African American Communities Experience a Health Burden from Commercial Tobacco

Commercial tobacco* gets in the way of achieving health equity for African American people:

  • In 2020, 19.4% of non-Hispanic Black adults currently used any tobacco product.1
  • In 2021, an estimated 8.2% of non-Hispanic Black youth currently used any tobacco product, compared with 11.0% of non-Hispanic White youth.2 An estimated 3.1% of non-Hispanic Black youth currently used cigars, compared with 1.4% of non-Hispanic White youth.2
  • African American people usually start smoking at an older age than White people do but are more likely to die from smoking-related disease.3,4
  • About the same percent of African American adults and White adults smoke, but African American people smoke fewer cigarettes per day.3,4
heartbeat and cigarette

Despite starting to smoke cigarettes later in life, African American people are more likely than other racial and ethnic groups to have related health problems.

African American people are more likely to die from smoking-related diseases (e.g. heart disease, diabetes) than Hispanic people and Non-Hispanic, White people.3,4,5

More details on some of the reasons for these health disparities – and the public health measures that can improve health equity for African American people – are in this website section.

*“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes.
  1. Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep 2022;71:397–405 [accessed 2022 May 25].
  2. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1–29. [accessed 2022 May 24].
  3. U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General [PDF - 389KB]. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 1998 [accessed 2021 Jan 19].
  4. Schoenborn CA, Adams PF, Peregoy JA. Health Behaviors of Adults: United States, 2008–2010 [PDF - 3.2MB]. National Center for Health Statistics. Vital Health Stat 10(257) [accessed 2021 Jan 19].
  5. Robinson RG, Barry M, Bloch M, Glantz S, Jordan J, et al. Report of the Tobacco Policy Research Group on marketing and promotions targeted at African Americans, Latinos, and women. Tobacco Control, 1992 [PDF - 1.2MB];1(Suppl 1): S24-S30 [accessed 2021 Jan 19].
  6. Gardiner PS. The African Americanization of menthol cigarette use in the United States. Nicotine & Tobacco Research [PDF - 262KB]. 2004: V6(S1): S55–S65. [accessed 2021 Jan 19].
  7. Gately, Iain. Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization. New York: Grove Press, 2001.
  8. Edmund S. Morgan, American Slavery, American Freedom: The Ordeal of Colonial Virginia (New York: Norton, 1975), pp. 154–157.
  9. McCandless, P. M., Yerger, V. B., & Malone, R. E. (2012). Quid pro quo: Tobacco companies and the black press. AJPM, 2012;102(4):739-750 [accessed 2021 Jan 19].
  10. Prather C, Fuller TR, Jeffries WL 4th, et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity. 2018;2(1):249-259. [accessed 2021 Jan 19].
  11. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press, 2013 [accessed 2021 Jan 19].
  12. Institute of Medicine (US) Committee on the Consequences of Uninsurance. Care Without Coverage: Too Little, Too Late. Washington (DC): National Academies Press, 2002 [accessed 2021 Jan 19].
  13. Scharff, DP et al. More than Tuskegee: understanding mistrust about research participation. Journal of health care for the poor and underserved, 2010;21(3): 879-97 [accessed 2021 Jan 19].
  14. Armstrong K, Ravenell KL, McMurphy S, and Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Preventive Med 2007;97(7): 1283–1289 [accessed 2021 Jan 19].
  15. U.S. National Library of Medicine. Native Voices: Timeline: Government admits forced sterilization of Indian Women, 2011 [accessed 2021 Jan 19].
  16. Stern AM. Sterilized in the name of public health: race, immigration, and reproductive control in modern California. Am J Public Health 2005;95(7):1128-38 [accessed 2021 Jan 19].
  17. Novak NL, Lira N, O’Connor KE, Harlow SD, Kardia SLR, Stern AM. Disproportionate Sterilization of Latinos Under California’s Eugenic Sterilization Program, 1920-1945. Am J Public Health. 2018;108(5):611-613 [accessed 2021 Jan 19].
