TReND explores smoking interventions among diverse populations

A special issue of the American Journal of Health Promotion focuses on “Cigarette Smoking Interventions Among Diverse Populations” and explores tobacco control efforts to reduce the burden of cigarette smoking among racial/ethnic minority groups and low-SES groups.

Since the Surgeon General’s first report on tobacco in 1964, US smoking rates have been halved. In reality, however, smoking and its correlate burden of disease are not evenly distributed across the population. Subgroups such as racial/ethnic minorities and people with lower socio-economic status have not benefited as much from smoking prevention and cessation programs as whites and those of higher SES.

SES, race, and ethnicity are significant contributors to higher smoking rates among particular populations:

• 49.1% of individuals with a general equivalency diploma (GED) or high school diploma smoke compared to 11.1% of those who are college-educated.
• 31.1% of people living below the poverty level smoke, compared with 19.4% of those at or above the poverty level (19.4%).
• 23% of American Indians/Alaska Natives smoke. This is a higher rate than in other racial and ethnic groups.
• Among groups with low smoking rates, such as Latinos (14.5%) and Asians (12.0%), people who share a specific national origin (e.g., Puerto Rico, Korea, the Philippines) have higher smoking rates.
• Second-hand smoke exposure is higher among African-Americans, individuals with lower incomes, and blue-collar workers.

“Understanding how to effectuate behavior change in these populations is paramount if we are to achieve both our national health objective of reducing cigarette smoking and improve the nation’s health status overall,” write researchers from the Tobacco Research Network on Disparities (TReND) in a Commentary that introduces the supplement.(1) TReND was established by the National Cancer Institute and the Legacy Foundation in 2004 to expand the body of knowledge about tobacco and health disparities.

The special issue’s introductory commentary describes multi-level strategies that have contributed to reductions in cigarette smoking (and, by proxy, to reductions in exposure to secondhand smoke). These strategies include:

• policies such as smoking bans and cigarette taxes
• clinical cessation efforts
• population-based strategies such as media campaigns, telephone quit lines, and online behavioral interventions

Such strategies have limitations, however. The latest clinical practice guidelines omit specific recommendations for smoking cessation among racial/ethnic minorities, citing a lack of evidence to support culturally appropriate approaches. In this case, lack of evidence is due to lack of research, not to a body of data that refutes the efficacy of particular approaches.

“The articles in this issue confirm that if we are to impact tobacco-related disparities, we need to consider not only ethnicity, culture, and social class but smoking frequency and intensity and the environmental and social context in which smoking occurs,” TReND researchers note.

The supplement includes a literature review of tobacco-use treatments in US ethnic minority populations and original research on specific groups, such as youth with mental health disorders, American Indians, Asian Americans, low-income pregnant smokers, and Latinos.

Intervention approaches discussed include national mass-media smoking cession campaigns, quit lines, health care providers, multi-unit housing policies, and social support.

(1) Fernander A, Resnicow K, Viswanath K, Pérez-Stable EJ. Cigarette Smoking Interventions Among Diverse Populations. American Journal of Health Promotion: May/June 2011;25:(special issue)sp5. Abstracts S1-S4. http://ajhpcontents.org/doi/full/10.4278/ajhp.25.5.c1