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.
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.
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 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.
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 |