  18. Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Preventive Medicine 2005;41(2):511-20 [accessed 2021 Jan 19].
  19. Charlesworth A and Glantz S. Smoking in the movies increases adolescent smoking: A review. Pediatrics 2005;116(6): 1516-28 [accessed 2021 Jan 19].
  20. Counter Tobacco.Org. Disparities in Point-of-Sale Advertising and Retailer Density. [accessed 2021 Jan 19].
  21. U.S. Federal Trade Commission. Federal Trade Commission Cigarette Report for 2017 [PDF - 361KB]. 2019 [accessed 2021 Jan 19].
  22. Lee JG, Henriksen L, Rose SW, Moreland-Russell S, and Ribisl KM. A systematic review of neighborhood disparities in point-of-sale tobacco marketing. Am J Public Health, 2015;105(9): e8-e18 [accessed 2021 Jan 19].
  23. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention, 2012 [accessed 2021 Jan 19].
  24. Ganz O, Rose SW, Cantrell J. Swisher Sweets ‘Artist Project’: Using musical events to promote cigars. Tobacco Control 2018;27: e93-e95 [accessed 2021 Jan 19].
  25. Robertson L, McGee R, Marsh L, and Hoek J. "A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine & Tobacco Research 2015;17(1): 2-17 [accessed 2021 Jan 19].
  26. Ton HT, Smart AE, Aguilar BL, et al. Menthol enhances the desensitization of human alpha3beta4 nicotinic acetylcholine receptors. Mol Pharmacol 2015;88(2):256-64 [accessed 2021 Jan 19].
  27. Oliver AJ, Jensen JA, Vogel RI, Anderson AJ, and Hatsukami DK. Flavored and nonflavored smokeless tobacco products: Rate, pattern of use, and effects. Nicotine Tob Res 2013;15(1):88-92 [accessed 2021 Jan 19].
  28. Brown & Williamson. The growth of menthols 330000-770000. Macon, GA: Brown & Williamson Tobacco Corporation, 1978. [accessed 2021 Jan 19].
  29. Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004-2014. Tob Control. 2016;25:ii14-ii20. [accessed 2021 Jan 19].
  30. U.S. Food and Drug Administration. Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol Versus Nonmenthol Cigarettes. Rockville, MD [accessed 2021 Jan 19].
  31. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health, 2019. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. [accessed 2021 Jan 19].
  32. National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Smoking and Tobacco Control Monograph No. 19, NIH Pub. No. 07-6242, June 2008 [accessed 2021 Jan 19].
  33. Center for Public Health Systems Science. Point-of-Sale Strategies: A Tobacco Control Guide [PDF - 7.8MB]. St. Louis: Center for Public Health Systems Science, George Warren Brown School of Social Work at Washington University in St. Louis and the Tobacco Control Legal Consortium, 2014 [accessed 2021 Jan 19].
  34. Kong AY, Queen TL, Golden SD, Ribisl KM. Neighborhood Disparities in the Availability, Advertising, Promotion, and Youth Appeal of Little Cigars and Cigarillos, United States, 2015. Nicotine Tob Res. 2020 [accessed 2021 Jan 19].
  35. Henriksen L, Schleicher NC, Dauphinee AL, Fortmann SP. Targeted Advertising, Promotion, and Price for Menthol Cigarettes in California High School Neighborhoods. Nicotine Tob Res 2012;14(1): 116-121 [accessed 2021 Jan 19].
  36. Giovino GA, Villanti AC, Mowery PD et al. Differential Trends in Cigarette Smoking in the USA: Is Menthol Slowing Progress? Tobacco Control, 2015;24(1):28-37 [accessed 2021 Jan 19].
  37. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General [PDF - 9.8MB]. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2020 [accessed 2021 Jan 19].
  38. Levy DT, Pearson JL, Vilanti AC, Blackman K, Vallone DM, Niaura RS, Abrams DB. Modeling the Future Effects of a Menthol Ban on Smoking Prevalence and Smoking-Attributable Deaths in the United States. American Journal of Public Health, 2011;101: 1236-1240 [accessed 2021 Feb 17].
  39. Slopen N, Kontos EZ, Ryff CD, Ayanian JZ, Albert MA, Williams DR. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9-10 years: a prospective study of middle-aged adults in the United States. Cancer Causes Control 2013;24(10):1849-1863 [accessed 24 May 2022].
  40. Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife. Nicotine Tob Res. 2012;14(10):1161-1169 [accessed 2021 Jan 19].
  41. Pew Research Center, Race in America 2019 [PDF - 1.6MB]. [accessed 2021 Jan 19].
