Surgeon General's Report on Women and Smoking
African American Women and Smoking

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Smoking Prevalence Among African American Women

• In 1998, smoking prevalence was intermediate among black women (21.9 percent) and white women (23.5 percent),  highest among American Indian or Alaska Native women (34.5 percent) and lowest among Hispanic (13.8 percent) and Asian or Pacific Islander women (11.2 percent).

• Among black women, the prevalence of ever smoking increased from 1965 through 1985. The increase was not statistically significant; however, the subsequent decrease from 1985 through 1998 was significant.

• Several studies have looked at prevalence of smoking among women over time, which provides an opportunity to examine when persons take up smoking and how smoking diffuses through a population over time.

  • For black women, a large increase in smoking prevalence occurred in the 1920-1924 birth cohort.
  • Prevalence peaked in the 1935-1939 and 1940-1944 birth cohorts (51 percent).
  • In the 1940-1944 cohort, smoking prevalence was comparable among white women and black women.
  • Among whites, blacks and Hispanics, smoking prevalence and the proportion of women who had ever smoked declined in cohorts of women born after 1944.

• Among women who smoked in 1998, white women (14.0 percent) were more likely to be heavy smokers than were black women (4.5 percent) or Hispanic women (2.1 percent).

• Among racial and ethnic groups, a significant difference of heavy smoking by gender was observed among white non-Hispanics, black non-Hispanics, and Hispanics.

• Recent data are limited for assessing cigarette brand preference among women by race and ethnicity.

• The National Health Interview Survey (1978-1980) showed the three most popular brands for black women were Kool (24.4 percent), Salem (19.4 percent), and Winston (10.3 percent).

• Another study from 1986 demonstrated the three most popular brands among black women were Newport (20.5 percent), Kool (20.3 percent), and Salem (19.7 percent).

• Black women may be more sensitive than white women to the dependence-producing properties of nicotine. Researchers have hypothesized that black women may smoke cigarettes with a higher nicotine content or inhale more deeply than do white women.

Smoking Prevalence among Young African American Women

• The prevalence of ever smoking has been shown to be lower among young black and Hispanic women than among young white women.

• In one study, in 1997-1998 the prevalence of current smoking among young women was substantially lower among young black women (9.6 percent) than among young white women (31.6 percent).

• Young black women had a dramatic decrease in smoking prevalence from 1983-1985 (27.8 percent) through 1997-1998 (9.6 percent).

Smoking Among African American Girls

• Studies conducted in 1998 showed that white girls were more likely than black or Hispanic girls to have ever tried smoking.

• Survey data from 1990-1994 indicate smoking prevalence among high school senior girls was lowest among blacks (8.6 percent), intermediate among Hispanics (19.2 percent) and Asian or Pacific Islanders (13.8 percent), and highest among American Indian or Alaska Natives (39.4 percent) and whites (33.1 percent).

• 1998 data show that among smokers, black girls (9.7 percent) and Hispanic girls (15.8 percent) were less likely than white girls (34.2 percent) to be heavy smokers (one-half pack of cigarettes or more per day).

• The process of smoking initiation may be different across racial and ethnic groups.

• According to a school-based survey, concerns about weight and dieting may have been less important among African American girls than among white girls.

• In another study of seventh-grade adolescents in an urban school system, African American adolescents who knew about the weight-suppressing effect of smoking were less likely to experiment with cigarettes than were those who believed that smoking had no effect on weight.

• Studies vary on whether sibling smoking may be a factor for the initiation of smoking among younger sisters and brothers. The pattern may vary by race or ethnicity; in particular, African American girls appeared to be less susceptible than white girls to the influence of siblings, other family members, and peers who smoked.

• Theories of smoking and drug use have suggested that persons have difficulty resisting temptations to smoke if they are anxious, hostile, irritable, or psychologically distressed. A study reported that the intense feelings of anger and irritability were related to both smoking initiation and maintenance among African American adolescents, whereas among white adolescents these emotions were associated only with smoking initiation.

