By Robert G. Robinson, Dr. PH and Norma J. Goodwin, M.D., Founder and President, Health Power
Republished: February 2016 for Black History Month
The January 17, 2014 release of the 50th Anniversary of US Surgeon General Luther Terry’s landmark report, which linked smoking and ill health including lung cancer and heart disease, and 31 subsequent Surgeon General Reports have highlighted the destructive health and financial burdens caused by tobacco use.
It is now well documented that a wide variety of cancers and other illnesses, such as chronic obstructive pulmonary disease (COPD) – especially emphysema and chronic bronchitis- are associated with smoking. In fact, medical experts now agree that smoking is the leading cause of preventable death in the U.S. With the coordination of the Centers for Disease Control and Prevention (CDC), multiple activities will be highlighted throughout 2014 recognizing progress related to tobacco use in the past 50 years.
Focus on African Americans and Smoking for Black History Month
In keeping with Black History Month, Health Power for Minorities (Health Power), the Google ranked No. 1 source of health information for minorities, worldwide, has chosen to contribute to this historic anniversary year regarding ‘smoking and health’ by focusing on key tobacco related victories and special needs of African Americans.
More in-depth information regarding that in this blog post is contained in Health Power’s feature article for Black History Month, 2014 entitled: African Americans and Tobacco: Key Victories and Special Needs, beginning among “Site Highlights on the Home Page – www.healthpowerforminorities.com .
The expanded information relates to:
(a) Outstanding community action by African Americans and African American communities;
(b) Tobacco industry historical and continuing marketing of tobacco use by minorities;
(c) Marked African American preference for menthol cigarettes and possible contributing factors; and
(d) Special contribution of “Pathways to Freedom”, a 3-part guide to help African Americans quit smoking, with a detailed summary of each of its three components.
User-friendly and Community Competent Health Power Information and Tools
In addition to release of this article during the historic 50th Anniversary of the Surgeon General’s Report linking smoking and health, Health Power is sharing in this article the following tailored, or customized, user-friendly and community relevant smoking related information and tools for minorities/multicultural populations:
(a) Smoking and Health Section of the Health Power website
(b) 5 Quit Smoking and Win Tip Sheets, with links to each.
Special Tobacco Related Needs of Minorities: A Forward Agenda
In spite of the historic gains made by African Americans in the past 20 years, which are discussed below, African Americans continue to lead the nation in tobacco-related disease and death. What makes this a crisis is that tobacco is the greatest preventable cause of disease and death.
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).
Current Smoking Rates by Race or Ethnicity
Race or Ethnicity
Ages12-19 Years Old
Source: 50th Anniversary Surgeon General’s Report
Solutions to Avoiding the Disability and Early Death Associated With Smoking
- to not begin smoking, or
- to quit smoking, or
- not to smoke around other people, sparing them secondhand and third hand smoke.
- Avoiding the harms of smoking in the environment for non-smokers by creating smoke free environments and communities:
– Secondhand smoke is consuming the poisons in the air produced by tobacco smoke, and
– Third hand smoke results from the poisons that remain after the smoke has disappeared
Factors Contributing to Unacceptably High African American Smoking Levels
Situations that challenge successful African American attempts to quit smoking,compared to Whites, include:
- High stress levels experienced by many African Americans – and other racial and ethnic minorities – daily in association with experience daily, such as:
– High levels of unemployment and underemployment,
– Lack of health insurance or inadequate insurance, (The Affordable Care Act, or ‘Obamacare’ will help here)
– Police harassment, etc,
- Less access to quit smoking services, thus reinforcing addiction patterns,
- Receipt of less quit smoking advice from their physicians, also reinforcing addiction patterns,
- Constant targeted marketing by the tobacco industry INCLUDING use of menthol cigarettes, and
- excessive dependence on menthol cigarettes.
African Americans a Special Target of the Tobacco Industry
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 African American adults to continue smoking.
Industry dollars find their way into Black magazines, artistic programs, service organizations, scholarships, professional internships civil rights organizations, and almost any other major organization or event that serves the African American Community. In the course of these campaigns, the tobacco industry learned to exploit the African American preference for menthol cigarettes
Menthol Cigarettes for African Americans: A Special Tobacco Industry Target
The tobacco industry for years has focused on a particular type of cigarette smoker, using
- Menthol makes it easier for youth to begin smoking,
- It soothes the intake of smoke, and
- 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.
Supportive myths about menthol also circulate among some African Americans. For example, menthol is associated with medicinal products, and thus that makes menthol cigarettes healthier. Yet, this could not be further from the truth.
Key African American Victories against the Tobacco Industry
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 women that this Community victory was possible. And this victory has continued because in 2014 African Americans continue to smoke at lower levels than Whites, an accomplishment that should be leveraged in community competent smoking cessation intervention efforts.
What Made Key African American Victories 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 Tobacco Company,
- African Americans Reject X Cigarette,
- A tobacco control movement in response to advocacy from people of color that for the first time prioritized diversity,
- Support of national organizations like the National Medical Association, that partnered with CDC in a national communications campaign targeting African Americans called “Legends”
- Activities of the National Association of African Americans for Positive Imagery, funded by CDC, launched major counter marketing campaigns and facilitated involvement by other community organizations in tobacco prevention and control in the Black Community;
Multiple local programs in churches and community-based organizations who for the first time focused on helping people quit, and advancing tobacco control policies; and
“Pathways to Freedom” (PTF), a smoking cessation guide developed specifically for African Americans that was supported and disseminated by the American Cancer Society and the CDC. 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. Pathways to Freedom highlighted community competence, making it possible for Churches to reference prayer as a means to quit smoking. In addition, community organizations for the first time, had something tangible they could deliver to the participants in their programs. Engaging tobacco prevention and control was no longer a problem.
