There was a strong, sustained and uniform decline in the adjusted odds of AA adult daily smoking, by 3% per year in the decade from 1992–3 to 2001–2, across state groups with very different approaches to tobacco control. In each of these disparate state groups, rates of daily smoking among AAs are now substantially less than those for NHWs of similar age, education and income status. Further, in these states, daily smoking rates for AAs have been less than or equal to rates for NHWs since at least 1992–3.
When we compared the age‐specific rates of daily smoking, there seems to be a strong birth cohort effect that extends through the age 40 years in 2002. Importantly, there was no significant difference in occasional smoking behaviour between either group. Thus, the most likely explanation for this very large effect is that AAs aged <40 years in 2002 never became smokers in the first place. Many studies have noted that cohorts of AAs since the 1970s have had much lower initiation rates than NHWs1,5,15
and our analysis demonstrates the time that it takes for this lower initiation rate to affect prevalence. Indeed, it is only recently that the Centers for Disease Control and Prevention has documented the elimination of a long‐term higher smoking prevalence among AA and NHW adults.3
Our goal was to compare the effectiveness of a comprehensive tobacco control programme (CA) versus price‐centred programmes (NY and NJ) with the TGS as control states in reducing adult AA and NHW smoking prevalence rates over time. Given the differences in the emphasis of state tobacco control programme, we expected that the reduction in daily smoking rates would differ by state group. Indeed, for NHWs, the decreases in daily smoking rates varied by state group depending on the tobacco control strategies, with CA showing the greatest reductions even after controlling for potentially confounding demographic differences. This finding supports previous research showing the effectiveness of the California Tobacco Control Program in changing social norms and reducing both initiation and prevalence of smoking.16,17
However, we found that among AAs, there have been large and fairly uniform declines in daily smoking prevalence across the state groups we examined, regardless of the type of tobacco control strategies.
Our analysis of the age‐specific data in 1992 compared with 2002 has demonstrated that the decline in AA smoking may be coming mainly from a cohort effect of a major reduction in smoking among people born after 1960. Such a decline in AA initiation has previously been reported for CA.4
In addition, it has been observed that, throughout the 1990s, AA adult smokers were less likely to successfully quit than NHWs.4
Therefore, it is unlikely that the observed age‐specific changes could have resulted from increased rates of quitting.
As the window of initiation has been documented to be closed by the mid‐20s,18
this large initiation effect occurred prior to the study period under consideration (ie, started in the 1970s–1980s). Further, the effect has been so large that it probably would overpower any effect of a tobacco‐control programme or price on quitting behaviours. To address whether there was a difference in quitting among AAs requires a different analysis and will be the subject of a future study. However, the time that it has taken for this initiation effect to change the overall prevalence rate among AAs suggests that the prevalence rates among NHWs in CA will continue to decline rapidly in future years, as the programme has been shown to have had a major effect on initiation.17
Whether or not the tobacco control programme influenced AA initiation in a similar manner would also need to await future surveys.
It is also possible that the lack of difference in AA smoking trends across the states resulted from the fact that AA smoking patterns were not sensitive to price. It is possible that the effect of differences in cigarette prices between the states was muted because of the more efficient way that AAs seem to smoke their cigarettes (eg, lower daily cigarette consumption yet higher blood levels of nicotine).19
However, differences in the efficiency of smoking for AAs in various US regions have not been reported. Another possibility is that the AA community has become somewhat immune to the promotional efforts of the tobacco industry. A community‐wide AA reaction was observed before the CA campaign in response to the use of cultural images in the marketing of Uptown cigarettes.20,21,22
Additional research into tobacco industry marketing receptivity over time among AAs is necessary.
It has been noted that young adult males (aged 20–29 years) have, for many years, had a relatively lower coverage rate in the CPS than other demographic groups, particularly among minority populations.11
This may account for the observed gender difference in the AA sample that is not present among NHWs. However, there is no evidence that relative coverage rates have changed over time,23
and the trends in smoking behaviour presented here did not differ significantly by gender. Thus, any difference in response rates by gender would have minimal effect on these results. Additionally, the CPS data that we use are from self‐reported surveys, and as such, may be affected by trends in social desirability bias. If respondents are increasingly reluctant to report smoking then this may exaggerate the actual decline in smoking prevalence. However, there was no decline in reported occasional smoking among AAs, and it is unlikely that such biases could account for the magnitude of the trends presented here.
This is the first study to examine the disparity in AA and NHW smoking prevalence across groups of states with varying tobacco control strategies and efforts. There were uniformly large annual rates of decline in AA adult daily smoking from 1992–3 to 2001–2 across states, regardless of the type of state‐wide tobacco control strategy. Further, the more recent cohort of AAs does not seem to take up daily smoking at the same rate as did earlier groups. Future research on factors that may have contributed to these declines is warranted. Because of these declines, we could expect that tobacco‐related disease rates for AAs will decrease more rapidly than for NHWs in the medium‐term future.
What this paper adds
- Historically, smoking prevalence rates have been higher in the US African‐American (AA) adult population compared to the non‐Hispanic white (NHW) population. However, in recent years, the prevalence gap between AAs and NHWs has closed.
- We examined how smoking rates have changed for AAs and for NHWs across states with differing tobacco control strategies: California (CA; high cigarette price/comprehensive programme), New York (NY) and New Jersey (NJ; high cigarette price/no comprehensive programme), and tobacco‐growing states (TGS; low cigarette price/no comprehensive programme).
- There were uniformly large declines in AA smoking from 1992–3 to 2001–2 across states, independent of type of tobacco control strategy, whereas adjusted NHW smoking prevalence declined significantly only in CA.
- Findings suggest that more recent cohorts of AAs appeared to have taken up smoking at lower rates than older cohorts. Further research is needed to look into factors associated with smoking declines among AAs and may be of benefit to the other population groups.