Smoking and Pregnancy

• Smoking prevalence during pregnancy differs by race and ethnicity. Although the prevalence declined in all racial and ethnic groups from 1989 through 1998, the greatest decline occurred among black mothers (from 17.2 percent in 1989 to 9.6 percent in 1998) and white mothers (from 21.7 percent to 16.2 percent).

• A 1992 study examined the relationship between early relapse and personal characteristics, including race. Overall, 46 percent of pregnant African American women and 28 percent of pregnant white women relapsed; 70 percent of those who relapsed resumed smoking by week 3 after childbirth.

• The high incidence to relapse during the postpartum period in the general population suggested that concern for the health of the fetus is a strong deterrent to smoking during pregnancy but that women may be less aware of, or less concerned about, the risks from environmental tobacco smoke on the health of infants and children.

• The effects of smoking on birth weight appear to be similar among various racial groups in the United States. The findings from one study suggested stronger effects of smoking among black women than among white women.

Health Effects of Smoking Among African American Women

Lung Cancer

• The overall incidence of lung cancer among black women resembles that among white women.

• In 1997, the age-adjusted incidence per 100,000 women was 42.6 percent among blacks and 45 percent among whites.

• In 1996-1997 lung cancer incidence rates among women younger than age 65 years were higher among blacks than among whites. This finding suggests that the differences between incidence among black women and white women may increase in the future.

• Because of the poor survival associated with lung cancer, mortality parallels incidence for all age and ethnic groups. The five-year relative survival rates among black women and white women diagnosed with lung cancer in 1989-1996 were 13.5 percent and 16.6 percent, respectively.

• Few case control studies reported data on variation in smoking-associated risk by race or ethnicity.

• In a hospital-based study, the odds for lung cancer were higher among black women than among white women at each level of tar exposure.

Coronary Heart Disease (CHD)

• Despite a continuing decline since the 1960s in mortality from CHD, this condition still ranks first among the causes of death for middle-aged and older women. The effect of CHD risk among women seems to be relatively similar regardless of racial or ethnic group.

Chronic Obstructive Pulmonary Disease (COPD)

• According to data from 1995, the steep rise in mortality from COPD among women in the U.S. continued during 1980-1992 and was similar among white women and African American women.

• In 1992, COPD mortality was 44 percent among white women and 78 percent among African American women.

• In 1992, the overall age-adjusted death rates were 1.67 times higher among white men than among white women, and 2.21 times higher among African American men than among African American women.

Body Weight and Fat Distribution

• Among current smokers, there tends to be a U-shaped curve for the relationship between smoking and body mass: typically, moderate smokers (approximately 10 to 20 cigarettes per day) weigh less than light smokers (less than 10 cigarettes per day), and heavy smokers (20 or more cigarettes per day) weigh more than moderate smokers. This relationship was particularly pronounced among black women in a study conducted in 1993.

• Many studies reported a positive association of smoking with a high waist-to-hip ratio (WHR) among women. WHR among black women was 2 percent higher among current smokers than among those who had never smoked. WHR was also higher among current smokers than among those who had never smoked, for women and men, black or white.

Smoking Cessation Among African American Women

• Published data shows the percentage of smokers who had quit smoking increased significantly among white women (from 19.6 percent in 1965 to 47.4 percent in 1998) and among black women (from 14.5 percent to 34.7 percent).

• Data from the 1993 National Health Interview Survey showed that 74.9 percent of African American women smokers would like to stop smoking.

• Overall, research has suggested that more African American men achieve cessation than do African American women.

• Mixed results have been observed in studies that have examined the differences in quit rates between African American women and non-Hispanic white women.

• Much of the research that has been reported on cessation programs for African American women has focused on pregnant women. Several approaches have been tested in prenatal smoking cessation programs for low-income women. However, results have been inconsistent.

Publication date: 2001