smoke is inhaled via long tubes. Because narghile is culturally sanctioned, parents may use it in the home and encourage even smaller children to use it, even though many Arab American parents simultaneously discourage cigarette use.⁸
• In Hispanic and Latino communities, promoting and advertising for tobacco products is common. Tobacco companies fund education programs and support Hispanic art and cultural events,⁴ making intervention and prevention efforts in this communities challenging.
• Tobacco companies also target African American youth in campaigns (e.g., using hip-hop characters seen in Kool cigarette advertisements).²

Needs

Prevention and intervention efforts should be culturally appropriate:

• Research has shown that it is possible to successfully disseminate smoking cessation information to specific ethnic communities if done in a knowledgeable and culturally sensitive manner.⁹
• Studies of treatments shown to be efficacious with White smokers have not as strongly supported those same treatments with African American smokers. Research needs to explore the efficacy of interventions for different ethnic groups, rather than assuming the same treatment will work with all cultures and groups.⁷
• Some research suggests interventions aimed specifically at African Americans should consider addressing aspects of spirituality, self-efficacy, social support, stress, and education about the health consequences of smoking, because these influences may be of particular importance for this group of people.⁷
• Given the research that suggests African Americans may metabolize cotinine more slowly and take in more nicotine than other ethnic groups, some have suggested that pharmacological interventions that maintain nicotine levels (e.g., bupropion and patches), as opposed to rapid release methods (e.g., inhalers and sprays), may be more beneficial.⁷
• Cultural influences should be utilized in both cessation and prevention efforts For example, in the African American community, parents heavily influence young people in the community and social norms are believed to be a major reason many Black women and teenagers have chosen not to smoke. These and other cultural influences can be used to support prevention efforts in communities.¹⁰

Reports

Helpful Links

CDC-funded National Networks
This website provides information on the CDC-funded National Networks for tobacco prevention and control initiative.
http://www.tobaccopreventionnetworks.org/ 

Center for Disease Control:
Tobacco Use Among US Racial/Ethnic Minority Groups
1998 Surgeon General's Report
This link will take you to the CDC's links to the Surgeon General's Report from 1998 (the most recent report on tobacco and racial/ethnic minority groups). Fact sheet, summaries and the full report are all available through this site.
http://www.cdc.gov/tobacco/sgr/sgr_1998/index.htm

American Lung Association: Racial Disparity

The National Networks for Tobacco Control and Prevention
Provides links and information about the six Networks funded by the CDC Office on Smoking and Health (OSH) to "target specific subgroups experiencing tobacco-related disparities within their respective populations for interventions."
http://www.tobaccopreventionnetworks.org/site/c.ksJPKXPFJpH/b.2580071/

The National Latino Council on Alcohol and Tobacco Prevention (LCAT)
"The National Latino Council on Alcohol and Tobacco Prevention (LCAT) is a non-profit 501 © 3 tax exempt, national organization created in 1989 by a group of Latino public health professionals and community advocates from throughout the United States. LCAT's mission is to combat alcohol and tobacco problems and their underlying causes in Latino communities."
http://www.nlcatp.org/

Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL)
"A national network of organizations and individuals working towards social justice and a tobacco-free Asian American and Pacific Islander (AAPI) community.  Here you will find information and resources about tobacco control issues in Asian American & Pacific Islander communities and other priority populations."
http://www.appealforcommunities.org/

The National African American Tobacco Education Network (NAATEN)
"NAATEN is a collaborative of national, state and community based organizations serving the African American/Black community."
http://www.healthedcouncil.org/naaten/

National Tribal Tobacco Prevention Network
Their mission is "to enhance the wellness of American Indian and Alaska Native communities by providing culturally appropriate tobacco education and prevention resources, technical support, training, networking opportunities and advocacy."
http://www.npaihb.org/programs/national_tribal_tobacco_prevention_network/

The Intercultural Cancer Council (ICC)
"The Intercultural Cancer Council (ICC) promotes policies, programs, partnerships, and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the United States and its associated territories. "
http://iccnetwork.org/who/