Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Why is ethnicity important to cessation?

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.  Four ethnic/racial groups in the United States (African Americans, Hispanic/ Latinos, American Indian/ Alaska Natives, and Asian Americans) account for 36.3% of the current population.1 It is estimated that by 2050 these groupswill account for more than half of the United States popultion.  For this reason, it is critical for current health care providers and public health entities to address tobacco use among different ethnic groups.

Influencing factors for smoking among different ethnicities

Some of the most common factors that have been shown to influence smoking rates among different ethnic groups are socioeconomic status (SES), language 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 cessation 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 following cessation 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. The following data represents the percentages of adult smokers in the United States by ethnicity in 2012.3

Ethnicity

Percentage of adults who were current cigarette smokers in 2012

American Indian/Alaska Natives (non-Hispanic)

21.8%

White (Non-Hispanic)*

19.7%

African American (non-Hispanic)

18.1%

Hispanic

12.5%

Asian (non-Hispanic; excludes Native Hawaiians and Pacific Islanders)

10.7%

Multiple race individuals

26.1%

*Whites 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.

American Indians/Alaska Natives

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 2012, 18.1% of African Americans smoked cigarettes; smoking rates are higher among African American males (22.1%) than females (18.4%). In addition, while Caucasian men consumed more cigarettes than African American men, African American men were more likely to suffer from smoking-related disease (e.g. lung cancer). 3

Hispanic/ Latinos

In 2012, 12.5% of Hispanic individuals smoked cigarettes; smoking rates are higher in males than females. There are several variations amongst sub-groups. For instance in 2008, Cubans had the highest smoking rate (21.5%) followed by American-born Mexicans (20.1%), Puerto Ricans (18.6%), Central and South Americans (12.8%), and immigrant Mexicans (11.6%), with the lowest rates among Dominicans at 10.7 percent.4

Asian Americans and Native Hawaiian/Pacific Islanders

Smoking tends to be lower for Asian Americans and Native Hawaiian/Pacific Islanders. In 2008, 9.9 % of the population smoked cigarettesand was higher among men (15.6%) than women (4.7%).5

Southeast Asians tend to smoke more compared with other Asian subgroups. Length of time in the US can also affect smoking rates. Chinese men tend to smoke more the longer they live in the US, while Southeast Asians tend to smoke less.

 

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:6

  • Cardiovascular disease
  • Respiratory disease
  •  Cancer (various types)
  • Adverse reproductive effects
  • Rheumatoid arthritis
  • 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. Athough their exposure to cigarette smoke is lower, the age-adjusted lung cancer incidence rate is 26% higher among Black men that it is for White men.7

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 view smokers as a whole population rather than looking at individual ethnic groups. Recent research has stressed the need for culturally adapted interventions and prevention strategies which have been found to produce higher abstinence rates.8

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.8
  • 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.8

Overall, research has found supporting evidence that confirms culturally appropriate cessation programs yield higher abstinence rates.  Therefore, cessation program developers, and healthcare providers providing cessation services 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 Quitlines. For instance, recent data shows that African American smokers are more likely to use Quitlines when compared to other ethnic groups. In addition, Asian language speakers are reaching out to Quitlines just as much as Whites.9

Helpful Links

  • CDC-funded National Networks: This website provides information on the CDC-funded National Networks for tobacco prevention and control initiative. http://www.ttac.org/resources/specific_populations.html
  • Tobacco Research Network on Disparities: http://www.tobaccodisparities.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/
    References: 

    [1] Centers for Disease Control and Prevention (n.d.). Racial and Ethnic Minority Populations. Retrieved from: http://www.cdc.gov/minorityhealth/populations/remp.html

    [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): 11-30.

    [3]Centers for Disease Control and Prevention (2014). Current Cigarette Smoking Among Adults—United States, 2005–2012. Morbidity and Mortality Weekly Report, 63(02):29–34.

    [4] American Lung Association (2014).  Hispanics. Retrieved from: http://www.lung.org/stop-smoking/about-smoking/facts-figures/hispanics-and-tobacco-use.html

    [5] American Lung Association (2014).  Asian Americans/Pacific Islanders. Retrieved from: http://www.lung.org/stop-smoking/about-smoking/facts-figures/asian-americans-tobacco.html

    [6] U.S. Department of Health and Human Services (2014). The Health Consequences

    of Smoking—50 Years of Progress A Report of the Surgeon General. Rockville, MD. Retrieved from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/exec-summary.pdf

    [7] American Lung Association (2014).  Lung Cancer Fact Sheet. Retrieved from: http://www.lung.org/lung-disease/lung-cancer/resources/facts-figures/lung-cancer-fact-sheet.html#RacialEthnic_Differences

    [8] 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).

    [9] North American Quitline Consortium (2011). The Use of Quitlines Among Priority Populations in the U.S.: Lessons from the Scientific Evidence. Retrieved from: http://c.ymcdn.com/sites/www.naquitline.org/resource/resmgr/Issue_Papers/IssuePaperTheUseofQuitlinesA.pdf