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Foreword and Preface
The United States of America is a rich
blend of cultures. This diversity demands close attention from the agencies and
individuals responsible for protecting the public’s health. For too long in tobacco
control, attention to diversity has been less consistent than is necessary for planning
and developing effective health programs. As a result, we sometimes lack sufficient
information on which to base tobacco control interventions. With this report, we begin to
address such problems and point the way to filling these gaps in knowledge.
Tobacco use causes devastating disease
and premature death in every population in the United States. For four major U.S.
racial/ethnic minority groups — African Americans, American Indians and Alaska Natives,
Asian Americans and Pacific Islanders, and Hispanics — patterns of tobacco use, adverse
health effects, and the effectiveness of interventions need to be understood in terms of
tobacco’s cultural and socioeconomic effects on the members of these groups. This
report describes the complex factors that play a part in the growing epidemic of diseases
caused by tobacco use in these four groups.
Since 1964 when the first Surgeon
General’s report on smoking and health was released, this report is the first to
focus exclusively on tobacco use among members of these four racial/ethnic groups.
Together these groups constitute about 25 percent of the U.S. population, and that
proportion is growing rapidly. Public health programs must effectively address the health
needs of this significant proportion of people. Such action is of paramount importance to
reducing tobacco use in the United States and meeting national health objectives for the
year 2000. We hope that this report will provide the basis for renewing our commitment to
develop more effective tobacco control programs and policies for people of every racial
and ethnic background. In addition, the report can be used by parents and communities as a
tool to develop their own solutions. With continued diligence, we shall strive to reach
and exceed whenever possible our stated health goals by the year 2000 and reduce the
enormous health burden caused by tobacco products.
Claire V. Broome, M.D.
Acting Director
Centers for Disease Control and Prevention
and
Acting Administrator
Agency for Toxic Substances and Disease Registry
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From the Surgeon General,
U.S. Department of Health and Human Services
Effective strategies are needed to reduce
tobacco use among members of U.S. racial/ethnic groups and thus diminish their burden of
tobacco-related diseases and deaths. Cigarette smoking is the leading cause of preventable
disease and death in the United States. There is enormous potential to reduce heart
disease, cancer, stroke, and respiratory disease among members of racial and ethnic
groups, who make up the most rapidly growing segment of the U.S. population.
This Surgeon General’s report is the
first to address the diverse tobacco control needs of the four major U.S. racial/ethnic
minority groups—African Americans, American Indians and Alaska Natives, Asian
Americans and Pacific Islanders, and Hispanics. This report is also the only single,
comprehensive source of data on each group’s patterns of tobacco use, physical
effects related to tobacco smoking and chewing, and societal and psychosocial factors
associated with tobacco use.
The findings detailed in this report
indicate that if tobacco use is not reduced among members of these four racial/ethnic
groups, they will experience increasing morbidity and mortality from tobacco use. The toll
is currently highest for African American adults. Findings also suggest that some close,
long-term relationships between tobacco companies and various racial/ethnic communities
could hamper U.S. efforts to lower rates of tobacco use by the year 2000. Also notable is
the support that members of racial/ethnic groups have shown for legislative efforts to
control tobacco use, sales, advertising, and promotion.
As this report goes to press,
discouraging news comes from a report published by the Centers for Disease Control and
Prevention on the Youth Risk Behavior Survey about tobacco use among African American and
Hispanic high school students. Past-month smoking increased among African American
students by 80 percent and among Hispanic students by 34 percent from 1991 through 1997.
The consistent decline once seen among young African Americans has sharply reversed in
recent years. Past-month smoking prevalence increased from 13 percent to 23 percent among
African Americans and from 25 percent to 34 percent among Hispanics.
Although cancer remains common in
Americans of all racial and ethnic groups, the pattern of increasing lung cancer deaths in
the 1970s and 1980s among African American, Hispanic, and some American Indian and Alaska
Native subgroups has been halted or reversed for some groups from 1990 through 1995. Some
encouraging news from Cancer Incidence and Mortality, 1973–1995: A Report Card for
the U.S. was just published by the American Cancer Society, the National Cancer Institute,
and the Centers for Disease Control and Prevention. The report described lung cancer trend
data from 1990 through 1995 for African Americans, Asian Americans and Pacific Islanders,
and Hispanics. Lung cancer death rates declined significantly for African American men and
for Hispanic men and women from 1990 through 1995; death rates did not change
significantly for African American women or for Asian American and Pacific Islander men or
women. Although lung cancer trends may continue to decline among some racial/ethnic groups
for several more years, recent increases in smoking prevalence among adolescent African
Americans and Hispanics and among Asian American and Pacific Islander adolescent males,
coupled with the lack of decline among American Indian and Alaska Native adults, do not
bode well for long-term trends in lung cancer.
One purpose of this report is to guide
researchers in their future efforts to garner more information needed to develop effective
prevention and control programs. Several significant research questions need to be
addressed. For example, why are African American youths smoking cigarettes in lower
proportions than youths in other racial/ethnic groups? How does acculturation affect
patterns of tobacco use among immigrants to the United States? What are the differential
effects of gender on tobacco use among members of certain racial/ethnic groups? What
racial- and ethnic-specific protective factors and risk factors will promote the
development of culturally appropriate interventions to prevent and control tobacco use?
And to what extent are culturally specific tobacco control programs necessary to curb
tobacco use among racial/ethnic populations? While researchers are redirecting their
focus, federal, state, and private tobacco control partners need to address program
issues, such as how to develop and evaluate culturally appropriate prevention and
cessation interventions.
This report includes examples of numerous
racial- and ethnic-specific tobacco control programs used in communities across the
country. These and other racial/ethnic group-specific programs must be disseminated to all
areas of the country, where program planners can develop their own strategies, taking into
consideration the cultural attitudes, norms, expectations, and values of the targeted
cultural groups.
In each of these endeavors, we will
succeed only if we are sensitive to our cultural differences and similarities. I challenge
federal and state agencies as well as researchers and practitioners in the social,
behavioral, public health, clinical, and biomedical sciences to join me in the pursuit of
effective strategies to prevent and control tobacco use among racial/ethnic groups. By
meeting this challenge, we will progress toward achieving the nation’s year 2000
tobacco-related health objectives and will help to prevent the unnecessary disability,
disease, and deaths that result from tobacco use.
David Satcher, M.D., Ph.D.
Surgeon General
and
Assistant Secretary for Health
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