From the Journals

Black/White gap gone: ‘The only cancer where this has happened’


Smoking Prevalence Rates

Smoking prevalence rates were derived from National Health Interview Survey data from 1970 to 2016.

Mirroring findings in the racial patterns of lung cancer incidence rates, smoking prevalence rates declined in successive birth cohorts in both Black and White males and females, but the decline was again steeper in Black men and women than it was in White men and women.

As a result, the historically higher sex-specific smoking prevalence rates seen historically in Blacks disappeared in men born around 1960, and reversed in women born at the same time, Jemal and colleagues point out.

As the authors explain, the more rapid decline in smoking prevalence after 1960 is likely a reflection of the “precipitous” drop in smoking initiation rates among Black teenagers starting about the late 1970s through to the early 1990s.

For example, among 12th graders, smoking prevalence rates between 1977 and 1992 dropped from 36.7% to 8.1% among Black teens. In stark contrast, they hardly changed at all among White teens, dropping only from 38.3% in 1977 to 31.8% in 1992.

Jemal suggested that steeper decline in smoking initiation rates seen between the late 1970s and early 90s reflects the fact that Black teenagers were deterred from smoking because the cost of cigarettes kept going up.

He also suggested that smoking is less acceptable in the Black community than it is in the White community, especially among churchgoers, where smoking is severely frowned upon and nonsmoking is the community “norm.”

Additionally, Black youth may simply be heeding government antismoking messages to a greater extent than White youth, Jemal suggested.

He wondered if there are parallels now in the current pandemic. “When I go to a store here in Georgia, I would say almost all Blacks are wearing a mask [even though masks are not mandatory in Georgia] whereas it’s amazing the number of Whites who don’t wear a mask,” he recounts.

“So it would seem that Whites feel that government is simply interfering with their lives, while Blacks have a better perspective of the harms of smoking, so they are listening to the government’s antismoking campaigns,” he speculated.

Some Isolated Areas

Asked to comment on the study’s findings, Otis Brawley, MD, Bloomberg, distinguished professor of oncology and epidemiology at Johns Hopkins University in Baltimore, said that, while overall Black smoking rates are declining, there are some isolated areas where they are still very high.

For example, in his hometown of Baltimore, recent prevalence rates indicate that over 30% of Blacks are still smoking, “so these areas with high usage are still areas to focus on,” he told Medscape Medical News.

On the other hand, the study also supports the benefits of local, state, and federal government efforts to promote antismoking messages and tobacco-control activities over the past number of years.

“It proves that tactics used to control tobacco use have had some effect [even though] the study also shows that the tobacco industry’s advertising tactics such as the R.J. Reynolds targeted ads in the 90s can have deleterious effects,” Brawley noted.

Lung cancer has traditionally been one of the biggest drivers in the Black/White cancer mortality gap, Brawley said, adding that steeper declines in smoking initiation rates among Blacks compared with Whites are the main reason why this disparity is decreasing.

The study was supported by the Intramural Research Department of the American Cancer Society. The study authors have disclosed no relevant financial relationships. Brawley declares he does some consulting work for pharmaceutical company Genentech.

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