African Americans & Tobacco: From Victims to Victors

African Americans and Tobacco: From Victims to Victors
Robert G. Robinson, Dr.PH and Norma J. Goodwin, M.D.

Tobacco-use remains a major health problem for African Americans today, although historic gains have been made in the past 20 years. In fact, African Americans continue to lead the nation in tobacco-related disease and death. What makes this such a crisis is that tobacco is the greatest preventable cause of disease and death.
The solutions are:
  • to not begin smoking, or
  • to quit smoking, or
  • to not smoke around other people, sparing them secondhand and third hand smoke.
The only true way to avoid the harms of smoking is to create smoke free environments and communities. Secondhand smoke is consuming the poisons in the air produced by tobacco smoke, and thirdhand smoke is the poisons that remain after the smoke has disappeared.
African Americans are the third highest smoking community in the Nation, with Native Americans being the highest smoking, and Whites, the second highest. But it wasn’t always this way. Indeed, for 50 years African Americans smoked at higher rates than Whites. Beginning the habit after Black men served their country in World War II, African Americans rapidly joined the smoking parade, with the number of Black men smoking passing White men in the 1960’s, and Black women surpassing White women in the 1970’s. And African Americans smoked cigarettes that were the highest in tar (the poison that causes death and disease) and nicotine (the poison that causes addiction).

It was no wonder, when one considers the kind of stress many African Americans experienced [and continue to experience] each and every day, such as

  • Racism
  • Unemployment and under employment,
  • Lack of health insurance or inadequate insurance
  • Police harassment, etc.

These and other problems led to African American smokers finding it more difficult to quit smoking, compared to Whites. Also, they had access to fewer quit smoking services, and received less advice from their physicians to quit. Both of these situations reinforced their addiction patterns, making the challenge to quit all the more difficult.

African Americans a Special Target of the Tobacco Industry

The only two solutions to smoking are:

  • Not to begin smoking, or
  • To quit smoking.
However, both of these actions continue to be among the most difficult health solutions to achieve. Why? Because the tobacco industry spends millions of dollars targeting the Black Community with the two goals of: (a) getting young Black men and women to smoke; and (b) encouraging adults to continue smoking. 
These dollars find their way into Black magazines, artistic programs, service organizations, scholarships, professional internships, and civil rights organizations, and almost any other major organization or event that serves the African American Community. Ironically, before African Americans were smoking customers, racist stereotype images of them were used by the tobacco industry for mockery and aimed at White smokers.
It was not until African Americans became smoking customers after World War II that the tobacco industry adopted a friendly role, supporting their community organizations, and becoming the first industry to use middle class Black images in marketing campaigns. And today, the tobacco industry goes beyond its desire to create and maintain customers by targeted menthol cigarette use.

Menthol Cigarettes for African Americans: A Special Tobacco Industry Target

The tobacco industry is now focusing on a particular type of smoker: menthol cigarette smoker. African Americans are the highest users of menthol cigarettes in the nation. In fact, over 80%, or 4 out of every 5, Black smokers smokes menthol cigarettes, and their brand of choice is Newport. There are three major problems with menthol cigarette use.
1.Menthol makes it easier for youth to begin smoking,
 
2. It soothes the intake of smoke, and
 
 
3. African Americans who smoke menthol cigarettes have a harder time quitting than those who don’t use menthol cigarettes.
 
The reasons why it is harder to quit smoking menthol cigarettes are not known. Possibly there’s deeper inhalation, which may lead to higher levels of addiction, and thus make the product more difficult to give up. 
 
There are myths circulating about menthol. For example, because menthol is associated with medicinal products, some African Americans think that menthol cigarettes are healthier; yet this could not be further from the truth.
In spite of the targeting by the tobacco industry, the higher addiction levels and the greater challenges to quitting, African Americans experienced one of the greatest public health victories in the past 50 years.

In the years 1990 – 2001 African Americans either chose not to smoke or quit smoking at rates two times greater than Whites; and in 2001 for the first time in 50 years they smoked at levels lower than Whites. However, It is important to note that African American men continue to smoke at higher levels than White men. In other words, it is mainly on the shoulders of Black woman that this Community victory was possible. And this victory has continued because in 2013 African Americans continue to smoke at lower levels than Whites.

What Made this African American Victory Possible?

