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California's adult smoking rate hit a record low last year, 11.9 percent, state health officials announced this week. While smoking prevalence has fallen across the board, the number masks big disparities among demographic groups.
The state's analysis [PDF] shows smoking prevalence by sex, age, school grade and four ethnic groups – white, African American, Hispanic and Asian/Pacific Islander. But the state's own research in recent years has revealed wide variations in smoking rates among and within Asian ethnic groups; lesbian, gay, bisexual and transgender populations; and people on active military duty. The disparities underscore the challenges of combating tobacco use in different communities.
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Take for example African Americans, who have the highest smoking rate of the four ethnic groups represented. More than 18 percent of African American men and nearly 15 percent of women were smokers last year. For African American women, smoking prevalence has remained relatively flat for the past five years.
"This is something we are really struggling with," said Colleen Stevens, chief of the California Tobacco Control Program. "I don't think we can clearly say we have all the answers, either to the cause of why it's happening or the absolute solution."
Research has shown that there is more advertising of tobacco products in African American communities, Stevens said. A recent study by Stanford University found that menthol cigarettes were marketed in a predatory manner to African American high schoolers in California.
Stevens said the state is working with community leaders and conducting focus groups to figure out how best to decrease smoking among African Americans.
At the other end of the spectrum are Asian/Pacific Islanders. Four percent of Asian/Pacific Islander women and 8.4 percent of men smoked last year – the lowest rates of any ethnic group. But those numbers obscure variations among specific ethnicities and generational differences.
Several years ago, after receiving a bump in funding, the program conducted smoking surveys of several specific populations, including lesbian, gay, bisexual and transgender adults; active military personnel; and Vietnamese, Asian Indian, Chinese and Korean adults.
"We really felt we didn't have a good handle on male, female, one Asian group to another," Stevens said. "We really tried to figure out where the need was."
The results revealed huge disparities. Smoking prevalence among lesbian, gay, bisexual and transgender Californians was nearly double that of the general population in 2002. LGBT women, specifically, smoked at a rate of 32.5 percent, compared with 11.9 percent for adult women generally.
Similarly, the smoking rate among Californians actively serving in the military was 33.8 percent in 2002 – well above the 15.4 percent rate among the general population.
While about 12 percent of all Asian/Pacific Islanders smoked in 2002, surveys showed that as many as 41 percent of Korean men ages 18 to 24 were smokers, and assimilation affected Korean men and women differently.
"Korean men, the longer they're in this country, the better their English, the lower they smoke. Korean women come in smoking very low; the longer they're in this country … it starts to creep up. It's a social norm that pulls people," Stevens said.
Indeed, 36.1 percent of Korean men who spent less than 10 percent of their lives in the United States smoked, the survey showed. By the time they had spent 75 to 100 percent of their lives in the country, smoking prevalence dropped to 31.1 percent.
Korean women, on the other hand, have a smoking rate of 0 percent when they've been in the country less than 10 percent of their lives. Among those who had been in the U.S. 75 to 100 percent of their lives, smoking prevalence is 13.2 percent.
Perceptions of and attitudes toward smoking also varied substantially among different groups. Whereas 98.3 percent of Vietnamese men who smoked said they believed smoking harmed their own health, less than 80 percent of Korean smokers strongly agreed with this statement, and about 16 percent slightly agreed.
Aggregating demographic groups "is troubling – especially for populations where the rate is higher," said S. Alecia Sanchez, director of state legislative advocacy for the American Cancer Society. "We're very concerned about that because these people are gambling with their health in a way we know is really dangerous."
Understanding and targeting disparities in smoking prevalence requires more resources, Sanchez said. The American Cancer Society is sponsoring the California Cancer Research Act, which would increase the tax on each pack of cigarettes from 87 cents to $1.87. The initiative has qualified for the next statewide ballot.
A majority of the revenue – $855 million in its first year, decreasing about 3 percent thereafter – would support research of tobacco-related disease and cancer. Funding for the California Tobacco Control Program would increase by three times, Sanchez said.
Since 1988, when California voters approved a 25-cent tax on tobacco products through Proposition 99, the proportion of adults who smoke has dropped 49 percent. A nickel from each pack of cigarettes has funded the state's tobacco control efforts.
"A lot of progress that's happened in the state of California has been a result of how that money was invested," Stevens said. "But there are still 3.6 million smokers in California alone. … So even though our overall prevalence is marvelously low compared to everybody else, we still know we have a lot of work to do."
California is the second state, behind Utah, to reach a federal target of reducing the adult smoking rate to 12 percent by 2020.