  42. Robert Wood Johnson Foundation, Harvard T.H. Chan School of Public Health, National Public Radio. Discrimination in America: Experiences and Views on Effects of Discrimination Across Major Population Groups in the United States, 2017 [accessed 2021 Jan 19].
  43. Bennett GG, Yaus Wolin K, Robinson EL, Fowler S, Edwards C. Perceived racial/ethnic harassment and tobacco use among African American young adults. Am J Public Health 2005;95(2): 238-240 [accessed 2021 Jan 19].
  44. Discrimination in America: Experiences and Views on Effects of Discrimination Across Major Population Groups in the United States [PDF - 1.1MB],” a 2017 poll developed by the Harvard T.H. Chan School of Public Health, Robert Wood Johnson Foundation and National Public Radio (NPR).
  45. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews 2010;35(1):2–16 [accessed 2022 May 25].
  46. Guyll M, Matthews KA, Bromberger JT. Discrimination and unfair treatment: Relationship to cardiovascular reactivity among African American and European American women. Health Psychology 2001;20(5):315 [accessed 2022 May 25].
  47. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2021 Jan 19].
  48. Centers for Disease Control and Prevention. STATE System Preemption Fact Sheet. [accessed 2021 Sept 23].
  49. U.S. Department of Census. Race and Ethnicity in the United States: 2010 Census and 2020 Census. [accessed 2021 Sept 23].
  50. Tsai J, Homa DM, Gretzke AS, et al. Exposure to Secondhand Smoke Among Nonsmokers — United States, 1988–2014. Morbidity and Mortality Weekly Report, 2018;67(48);1342–1346 [accessed 2021 Jan 19].
  51. Pizacani BA, Maher JE, Rohde K, Drach L, and Stark MJ. Implementation of a smoke-free policy in subsidized multiunit housing: effects on smoking cessation and secondhand smoke exposure. Nicotine Tob Res 2012;14(9): 1027-1034 [accessed 2021 Jan 19].
  52. Hafez, A. Y., Gonzalez, M., Kulik, M. C., Vijayaraghavan, M., & Glantz, S. A. (2019). Uneven access to smoke-free laws and policies and its effect on health equity in the United States: 2000–2019American journal of public health109(11), 1568-1575 [accessed 2021 Jan 19].
  53.  Gonzalez M, Sanders-Jackson A, Song AV, Cheng K, Glantz SA. Strong Smoke-Free Law Coverage in the United States by Race/Ethnicity: 2000–2009. American Journal of Public Health. 2013. 103, e62_e66 [accessed 2021 Feb 17].
  54. Babb S, Malarcher A, Schauer G, et al. Quitting Smoking Among Adults—United States, 2000–2015. MMWR Morb Mortal Wkly Rep 2017;65(52):1457–1464 [accessed 2022 May 25].
  55. Zhang L, Babb S, Schauer G, Asman K, Xu X, Malarcher A. Cessation behaviors and treatment use among U.S. smokers by insurance status, 2000-2015. Am J Prev Med 2019;57(4):478–486 [accessed 2022 May 25].
  56. Marshall LL, Zhang L, Malarcher AM, Mann NH, King BA, Alexander RL. Race/ethnic variations in quitline use among US adult tobacco users in 45 states, 2011–2013. Nicotine Tob Res 2017;19(12):1473–1481 [accessed 2022 May 25].
  57. DiGiulio A, Jump Z, Babb S, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018. MMWR Morb Mortal Wkly Rep 2020;69:155–160 [accessed 2021 Mar 8].
  58. A. Lebrun-Harris LA, Fiore MC, Tomoyasu N, and Ngo-Metzger Q. Cigarette Smoking, Desire to Quit, and Tobacco-Related Counseling Among Patients at Adult Health Centers. American Journal of Public Health 2015; 105 (1): 180-188 [accessed 2021 Jan 19].
  59. Flocke SA, Hoffman R, Eberth JM, Park H, Birkby G, Trapl E, et al. The Prevalence of Tobacco Use at Federally Qualified Health Centers in the United States, 2013. Prev Chronic Dis 2017; 14:160510.
  60. Webb Hooper M, Antoni MH, Okuyemi K, Dietz NA, and Resnicow K. Randomized controlled trial of group-based culturally specific cognitive behavioral therapy among African American smokers. Nicotine Tob Res 2017; 19(3): 333-341 [accessed 2021 Jan 19].
  61. Davis, K. C., Duke, J., Shafer, P., Patel, D., Rodes, R., & Beistle, D. Perceived effectiveness of antismoking ads and association with quit attempts among smokers: evidence from the Tips from Former Smokers campaign. Health Communication 2017; 32(8): 931-938. [accessed 2021 Jan 19].