There were multiple reasons to explain why Blacks began choosing health and life over disease and death: During the 1990’s there were several advocacy campaigns demonstrating the Community’s desire to confront the tobacco industry.

  • African Americans Confront R J Reynolds – In 1990 R J Reynolds Tobacco Co. developed Uptown Cigarette in a black and gold package and stated, for the first time, it was a cigarette produced especially for the Black Community. The Black Community in Philadelphia, where the Uptown was test marketed, rose up and said no – we have the right to decide what comes into our Community. The protest was so successful that R J Reynolds withdrew Uptown cigarettes within 13 days – the first successful protest by the Black Community against the tobacco industry.
  • African Americans Reject X Cigarette – Shortly thereafter, a distributor in Boston tried to market X Cigarette in a black, green and red package. They ignored the company’s use of a Black hero’s name, Malcolm X, and the fact that the colors are traditionally viewed as the liberation colors for the Black Community. The Black Community, led by clergy and joined nationally by others across the nation, also forced X Cigarette off the market.

Not surprisingly, both Uptown and X cigarette were menthol. Further, aside from Uptown, the only cigarette produced by R J Reynolds with a higher tar and nicotine content was unfiltered camels.

Other activities related to the success of the African American Community – Other successful activities of African Americans regarding elimination of the black-white tobacco-use disparity (differences or inequalities) are too numerous to detail. However, they included:

  • National communication campaigns targeted by the Federal Government;
  • A tobacco control movement that for the first time prioritized diversity in its membership and leadership;
  • Support of national organizations like the National Medical Association, and National Association of African Americans for Positive Imagery regarding  tobacco prevention and control in the Black Community;
  • Multiple local programs in churches and community-based organizations focused on helping people quit, and advancing tobacco control policies; and
  • Pathways to Freedom (PTF), a smoking cessation guide developed specifically for African Americans. Indeed, one of the factors that made the increase in non-smoking advocates in Black Churches and organizations possible was the distribution of over 1 million copies of Pathways to Freedom from 1993 to 2001. Churches were able to even reference prayer in PTF,  and organizations for the first time, had something tangible they could deliver to the participants in their programs.

Parallels between Tobacco Industry Marketing and Slavery:

The journey from victim to victor parallels the history of slavery to freedom for the African American Community. The intersection of tobacco with each phase of this struggle is both symbolic and ironic.

  • African Americans were in chains and they picked the cotton.
  • After slavery, they continued to pick cotton, and they also worked the least desirable jobs in the tobacco industry factories.
  • They witnessed their people’s images used to mock them in the marketing of cigarettes before they were smoking customers.
  • They then saw the tobacco industry use Black middle class images in their advertising after they became addictive customers.
  • Finally, based in part on a constant desire to quit smoking and a great concern about health, the African American Community achieved, at the beginning of the 2000’s, one of the great public health victories by eliminating the disparity in smoking that existed between the White and Black Communities.
  • When the history of health disparities is written, the noteworthy role of the African American Community and the strategies and actions that made their victory possible, will assume a central part of the analysis and reporting.

 Pathways to Freedom (PTF) : An Overview

A 3-part Guide with the Following Sections:

Section 1 of Pathways to Freedom – Basic Facts on Smoking and Tobacco Industry Targeting

 Introduction to health results of smoking;

– Smoking causes more deaths in the Black Community than auto accidents, AIDS, homicides, and drug and alcohol abuse combined;

– Smoking is the cause of several cancers including lung, throat, mouth, bladder, cervix, stomach and kidney;

 Smoking also causes heart disease, stroke, chronic obstructive pulmonary disease (COPD), or emphysema and chronic bronchitis, and diabetes;

– Secondhand smoke also is a cause of disease and makes life worse for those who have
Asthma. This is especially harmful for children in the Black Community, who have asthma
rates 25% higher than White children;

– Promotion of smoking by the tobacco industry (targeting) is sharp, and constant. Ads are everywhere, and the amount of money given to community service and art organizations is almost endless;

– Frequent stressors of Black life – – such as poverty, unemployment and harassment – – 
strengthen the addiction; and the addiction is made worse by the high rate of menthol use in the Black Community.

Note: The Health Power Section on “Smoking and Health”, and our 5 “Quit Smoking and Win Tip Sheets” provide important additional information related to smoking.  Click at the bottom of this page to find them.

