New research from the Yale School of Public Health reveals that differences in smoking habits between African-Americans and whites may lead to a disparity in necessary screening for lung cancer.
[Photo: Dr. Theodore Holford]
While cigarette smoking, the leading cause of preventable death in the United States, has been widely studied over the past decades, most studies have focused on how the habit affects the population as a whole. Attention to smoking patterns within specific racial and ethnic groups has been limited.
In a paper published in Nicotine & Tobacco Research, Dr. Theodore Holford, the Susan Dwight Bliss Professor of Public Health (Biostatistics), used data from the National Health Interview Surveys, conducted from 1965-2012, to pinpoint differences in tobacco-smoking habits between African-American and white smokers. The study analyzes the changes in smoking behavior that occurred after the publication of the landmark United States Surgeon General’s Report on Smoking and Health in 1964, which was the first federal report to link smoking with adverse health effects, and spurred a nationwide effort to curb tobacco use.
“Racial differences in smoking initiation, cessation and intensity give rise to substantial differences in risk for tobacco-related diseases,” said Dr. Holford. “Further research is needed to quantify these effects for specific diseases but this study shows that commonly used measures may give rise to disparities in access to life saving interventions.”
Dr. Holford found that while African-American are less likely than whites to start smoking in their late teen years—when most smoking habits start—they are also less likely than whites to quit as they get older. In addition, African-Americans who smoke report using fewer cigarettes per day.
These differences result in important and somewhat contradictory differences in lifetime exposure. Though white smokers tend to begin when they are younger, African-Americans tend to continue smoking into their later years, resulting in longer average duration of exposure when the effects of tobacco-related disease become more apparent.
Yet lower smoking intensity gives rise to African-Americans having fewer average pack-years (calculated by multiplying the number of packs smoked per day by years of smoking), which is a criterion used to determine eligibility for lung cancer screening. By this criterion, fewer at-risk African-Americans are eligible for screening. However, this is problematic because their risk of death from tobacco-related diseases is as high or higher than that of their white counterparts.
The results of Dr. Holford’s study will be useful in better understanding racial disparities in several tobacco-related diseases, which in addition to lung cancer include heart disease and chronic obstructive pulmonary disease.
The results also underline the need to consider variations in smoking habits among racial groups in developing health care policy, in particular lung cancer screening eligibility. Current guidelines that make no distinction among different subsets of the population may not be the most effective use of efforts to control death from tobacco related diseases like lung cancer, Dr. Holford said. Additional studies are needed to determine whether a sufficient number of African Americans are screened under current guidelines, or if changes are necessary to current policy.
Dr. Holford co-authored the paper with researchers from Cancer Control Department of Oncology at Georgetown University, and the Department of Epidemiology at the University of Michigan School of Public Health.