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Reducing socioeconomic inequalities may be the key to smoking cessation among blacks

Cigarette smoking among Americans declined markedly over the past three decades, but this trend has leveled off recently. Of great concern is the dramatic increase in the rate of smoking among adolescents. Also, a recent study has found that although smoking declined from 25 percent to 20 percent among whites from the 1980s to 1990s, one-third of blacks continued to smoke during this same period. According to the study findings, income, education, and other socioeconomic factors explained most of this black/white disparity in smoking cessation.

Public efforts aimed at changing smoking behavior among blacks should place more emphasis on reducing socioeconomic inequalities in education and access to care, concludes Catarina I. Kiefe, Ph.D., M.D., of the University of Alabama at Birmingham. This raises questions about the best way to allocate public resources for smoking cessation and calls attention to the potential limitations of programs designed to bring about behavior change.

In a study supported in part by the Agency for Healthcare Research and Quality (HS09446), Dr. Kiefe and her colleagues examined changes over a 10-year period in smoking behavior among over 5,000 blacks and whites who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study, a multicenter study of the evolution of risk factors for cardiovascular disease in young adults (18-30 years). The researchers found that the 25 percent of whites who smoked in 1985-1986 had declined to 20 percent in 1995-1996, but that the rate of black smokers stayed about the same, 32 percent and 33 percent, respectively.

More blacks than whites began smoking and fewer quit smoking during this same period. Thirteen percent of black men and 7 percent of black women began smoking over the 10-year period compared with 5 percent of white men and 3.5 percent of white women, with corresponding cessation rates of 19 percent, 25 percent, 31 percent and 35 percent. Yet adjustment for socioeconomic factors explained most of these racial disparities. Beneficial changes in smoking behavior were strongly and positively associated with higher educational attainment among men and women, independent of all other measured socioeconomic factors. Higher income was more strongly associated with beneficial smoking changes among black than among white men.

See "Ten-year changes in smoking among young adults: Are racial differences explained by socioeconomic factors in the CARDIA study?" by Dr. Kiefe, O. Dale Williams, Ph.D., Cora E. Lewis, M.D., M.S.P.H., and others, in the February 2001 American Journal of Public Health 91(2), pp. 213-218.

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