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Disparities


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Overview
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Socioeconomic Status (SES)
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Updated: November 29, 2011

Overview

Some geographic areas have higher smoking rates than others. In 2009, current smoking prevalence was highest in Kentucky (25.6%), West Virginia (25.6%) and Oklahoma (25.5%) and lowest in Utah (9.8%), California (12.9%), and Washington (14.9%).1,2 Evidence shows that tobacco use also varies by racial and ethnic group, socioeconomic status, and level of education. It is important for employers to acknowledge the disparities in tobacco use so that they can tailor smoking cessation materials to meet the needs of specific employee populations.


Racial-Ethnic Groups

Below is the 2009 prevalence of cigarette smoking across different ethnicities, compared to an average rate of approximately 20% for all U.S. adults.
  • 22.2% Whites1
  • 21.3% African Americans1
  • 14.5% Hispanics1
  • 12.0% Asians [excluding Native Hawaiians and other Pacific Islanders]1

American Indians and Alaska Natives
American Indians and Alaska Natives have the highest rate of smoking of all racial and ethnic groups. It is important to keep the following in mind when developing smoking cessation initiatives for this group:
  • Tobacco use is cultural for many American Indians and Alaska Natives. Tobacco is considered a sacred gift, and is used during religious ceremonies and as traditional medicine.
  • Although American Indians and Alaska Natives have the highest rates of smoking in the United States, they are less likely to be heavy smokers. In a 2008 study, 67.2% of American Indian and Alaska Native smokers reported using fewer than 15 cigarettes per day. Only 46.6% of white smokers smoke less that 15 cigarettes a day.3
  • According to the CDC, American Indians and Alaska Natives women have the highest rate of smoking during pregnancy (17.8%) compared to non-Hispanic white (13.9%) and non-Hispanic black (8.5%) women.3
  • American Indian and Alaska Native lands are sovereign nations; they are not subject to state or federal laws prohibiting the sale and promotion of tobacco products to minors or to tobacco taxes. 3

African Americans
Rates of tobacco use are not uniform across different racial-ethnic populations and tobacco use can impact different populations in different ways.
  • White men consume more cigarettes (about 30% to 40% more) than African American men, but African American men are 34% more likely than white men to develop lung cancer. Similar trends exist for African American women.4
  • According to the CDC, in 2008, about 5.6 million (21.3%) of non-Hispanic black adults in the United States, smoked cigarettes compared to 22.0% of non-Hispanic whites. African Americans accounted for approximately 12% of the 46 million adults who were current smokers.4
  • Research is not conclusive as to why the rates of lung cancer are so high among African Americans. Possible theories are:
    • African Americans are more likely to use menthol cigarettes which are shown to be more carcinogenic.5
    • Previous research in adults showed that black smokers take in 30% more nicotine per cigarette and take longer to rid their bodies of the drug, compared to white smokers.6

Hispanics
There are significant variations in smoking rates among Hispanic subgroups.
  • In 2008, 21.5% of Cuban-Americans smoked compared to 18.6% of Puerto Ricans, 20.5% of Mexican Americans, 10.7% of Dominicans, and 12.8% of Central and South Americans.6
  • In 2008, 20.7% of Hispanic men and 10.7% of Hispanic women in the United States smoked.6
Employers with a large Hispanic employee population may want to ensure that smoking cessation materials are published in Spanish as well as English.

Asian Americans and Pacific Islanders
The rate of smoking for Asian Americans and Pacific Islanders is significantly lower than the national average. This group is also more likely to quit than whites, but less likely to remain abstinent.
  • In 2008, 4.7% of Asian American women smoked. This rate is less than half that of Hispanic women (10.7%), just over a quarter that of non-Hispanic Black (18.0%) women, and almost one-fifth that of American Indian/Alaska Native women (22.4%).7
  • Southeast Asians (i.e., people from Vietnam, Cambodia, Laos) and Chinese men tend to have much higher rates of smoking than population groups from other Asian locations (i.e., Philippines, Korea, Japan).7
  • Southeast Asians who have a higher English language-proficiency and who have lived in the U.S. longer were less likely to be smokers than other Asians.7
  • The average number of cigarettes smoked per day by Chinese men increases with the time they live in the United States.7
  • Over 300 million men in China - more than the entire U.S. population - are smokers.8


Socioeconomic Status (SES)

Socioeconomic status is determined by income, education, and employment. People with low SES typically:
  • Have less than 12 years of education.
  • Have low incomes or are unemployed.
  • Live in areas that are medically underserved.

People with low SES are more likely to smoke.

  • Approximately 30% of Americans below the poverty line smoke compared with 18% living at or above the poverty level. are 40% more likely to smoke than those at or above the poverty line.9
  • Studies show that people with lower levels of education are more likely to smoke.9 Employers with a large population of employees with lower levels of education may want to ensure that smoking cessation materials are written at a lower literacy level.
    • 45.2% of smokers have a General Education Development (GED) diploma
    • 23.8% of smokers have a high school diploma
    • 23.8% of smokers have some college (no degree)
    • 18.8% of smokers have an associate degree
    • 9.9% of smokers have an undergraduate degree
    • 6.3% of smokers have a graduate degree


Resources

For more information about tobacco use and American Indians and Alaska Natives see:
American Lung Association, Key Facts About Smoking Among American Indians and Alaska Natives

For more information see about tobacco use and African Americans see:
American Lung Association, African Americans

Pathways to Freedom: Winning the Fight Against Tobacco

For more information on tobacco use and Hispanics see:
American Lung Association, Key Facts About Smoking Among Hispanics

For more information see on tobacco use and Asian-Americans and Pacific Islanders see:
American Lung Association. Key Facts About Smoking Among Asian Americans and Pacific Islanders.

For more information on tobacco use and socioeconomic status see:
Campaign for Tobacco-Free Kids. Tobacco and Socioeconomic Status.



Citations

1 Centers for Disease Control and Prevention. State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use Among Adults --- United States, 2009. MWWR. 2010;59(43): 1400-1406.
2 American Lung Association. General Smoking Facts. Available at:
http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/general-smoking-facts.html. Accessed November 23, 2011.
3 American Lung Association. Key Facts About Smoking Among American Indians and Alaska Natives. Available at: http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/american-indians-tobacco.html . Accessed November 23, 2011.
4 American Lung Association. African Americans. Available at: http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/african-americans-and-tobacco.html. Accessed November 23, 2011.
5Harvard School of Public Health. Harvard researchers gather more evidence implicating menthol in health disparities between white and black smokers. Available at: http://www.hsph.harvard.edu/news/press-releases/2005-releases/press08182005.html.
6Science Daily. Black, White Teens Show Differences In Nicotine Metabolism. Available at: http://www.sciencedaily.com/releases/2006/02/060201232537.htm. Accessed November 21, 2007.
7 American Lung Association. Key Facts About Smoking Among Hispanics. Available at: http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/hispanics-and-tobacco-use.html. Accessed November 23, 2011.
8American Lung Association. Key Facts About Smoking Among Asian Americans and Pacific Islanders. Available at: http://www.lungusa.org/stop-smoking/about-smoking/facts-figures/asian-americans-tobacco.html. Accessed November 23, 2011.
9 Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged =18 Years --- United States, 2005-2010. MWWR. 2011;60(35):1207-1212.

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