Section 2 of Pathways to Freedom – Tips for Smokers Who Want to Quit Smoking

Helpful tips for smokers who want to quit include:

– First, identify the triggers or urges that make you smoke, and avoid them. For example, a person may smoke when they are upset, watching TV, playing cards, reading a book or drinking an alcoholic beverage. Make a list of your triggers and remove objects from around you such as
ashtrays and matches that remind you of smoking.

Second, with the advice of a doctor, use pharmaceutical aids that help relieve the aches
from withdrawal.

Third, you can seek counseling, join a class or support group, or call a telephone quitline (1-800-quitline).

Fourth, set a quit day and make special preparations the night before you begin to quit;

Fifth, always remember that you are not alone. Seek the help of family and friends; or seek prayer to give you strength.

Sixth, remember the five D’s:

   Drink a lot of water,
   Deep breathing,
   Do something else,
   Discuss with friends and family, and
   Delay when you have the urge to pick up a cigarette. The urge to smoke will pass in
        3 to 5 minutes.

Seventh, watch what you eat to avoid gaining weight, and exercise to relieve the stress and help with the weight.

Eighth, if you begin smoking again, make a new commitment to try again. Most people who succeed in quitting don’t succeed on the first try.

Section 3 of Pathways to Freedom – What the Community Can Do

The third section of PTF focuses on what the Community can do to achieve a smoke-free society. In essence, the Community must (1) teach, (2) organize and (3) take action. This is very difficult because the number one enemy is the tobacco industry, and they have millions of dollars invested in (a) creating new smokers, and (b) keeping those who already smoke, smoking.

Fortunately, there are successful examples from which to learn:

  • Uptown, X, and other campaigns that specifically went after emerging menthol brands being pushed by the tobacco industry.
  • It takes a village: pastors, leaders, parents and children all joining together in the struggle. In this way the Black Community can put a lie to what was said by RJ Reynolds: “Health is a more active concern among Blacks than Whites…Fortunately, for this industry, this health concern does not translate strongly to anti-smoking attitudes….”
  • 10 Recommended Community Actions:

(1) Join with others to stop the sale of tobacco,

(2) Meet with store owners and ask them to remove tobacco products,

(3) Make sure schools are teaching about the dangers of smoking,

(4) Hold programs in faith based institutions,

(5) Advocate and/or work with employers and union leaders to create smoke free
regulations,

(6) Ask health clinics and professionals to provide low cost cessation programs,

(7) Help community groups say “no” to tobacco money,

(8) Support efforts to increase tobacco excise taxes,

(9) Urge elected officials to pass strong legislation (clean indoor/outdoor), and

(10) Share copies of Pathways to Freedom with friends, neighbors and family members.

History of Pathways to Freedom

Pathways to Freedom were first developed at the Fox Chase Cancer Center in Philadelphia, PA with a grant from the National Cancer Institute. It was the first tobacco cessation guide developed with African American leadership for the Black Community. In 1993, with the appointment of Dr. Robert Robinson as Associate Director for the Office on Smoking and Health (OSH) at the Centers for Disease Control and Prevention (CDC), Pathways to Freedom was adopted as the material of choice for Black smokers and the foundation for national distribution was put in place. Individuals and agencies can contact CDC for free copies of Pathways to Freedom. In 2003, Pathways to Freedom was revised by OSH, making possible the inclusion of menthol, and a more in-depth treatment of pharmaceutical treatments. Dr. Robinson is also a Health Power Editor.
In 2011,the National Cancer Institute provided Dr. Monica Webb Hooper at the University of Miami with a research grant to develop a Pathways to Freedom DVD. Questions regarding its distribution can be addressed to Dr. Webb at 305/284-4290.
How to Get Online Copies of PTF:

Go to the home page of the Office on Smoking and Health at (CDC) – athttp://www.cdc.gov/tobacco/. Scroll down to the sixth bullet under “Tools and Resources” to access the Publications Catalog. Once there, enter the Publications title and click the “All of these words” button. Once the publication appears, click the box to the left of it and then the Continue button.

You can order up to 500 PTFs at a time. If you would like several lots of 500 delivered to the same address, I’d recommend spacing out your orders, because otherwise the system interprets the subsequent orders as duplicate (mistaken) orders and only fulfills the first one. Please also note the delivery time frame.

The Guide:

Pathways to Freedom – The Guide

Research Tested Intervention Programs (RTIPs) Source: