In Underserved Communities, Tobacco Use Is Still Too Common

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The health effects of smoking cigarettes are well documented. Smoking not only accounts for about 80% of lung cancers, it's also a risk factor for many other cancers like esophageal, pancreatic, bladder, stomach, colorectal, liver, cervix, kidney - and the list continues.

And it's not only cancer: smoking contributes to the development of health conditions like heart disease and stroke, Type 2 diabetes and chronic obstructive pulmonary disease, among others.

The good news is that smoking cigarettes in the United States is on the decline, according to the Centers for Disease Control and Prevention (CDC). Recent data shows that 11.5% of Americans smoked cigarettes in 2021 compared to 20.9% in 2005.

But in underserved communities, this downward trend doesn't follow suit. In fact, underserved communities make up the greatest proportion of smokers in the United States - and tobacco companies specifically market to them.

Here are three communities that face greater hurdles when it comes to quitting tobacco.

1. Indigenous People

Indigenous people, which includes Native Americans and Alaska Natives, have the highest rate of tobacco use in the United States. The CDC reports that 22.6% of Native Americans and Alaska Natives - more than 1 in 5 - smoke cigarettes.

This, however, doesn't include the use of traditional tobacco leaves, which are used for ceremonial and healing purposes. At the start of religious ceremonies, tobacco is made as an offering to the spirits. But in the past, when the United States tried to ban Native American culture and force their assimilation, Native Americans did not have access to traditional tobacco. Instead, they used commercial tobacco in ceremonies - which fostered an addiction to smoking manufactured cigarettes.

Compound that with the fact that Native American tribes are sovereign nations - so changes to state and local laws, like clean indoor air policies that have helped drive down smoking across the United States, have not always covered the Native American population. But recently, the National Congress of American Indians has been working to enact clean indoor air policies and provide increased access to culturally appropriate tobacco treatment programs. And the American Indian Cancer Foundation has started campaigns to keep tobacco sacred in an effort to help people quit and prevent young Native Americans from starting.

2. Black Americans

The Black population has the highest rate of smoking cigarettes that contain menthol, a naturally occurring chemical in mint plants that can also be made synthetically.

The American Lung Association found that 77.4% of African American smokers choose menthol cigarettes versus 23% of white smokers. Tobacco companies specifically market menthol cigarettes to this population.

Menthol adds a cooling sensation to cigarettes, making it easier for people to smoke and more difficult to stop. Why? Menthol reduces the discomfort and irritation that comes from smoking. But because of this, some people might think menthol cigarettes are healthier - which isn't true. (Not to mention the fact that menthol can disguise important early symptoms of respiratory issues, like coughing and airway pain.) Menthol can also increase the likelihood of becoming addicted to cigarettes - and attract younger kids to smoking.

The American Lung Association reports that "menthol cigarettes were responsible for 1.5 million new smokers, 157,000 smoking-related premature deaths and 1.5 million life years lost among Black Americans from 1980-2018."

This year, the Biden administration has been reviewing proposals from the Food and Drug Administration (FDA) to remove menthol from cigarettes and cigars but has deferred decision-making in this area.

3. Low-Income Communities

People living in poverty smoke at a rate of 19.7%. They smoke more often and for twice as long as those who have an income that's three times higher, reports the American Lung Association.

It's perhaps no surprise, then, that more tobacco retailers are found in lower-income areas. Cigars and cigarettes are even less expensive in these areas, and those who live in public housing are twice as likely to smoke cigarettes than the general American public.

Those in lower-income areas may also be less likely to have health insurance, which contributes to higher smoking rates. People who regularly see the doctor are less likely to smoke - or are more likely to quit smoking - thanks to increased primary care visits and access to tobacco treatment programs and medication.

Education level is also linked to smoking: those who did not graduate from high school smoke at a rate of 20.7%, reports the American Lung Association, while those who graduated from high school smoke at a rate of 16.3% and those who graduated from college with a bachelor's degree smoke at a rate of 4.4%.

How To Stop Smoking

It's essential for anti-tobacco campaigns to target underserved communities and other at-risk populations - and for tobacco treatment programs and medications to be easily available for everyone. Michigan residents who would like to stop smoking can find free and low-cost resources here, including how to cover the cost of nicotine replacement therapies and other medications that support quitting. Michigan Tobacco QuitLink also offers free virtual and telephone support (call 800-784-8669).

Quitting tobacco isn't easy, but it is hugely beneficial. No matter how long you've smoked, it's never too late to quit. After 20 minutes of quitting, your heart rate and blood pressure drop. After eight hours, the carbon monoxide level in your blood returns to normal. After one to nine months, coughing, sinus congestion, shortness of breath and fatigue decrease. And after ten years? Your risk of dying from lung cancer is the same as it is for people who have never smoked.

Kimberlydawn Wisdom, MD, MS, FACEP, is the Senior Vice President of Community Health & Equity and Chief Wellness & Diversity Officer for Henry Ford Health. Read more about Dr. Wisdom.

Categories : FeelWell

Tags : Tobacco Use, Tobacco, Kimberlydawn Wisdom