"Even as antismoking campaigns have sharply reduced tobacco use in society at large, smoking has remained far more common among the poor of all races."
October 20, 2007
Baltimore Journal (in the NY Times)
The Smoking Scourge Among Urban Blacks
By ERIK ECKHOLM (excerpts)
BALTIMORE, Oct. 15 — Outside subways stops and bars in parts of this blighted city, slouching hustlers mutter “loosies, loosies” to passers-by, offering quick transactions, 50 cents a stick or three for a dollar.
Their illegal, if rarely prosecuted vocation: selling loose Newport cigarettes to those who do not have $4.50 to buy a pack.
In small corner markets, customers sometimes use code words like “bubble gum” or “napkins” to receive individual cigarettes wrapped in a napkin. Or they buy a flavored Black and Mild, the latest smoking craze here, from an opened five-pack.
Out-of-package sales are common in the poor areas of many cities, an adaptation to meager, erratic incomes and rising cigarette taxes. But researchers say they are just one facet of a high smoking rate among low-income urban blacks.
Even as antismoking campaigns have sharply reduced tobacco use in society at large, smoking has remained far more common among the poor of all races.
Still, officials here said they were surprised when a recent study suggested that more than half of poor, black young adults smoke cigarettes — almost always menthol, almost always Newports.
In the latest twist, the study also found that nearly one in four of them also smoke candy-flavored cigarillos, often inhaling despite the danger posed by higher tar and nicotine levels.
Alarmed by the findings, the city’s health commissioner, Dr. Joshua Sharfstein, on Monday convened health experts, community leaders and high school students to discuss the spreading use of Black and Milds, plastic-tipped cigarillos that come in flavors like wine, cream and apple and are often seen in hip-hop videos and the HBO series “The Wire,” which is set in Baltimore.
Amid violence and drug problems, smoking may seem a comparatively harmless vice. “But if you take a step back,” Dr. Sharfstein said, “it’s the smoking that will end up killing a lot of these kids, maybe not next week but well ahead of their time.”
In a stepped-up antismoking campaign, Baltimore officials are offering free nicotine patches or gum and are considering stronger measures to control sales of loosies, which are easily available to youngsters.
“The whole issue here is that the social norms haven’t changed the way they have in most of society,” said Frances Stillman of the Johns Hopkins School of Public Health, co-author of the study of smoking habits among Baltimore’s poor, which was published in August in the American Journal of Public Health. “Everybody smokes, and everybody thinks it’s O.K.”
In this latest study, researchers interviewed 160 blacks ages 18 to 24 who were enrolled in job training. In the group, 60 percent smoked cigarettes and 24 percent had recently smoked cigarillos.
A survey of 1,021 low-income blacks in Detroit, published in 2005 in the American Journal of Preventive Medicine, found that 59 percent of men and 41 percent of women smoked, a finding that “shocked everybody,” said the chief author, Jorge Delva of the University of Michigan School of Social Work.
It has long been known that smoking rates are higher among the poor and least educated of all races, but Mr. Delva and other experts said the rates recently found among inner city blacks were surprisingly high, possibly indicating that they were undercounted in broad standard surveys.
For a mix of cultural reasons as well as targeted marketing, menthol cigarettes are particularly favored by blacks: 75 percent of blacks nationwide smoke them, compared with less than 30 percent of whites.
In recent years, the promotion budgets of major cigarette companies have been disproportionately devoted to menthols, said Gregory N. Connolly, director of tobacco control research at the Harvard School of Public Health. “It appears the industry is targeting the most vulnerable groups through advertising and manipulation of menthol levels,” Mr. Connolly said.
A resident of the Montebello alleys, Antonio Stokes, 39, who was vague about how he made money, agreed. Of the Newport he bummed off a friend the other evening, he said: “It’s worse than crack. They should have a detox center for these things, too.”
Comment - one of the effects of menthol is to anesthetize the throat and lungs so they don't report the pain from the damage the smoke is doing. In many case the impact of "low nicotine" cigarettes is that the users smoke more of them, trying to get the same impact, and draw the smoke deeper into their lungs and hold it in longer. Biomedically, they tend to have their lung cancers deeper in their lungs
than those who don't smoke "light" and "safer" cigarettes.
But, whatever else it is, there is a perception problem here. The benefits of the cigarette in terms of a short-lived spiked high are immediate, and the costs are distant and out of sight, out of mind.
Individual humans, who don't have some way to learn from each other in larger organized groups, are about equivalent to parakeets in their inability to relate the actions and the results, in another place and time.
And, individual humans who don't tap into such groups might as well not have them. They will simply repeat one more time the mistakes that millions of others have made and are making, and not learn anything from each other, and never improve.
Perception, social connections, and enough humility to realize there are truths that are not "obvious" in the short-run -- these are the keys to getting out of this mess.
"Inability to listen" is not limited to certain groups, such as "people in authority." In fact, demolishing all authority destroys the ability to learn.
This is tangled by having two meanings of the same word "authority" - one is having a solid basis for conclusions, and the other is "being the one who gives the orders." In trying to rebel against the second, people tend to also toss out the first.
That doesn't make sense. Somewhere, someone knows stuff way better than you. That's a fact of life. It should be the first lesson in school in every grade - not to make people feel bad, but to try to make people willing to get together and pool wisdom before they go off and make dumb decisions that everyone (or anyone) could have told them not to make.
In downtown Baltimore or Detroit, the problem is worse, in that "everyone" in the vicinity believes the same mistaken thing. Studies and billboard counts show that Tobacco and Alcohol advertising and billboards are concentrated in urban poor areas, and it's hard to believe those companies don't know where their own signs are located and why.
I took Dr. Stillman's course in Tobacco Control at Johns Hopkins last year and it was truly eye-opening. Example" One tobacco company tried to open the market in an Eastern European country by pointing out that cigarettes tended to kill people early, so the country could save money on not having to cover retirement benefits for all those people. They had to back off when this was published in the newspaper.
Smoking will kill 5 million people a year, every year. (source: Harvard).The world-trade center attack killed 3 thousand people, once.
Guess which one we've spent more time and money trying to prevent.
See Should the FDA Regulate Tobacco,
Kennedy will ask FDA to regulate smoking,
Short YouTube hysterical videos on smoking - (don't be drinking a soda while viewing these!)
Jay Leno on Saddam Hussein and the tobacco industry
Zyban - bad day (office monitor)
And remember to wash your hands!
How I learned to stop smoking (on the porch)
When that guy across from you asks "Do you mind if I smoke?"
Oh, you don't always die from tobacco (song )
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resource:
World Health Organization webpage on the toll of smoking worldwide.
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