Reductions in smoking uptake reflected across all racial/ethnic groups in California, US

Current tobacco control programs over the past two decades led to a decrease in overall cigarette use uptake in the United States and California, with reductions largely observed among non-Hispanic white adults, according to a new study.

Researchers analyzed the 1982-2019 Tobacco Use Supplements to the Current Population Survey to calculate cigarette use prevalence, mean number of daily cigarettes smoked and quit ratios over time to identify disparities across race/ethnic groups and to compare declines between California and the U.S.

“Previous studies have shown marked differences in smoking behaviors between California and the rest of the U.S., suggesting a positive impact of the state’s efforts on reducing prevalence, tobacco consumption and tobacco-related diseases. ... However, relatively few studies have specifically examined differences between California and the U.S. in reducing racial/ethnic disparities in smoking, and none have detailed trends over time in cigarette uptake, prevalence, consumption and quitting among race/ethnic minority groups in the U.S.,” Kari-Lyn K. Sakuma, PhD, MPH, assistant professor in the School of Social and Behavioral Health Sciences at the College of Public Health and Human Sciences at Oregon State University in Corvallis, Oregon, and colleagues wrote in Nicotine & Tobacco Research.

Among all racial/ethnic groups, current smoking prevalence decreased, with a significant decline in Californian non-Hispanic white populations compared with other U.S. counterparts. The prevalence of current smoking among non-Hispanic white adults aged 18 to 35 years in California declined from 21% in 1992-1993 to 11.9% in 2018-2019 (P < .0001) and in the U.S. overall declined from 22.5% to 15.8%, respectively (P < .0001). The researchers also reported declines over time among Black adults (California: 25.3% to 12%; U.S.: 24.7% to 14.8%; P < .0001 for both), Asian/Pacific Islander adults (California: 13.8% to 6.6%; U.S.: 14% to 8.1%; P < .0001 for both), American Indian/Alaska Native adults (California: 26.3% to 5.9%; P < .0001); U.S.: 39.5% to 29.3%; P = .0005) and Hispanic/Latino (California: 14.7% vs. 7.6%; P = .0001; U.S.: 21% to 9.2%; P < .0001).

“The measure of current smoking provides a more robust snapshot of the proportion of smokers across each time point. For all racial/ethnic groups in California and the U.S., we see significant declines in current smoking prevalence across the decades,” the researchers wrote.

Researchers observed a 30% decline in cigarettes smoked per day across all racial/ethnic groups, with Californian groups demonstrating lower numbers. The greatest decrease occurred among Black adults in California, from 10.3 cigarettes smoked per day in 1992-1993 to three in 2018-2019 (P < .0001).

There was an increase in quit ratios over time, from 52.4% in 1992-1993 to 59.3% in 2018-2019 for Californian Hispanic/Latino populations. Quit ratios also increased during the same time frame, from 61.5% to 63.8% among Californian non-white Hispanic populations (P = .08).

According to the researchers, efforts to disaggregate Asian, Native Hawaiian, Pacific Islander and Hispanic/Latino subpopulations in surveillance studies and prioritize tailored interventions may help further reduce consumption and support smoking cessation.

“American Indian/Alaskan Native and African American populations are potentially at the lowest levels of consumption, but future studies and investments are needed to transition these groups to successful cessation,” the researchers wrote. “Future efforts to increase cigarette cessation rates, particularly among race/ethnic minority groups, should continue to be a major priority for tobacco control.”