Historical 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.
– They moved from slavery to sharecropping and continued to grow tobacco as a means of survival; and tragically continue their indebtedness to White landowners.
– After slavery, they were recruited by the tobacco industry to work in their factories and also worked the least desirable jobs.
– They witnessed their people’s images used to mock them in the marketing of cigarettes before they were smoking customers, prior to WWII.
– They then saw the tobacco industry use Black middle class images in their advertising and also coop community leadership and organizations with donations, scholarships and other seductive prizes. It all resulted in adoption of cigarette smoking, decades of addiction, and the highest levels of tobacco-related disease and death in the nation.
– 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, should assume a central part of the analysis and reporting.
Current Challenges Facing the African American Community
– African American men continue to smoke at higher levels than White males. Targeted cessation efforts need to be promoted to specifically reach Black men.
– Comprehensive tobacco prevention and control strategies (from cessation to policy) are needed to ensure that African American progress will be maintained.
– Interventions need to be developed to reach African Americans in their homes to create smoke free environments. This is particularly important because Black youth under age 5, especially important for children in poverty because they are at greatest risk for second and third hand smoke in the environment. [Double space to next item]
– Sustained support for Pathways to Freedom, the state-of-the-art cessation guide for African Americans. Support by National and State agencies is lagging. For example, even though the Quitlines across the nation distribute generic materials to smokers calling for counseling, they do not distribute Pathways to Freedom. This is especially disturbing given the proven ability of PTF to help Black phone callers quit, when compared to the use of other materials. Finally, PTF’s focus on menthol makes the guide especially relevant to Black smokers wanting to quit.
– The FDA must move forward in its deliberations, and ban the use of menthol in tobacco products; similar to the current ban on tobacco product sweeteners that appeal to children. The tobacco control movement failed the Black Community when they conceded menthol to the tobacco industry and did not push for FDA regulation.
– The Nation has seen a decline in community-based advocacy and program initiatives due to:
– a decline in funding, and
– a focus by Federal and State agencies on policy initiatives rather than community-focused programming and development.
It is the latter that led to the successful disparity elimination by the African American Community. Failure to renew a commitment to community initiatives will harm all Communities of Color.
Pathways to Freedom (PTF): An Overview
A 3-part Guide with the following sections:
Section 1 of Pathways to Freedom – Addresses 7 Basic Facts on Smoking, and Tobacco Industry Targeting
Section 2 of Pathways to Freedom – 8 Tips for Smokers Who Want to Quit Smoking
Section 3 of Pathways to Freedom – What the African American 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.However, 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: Consisting of 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 Whites than Blacks. 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 [left justify this line]
(10) Share copies of Pathways to Freedom with friends, neighbors and family members.
History of Pathways to Freedom
Pathways to Freedom was first developed at the Fox Chase Cancer Center in Philadelphia, PA with a grant from the National Cancer Institute in 1989. It was the first tobacco cessation guide in the nation 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, a more in-depth treatment of pharmaceutical treatments, and attention to relapse prevention. 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.
Health Power’s Culturally Relevant Quit Smoking and Win Tip Sheets
o Tip Sheet 1: Planning for Quitting Smoking
o Tip Sheet 2: What’s in Cigarette Smoke
o Tip Sheet 3: Avoiding and Fighting Smoking Triggers
o Tip Sheet 4: Why Quit Smoking?
o Tip Sheet 5: How to Help Friends Quit Smoking
Special Needs for Minorities:
- Wide dissemination and promotion of user-friendly, community competent and authoritative information and tools on smoking prevention and cessation, as well as oral tobacco use, including digital, video and broadcast vehicles;
- Increased support of earmarked collaborative efforts among, and with, credible organizations committed to eliminating racial and ethnic tobacco use by federal, state and local governmental agencies, foundations and leading pertinent non-profit organizations such as the American Cancer Society, American Heart Association, and American Lung Association;
- Conduct of racial/ethnic public information and education programs related to:
- The strong link of African Americans to Smoking Menthol cigarettes – An issue needing explicit attention in comprehensive tobacco control strategies
- FDA policy action which eliminates any exceptions currently available for menthol containing tobacco products
- Much more community competent information on alternative approaches to quitting smoking, or smoking cessation, such as: gum, patch, quit-lines, etc.
4. A clear focus on comprehensive approaches and community development to ensure the application of best practices and the ongoing strengthening of community-based capacity and infrastructure and the enhancement of social capital.
How to Get Online Copies of Pathways to Freedom:
Go to the home page of the Office on Smoking and Health at (CDC) – at http://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.
Pathways to Freedom – The Guide
Research Tested Intervention Programs (RTIPs) Source:
About the Health Power Website and Blog
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Our website, at http://www.healthpowerforminorities.com provides user-friendly, culturally relevant, and authoritative information, messages and tools for minority health improvement.
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Key Closing Points:
1. Smoking increases the risk and/or possible complications of three of Health Power’s “Big 4 Targets for Minority Health”: Diabetes, Hypertension, and Heart Disease (the 4th is Obesity). More information about all 4 conditions is provided in the “Site Highlights” section of Health Power’s Home Page, entitled: “Live Longer & Live Well: Prevention and Control of “Our Big 4 Targets”.
2. Remember the Health Power Motto, or Tagline: Knowledge + Action =Power! ®