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

Ethnic Groups

The significant variation in smoking rates among ethnic groups has contributed to an increasing interest in studying reasons for this variation.  Recent research suggests that smoking in the U.S. has been declining in the general population, but this is not the case for some subpopulations.  Recent data gathered from the CDC indicates that four ethnic/racial groups in the United States (African American, Hispanic/ Latinos, American Indian/ Alaska Natives and Asian Americans)  account for 33% of the current population. It is estimated that by 2050 more than half of the population will be comprised of these ethnicities.  For this reason, it has become critical for current health care providers and public health entities to address tobacco use among different ethnic groups.¹

Influencing factors/prevalence rates among different ethnicities

Some of the most common factors that have been shown to influence smoking rates amongst different ethnic groups are socioeconomic level (SES), languages barriers, reduced access to health care, and stress levels.   While most smokers may want to quit, low SES smokers often don’t have access to the resources typically found within a clinic or provided by a health care provider. In addition, researchers have found that individuals with lower SES are more likely to struggle in follwoing instructions and less likely to successfully complete an intervention program.²

Smoking prevalence by Ethnicity

Since smoking behavior is influenced by many different factors, we can expect smoking rates to vary among different ethnicities.^1,2,3 The following data represents the percentages of adult smokers in the United States by ethnicity in the year of 2010 :

*Caucasians are not considered a minority in the US; information on this page emphasizes minorities (special populations). Information included on the table is to be used as a comparison.

Americans Indian/Alaska Native

• American Indians and Alaska Natives have the highest rates of smoking when compared to any other ethnicity. Part of the reason for this might be that cigarettes are sold at a lower price on reservations.  Researchers have found that price is negatively correlated to smoking rates. In addition, Native Americans may have cultural values supporting tobacco use and tobacco is sometimes used during religious ceremonies and as medicine.

African American

• In 2008, 22.6 percent of African Americans smoked cigarettes; smoking rates are higher among African American (25.5%) males than females (18.0 %). In addition, while Caucasian men consumed more cigarettes than African American men, African American men were more likely than Caucasian to suffer from lung cancer.

Hispanic/ Latino

• In 2008, 15.8 percent of Hispanic smoked cigarettes; smoking rates are also higher in males than females. There are several variations amongst sub-groups. For instance, Cubans have the highest smoking rate (26.6%) for men and (19.31%) among women, followed by Mexican men (15.2%) and women (7.4%).

Asian American and Native Hawaiian/Pacific Islander

• Smoking tends to be lower for Asian Americans and Native Hawaiian/Pacific Islander population. In 2008, 9.9 % of the population smoked cigarettes; higher among men (15.6%) than women (4.7%).
• 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.⁹

Health Effects

Because smoking rates vary greatly by ethnicity, there is some variation in the way each ethnic group is affected by cigarette smoking. Cigarette smoking has been found to increase risk of developing diseases and reduce the health of the smoker in general. Among the most common diseases enhanced by smoking include: ⁵

• Cardiovascular disease
• Respiratory disease
• Cancer (Various)
• Adverse reproductive effects
• Death

The most common disease associated with cigarette smoking is lung cancer; however, consumption level may not correlate to health effects. For example, even though American Indians have the highest smoking rates, African Americans currently have the highest death prevalence of lung cancer. The following chart shows the lung cancer attributed mortality rates by ethnicity from 2003-2008.³

Culturally Appropriate Prevention and Intervention Efforts

As research has pointed out, there are various factors influencing smoking behavior among different ethnic groups and differences in the way it affects their health.  It would seem important to approach each ethnic group differently based on the need of that particular group. Regrettably, most cessation programs in the United States focus on getting “the message across” and do not look at individual ethnic groups, but rather at smokers as a whole population. Recent research has stressed the need for culturally adapted interventions and prevention strategies which have been found to produce higher abstinence rates. ²

Studies have looked at the efficacy of different approaches among ethnicities:

• A study compared the cessation outcomes between a standard intervention and a tailored intervention for African Americans. Higher abstinent rates were found in the tailored group at a 12 month follow up when compared to the standard group.²

• A study compared the effectiveness of Health Education (HE) and Motivational Interviewing (MI) between African Americans and Chinese Americans who were interested in stopping smoking and willing to make use of pharmacotherapy. After a six-month follow up, African Americans were found to benefit more from HE rather than MI. In contrast, Chinese-Americans benefited more from MI rather than HE.²

Overall, research has found supporting evidence that confirms culturally appropriate cessation programs yield higher abstinent rates.⁶   Therefore, cessation programs developers, and professionals helping smokers become a non-smoker should keep this in mind when assessing and assisting each individual.

Quitlines:

• Quitlines are telephone based support programs that provide quality and effective treatment for people who want to quit smoking.  Quitlines are a convenient and helpful way to initiate the quitting process since they are accessible from anywhere smokers may be, as long as they have access to a telephone.

• Recent research has shown that minority groups are benefiting from Quilines. For instance, recent data shows that African American smokers are more likely to use Quitlines when compared to other groups. In addition, Asian language speakers are reaching out to quitlines just as much as Caucasians.⁸

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/

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/

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/

1. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/ad    ult_data/cig_smoking/index.htm#national
2. Cox, L., Okuyemi, K., Choi, W. S., & Ahluwalia, J. S. (2011). A review of tobacco use treatments in U.S. ethnic minority populations. American Journal Of Health Promotion, 25(5, Suppl).

3. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses — United States, 2000–2004. Morbidity and Mortality Weekly Report. November 14, 2008; 57(45);1226-8. http://www.lung.org/assets/documents/publications/solddc-chapters/tobacco.pdf

4. http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2011
5. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/

6. Pérez-Stable, E. J., Marín, B. V., & Marín, G. (1993). A comprehensive smoking cessation program for the San Francisco Bay area Latino community: Programa Latino para dejar de fumar. American Journal Of Health Promotion, 7(6), 430-442.

7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169380

8. American Lung Association (ALA). 2006. Tobacco use and Hispanics/Latinos. Obtained from http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=346307 on September 29, 2006.