Tobacco Use Disparities by Race/Ethnicity

Tobacco use disparities among different racial and ethnic groups are a significant public health concern. These disparities are influenced by a complex interplay of socioeconomic factors, targeted tobacco industry marketing practices, cultural norms, access to cessation resources, and structural racism. The prevalence of current cigarette smoking is lower among non-Hispanic Asian and Hispanic adults, and higher among non-Hispanic American Indian and Alaskan Native, non-Hispanic White and non-Hispanic Black adults compared to the national average. Overall, these racial/ethnic disparities have been persistent in the US population (Figures 2.2.1 and 2.2.2), and wide variation exists at the state level (Maps 2.2.1, 2.2.2, 2.2.3, and 2.2.4).¹

The burden of tobacco products use continues to be disproportionally experienced contributing to an unequal burden of tobacco-related diseases, including cancer, heart disease, and respiratory illnesses. Non-Hispanic Black persons are found to start smoking at older ages, show greater intention to quit, but are less successful with quitting than non-Hispanic White persons. Consequently, they have longer duration of smoking and an elevated risk of lung cancer. Non-Hispanic Black, Asian American, and Hispanic/Latino people who smoke are more prone to light and intermittent smoking (smoking less than ten cigarettes per day) than heavy daily smoking (smoking ten or more cigarettes per day). However, due to low smoking intensity, individuals who smoke in these race/ethnic groups were less likely to be eligible for lung cancer screening which made them susceptible to later stage diagnosis and lower probability of survival. In 2021, the US Preventive Services Task Force extended lung cancer screening eligibility to individuals who smoke with lower smoking intensity and initiating screening at a younger age that would include more individuals from populations marginalized and historically targeted by the tobacco industry and reduce their lung cancer mortality risk.²

Racial disparities in exposure to secondhand smoke are also acute and persistent. Prevalence of secondhand smoke exposure among non-Hispanic Black individuals who do not smoke continued to be twice as high as among their non-Hispanic White counterparts (Figures 2.2.3). Black individuals accounted for 13% of all deaths, 15% of life years lost, 19% of productivity losses, and 24% to 36% of infant deaths attributable to secondhand smoke exposure in 2006. The value of lost productivity per death was estimated to be highest among Black people ($237,905), followed by Hispanic people ($192,500), other racial/ethnic groups ($180,995), and White people ($142,015).³ Although dated, these estimates reveal the disproportionately high burden of secondhand smoke exposure born by the Black communities.