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At-A-Glance
"Cigarette smoking is the leading
preventable cause of disease and death in the United States. We have an enormous
opportunity to reduce heart disease, cancer, stroke, and respiratory disease among members
of racial and ethnic minority groups, who make up a rapidly growing segment of the U.S.
population."
—David Satcher, MD,
PhD, Surgeon General
Major
Conclusions of the Surgeon General’s Report
- Cigarette smoking is a major cause of
disease and death in each of the four population groups studied in this report. African
Americans currently bear the greatest health burden. Differences in the magnitude of
disease risk are directly related to differences in patterns of smoking.
- Tobacco use varies within and among
racial/ethnic minority groups; among adults, American Indians and Alaska Natives have the
highest prevalence of tobacco use, and African American and Southeast Asian men also have
a high prevalence of smoking. Asian American and Hispanic women have the lowest
prevalence.
- Among adolescents, cigarette smoking
prevalence increased in the 1990s among African Americans and Hispanics after several
years of substantial decline among adolescents of all four racial/ethnic minority groups.
This increase is particularly striking among African American youths, who had the greatest
decline of the four groups during the 1970s and 1980s.
- No single factor determines patterns of
tobacco use among racial/ethnic minority groups; these patterns are the result of complex
interactions of multiple factors, such as socioeconomic status, cultural characteristics,
acculturation, stress, biological elements, targeted advertising, price of tobacco
products, and varying capacities of communities to mount effective tobacco control
initiatives.
- Rigorous surveillance and prevention
research are needed on the changing cultural, psychosocial, and environmental factors that
influence tobacco use to improve our understanding of racial/ethnic smoking patterns and
identify strategic tobacco control opportunities. The capacity of tobacco control efforts
to keep pace with patterns of tobacco use and cessation depends on timely recognition of
emerging prevalence and cessation patterns and the resulting development of appropriate
community-based programs to address the factors involved.
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Trends in tobacco use vary
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African Americans
- In the 1970s and 1980s, death rates from
respiratory cancers (mainly lung cancer) increased among African American men and women.
In 1990–1995, these rates declined substantially among African American men and
leveled off in African American women.
- Middle-aged and older African Americans
are far more likely than their counterparts in the other major racial/ethnic minority
groups to die from coronary heart disease, stroke, or lung cancer.
- Smoking declined dramatically among
African American youths during the 1970s and 1980s, but has increased substantially during
the 1990s.
- Declines in smoking have been greater
among African American men with at least a high school education than among those with
less education.
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American Indians and Alaska
Natives
- Nearly 40 percent of American Indian and
Alaska Native adults smoke cigarettes, compared with 25 percent of adults in the overall
U.S. population. They are more likely than any other racial/ethnic minority group to smoke
tobacco or use smokeless tobacco.
- Since 1983, very little progress has been
made in reducing tobacco use among American Indian and Alaska Native adults. The
prevalence of smoking among American Indian and Alaska Native women of reproductive age
has remained strikingly high since 1978.
- American Indians and Alaska Natives were
the only one of the four major U.S. racial/ethnic groups to experience an increase in
respiratory cancer death rates in 1990–1995.
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Asian Americans and Pacific
Islanders
- Estimates of the smoking prevalence among
Southeast Asian American men range from 34 percent to 43 percent—much higher than
among other Asian American and Pacific Islander groups. Smoking rates are much higher
among Asian American and Pacific Islander men than among women, regardless of country of
origin.
- Asian American and Pacific Islander women
have the lowest rates of death from coronary heart disease among men or women in the four
major U.S. racial/ethnic minority groups.
- Factors associated with smoking among
Asian Americans and Pacific Islanders include having recently moved to the United States,
living in poverty, having limited English proficiency, and knowing little about the health
effects of tobacco use.
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Hispanics
- After increasing in the 1970s and 1980s,
death rates from respiratory cancers decreased slightly among Hispanic men and women from
1990–1995.
- In general, smoking rates among Mexican
American adults increase as they learn and adopt the values, beliefs, and norms of
American culture.
- Declines in the prevalence of smoking have
been greater among Hispanic men with at least a high school education than among those
with less education.
- Factors that are associated with smoking
among Hispanics include drinking alcohol, working and living with other smokers, having
poor health, and being depressed.
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Choosing health
- More than 10 million African Americans,
American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics
smoke cigarettes. Without intervention, this number may swell in the coming decade.
- Both direct and passive exposure to
tobacco smoke poses special hazards to pregnant women, babies, and young children. Babies
and children who are exposed to tobacco smoke have more ear infections and asthma and die
from SIDS more often. Mothers who smoke during pregnancy are more likely to have low
birthweight babies and put their babies at increased risk of SIDS.
- Smoking trends today will determine how
heavy the health burden will be among communities tomorrow. Programs that reflect cultural
diversity will be the cornerstone in the battle against tobacco use.
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Powerful influences undermine
public health efforts
- Smoking is associated with depression,
psychological stress, and environmental factors such as peers who smoke and tobacco
marketing practices.
- Tobacco advertisements promote the
perception of cigarette smoking as safe and far more widespread and socially acceptable
than is actually the case.
- Tobacco companies garner community loyalty
by hiring community members, providing communities with tobacco sales and advertising
revenues, funding community organizations, and supporting educational, political,
cultural, and sports activities.
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Helping people enjoy smoke-free
lives
- Group approaches for quitting smoking
generally have not been successful with members of racial/ethnic minority groups, possibly
because the processes used have not been culturally relevant or because of a lack of
transportation, money, or access to health care.
- To be effective in discouraging tobacco
use among young people, strategies should include restricted access to tobacco products,
school-based prevention programs, and mass media campaigns geared to young people’s
interests, attitudes, and cultural values.
- Most successful programs for quitting
smoking do more than deliver culturally appropriate messages. They provide practical
information about the health consequences of tobacco use, resources to help people quit,
and specific techniques for quitting.
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Facts
at a glance
- In the 1970s and 1980s, smoking rates
declined substantially among African American youths, regardless of gender, self-reported
school performance, parental education, and personal income, but have increased markedly
since 1992.
- If current patterns continue, an estimated
1.6 million African Americans who are now under the age of 18 will become regular smokers.
About 500,000 of those smokers will die of a smoking-related disease.
- Studies show that adverse infant health
outcomes (e.g., the likelihood of pregnant women delivering low birthweight babies, SIDS,
and high infant mortality) are especially high for African Americans and American Indians
and Alaska Natives. Cigarette smoking also increases these risks, especially for SIDS,
among Asian Americans and Pacific Islanders and among Hispanics.
- In all four racial/ethnic minority groups,
the percentage of persons who have ever smoked and have quit increases with increasing
age.
- In all racial/ethnic minority groups
except African Americans, men are more likely than women to use smokeless tobacco.
- Asian Americans and Pacific Islanders are
the least likely of the four U.S. racial/ethnic minority groups to smoke, but several
local surveys report very high smoking rates among recent male immigrants from Southeast
Asia.
- Most African American, Asian American and
Pacific Islander, and Hispanic smokers smoke fewer than 15 cigarettes a day. Heavy
smoking—25 or more cigarettes a day—is most common among American Indians and
Alaska Natives, but still lower than among whites who smoke.
Both complete and summary versions of Tobacco Use Among U.S.
Racial/Ethnic GroupsAfrican Americans, American Indians and Alaska Natives,
Asian Americans and Pacific Islanders, and Hispanics: A Report of the
Surgeon General are available.
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