Tobacco&Related&Health& Dispari3es& Disclosure& Smoking&Prevalence&2012& 12/8/15& Tobacco&use&and&Smoking&Prevalence&by& Racial/Ethnic&Group&

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1 12/8/15 TobaccoRelatedHealth Dispari3es PhillipS.Gardiner,Dr.P.H. PolicyandRegulatorySciencesProgramOfficer,TobaccoRelated DiseaseResearchProgram(TRDRP)UniversityofCalifornia OfficeofthePresidentandCoFChairAfricanAmerican TobaccoControlLeadershipCouncil UCSFBenioffChildren'sHospitalOakland September8,2015 Oakland,California Disclosure IhavenoFinancialInterestinanyTobaccoand orefcigareoecompanies IhavenoFinancialInterestinany PharmaceuPcalCompanies SmokingPrevalence2012 AfricanAmericans 18.1% Am.Indians/AlaskaNaPves 21.8% AsianAmericans 10.7% Hispanics 12.5% Whites 19.7% MulPracial 26.1% (MMWR,2014) TobaccouseandSmokingPrevalenceby Racial/EthnicGroup AmericanIndian/AlaskaNa3ve21.8% AlaskaNaPves 45.1% NorthernPlainsTribes 50% Men 49% Women 51% SouthwestTribes 14.5% Men 19% Women 10% MMWR,2014;RSG,1998;NezFHenderson,2005 SmokingPrevalencebyRacial/Ethnic Group Hispanic/La3no 12.5% CubanAmericans 27.7% PuertoRican 20.1% MexicanAmericans 17.3% Dominicans 13.0% Central/SouthAmericans 11.8% MMWR,2014;NaPonalCenterforHealthStaPsPcs(1997F2003) SmokingPrevalencebyRacial/Ethnic Group AsianandPacificIslanders11.3% Males Females Cambodian 24.6% 7.9% Chinese 15.3% 6.2% Filipino 23.7% 9.3% Japanese 13.2% 12.7% Korean35.9% 9.2% Vietnamese31.5%1.1% MMWR,2014;CaliforniaInterviewSurvey,2001 1

2 12/8/15 SmokingPrevalencebyRacial/Ethnic Group AfricanAmericans/Blacks18.1% Males Females Afr.Americans Barbadians Dominicans Hai3ans MMWR,2014;WorldBank,2002 UndercounPngAfricanAmericanSmoking RDDTSCommunity Afr.Am.Teens CigarUse8F13%a.,b.32F44%c. Afr.AmAdults SmokingRates22.4%a.38.9%d. a.cdc,2003;b.gilpinandpierce,2003;c.yerger,etal.,2001;d.dell,etal., 2005 AfricanAmericanSmoking: UndercountedbyaSignificantAmount RDDTS Blacks Whites 19% 13% CARABlacksWhites 33%19.5% (Landrineetal.,2013;TelephoneSurveys) AfricanAmericanSmoking:ABimodal Distribu3on? TheProblem:RDDTS,Householdsurveysand SchoolFbasedsurveysreflecttobaccouseof highersesafricanamericans Poorinnercityresidents(fewerlandlines,less stableandlackingtrust) HighincarceraPonrates LowandepisodicschoolaOendance CigarsandBlunts SurveysMissOtherTobaccoUse 49.3%ofBlackcigareOesmokersand 14.9%ofBlackcigareOenon\smokershad smokedatleastonenonfcigareoeproductin thepast30days Cigarillos Cigars Blunts (Landrineetal.,2013;Polytobaccouse) UniqueAfricanAmericanSmoking Characteris3cs 1.SmokeFewerCigareOesPerDay 2. TakeFewerPuffsPerCigareOe 3. SlowerCoPninemetabolism 4. SmokeHigherNicoPneCigareOes ComparedtootherRacial/Ethnic groups (1,Clark,etal.,1996;2,McCarthy,etal,1995;3and4Wagenknecht,etal., 1990;PerezFStable,etal.,1998;Benowitz,1998); 2

3 12/8/15 UniqueAfricanAmericanSmoking Characteris3cs 5. BeginSmokingLaterinLife 6. HighestRatesofMentholCigareOe Use (NSDUH,2004F2008;RSG,1998) RacialDifferencesCo3nineClearance, Half\Life,andNico3ne Black White CoPnine0.56ml(p=.009)0.68ml Half/Life1064min(p=.07)950min Nic/Cig 1.41mg(p=.02)1.09mg (PerezFStable,etal.,1998) Melanin\Melanin\Melanin CancerIncidenceRates*byRaceandEthnicity,2005F2009 Melaninisthesubstancethatgivescolorto ourskin NicoPneisstoredinPssuesthatcontain melanin Therefore,thedarkeryourskin,themore nicopneisstoredinyourbody. CancerDeathRates*byRaceandEthnicity,US,2005F2009 AgeAdjustedDeathRates per100,000(males,1992\1994)(rsg,1998) AA AIAN AAPI WHispanic OralCancer Esophagus LungCancer CHD CVD

4 12/8/15 AgeAdjustedIncidenceRates (AllsitesandLung)per100,000(FemalesandMales,ACS2007) AAAIANAAPIWhitesHispanic AllSites M F LungCancer M F AgeAdjustedMortalityRates (AllsitesandLung)per100,000(FemalesandMales,ACS2007) AAAIANAAPIWhitesHispanic AllSites M F LungCancer M F LungCancerTreatmentDispari3es EarlyFstage,nonFsmallFcelllungcancer.10,984 papents65yearsofageorolder,860wereafrican American,10,124wereWhite. Whites Afr.Am. Surgery76.7% 64.0% Survival34.1% 26.4% (NCI,2003) Heart Disease Age-Adjusted Death Rates per 100,000 Persons by Race Hispanic Origin: U.S., 2005 (CDC, 2007) Age-Adjusted Death Rate per 100,000 Persons All Races White African American American Indian/Alaska Native Asian/Pacific Islander Hispanic AfricanAmericanMentholUseSkyrockets TheAfricanAmericaniza3onof MentholCigareces 50YearsofPredatoryMarke3ng % % % 2006>80% Roper,B.W.(1953).AStudyofPeople scigareoesmokinghabitsandantudes VolumeI.PhilipMorris,BatesNo MSA,Inc.(1978)TheGrowthof Menthols,1933F1977.BrownWilliamson,BatesNo F785.NSDUH, 2004F

5 12/8/15 TobaccoIndustry sassaultontheafrican AmericanCommunity(1960s70s) 91%ofAdverPsingBudgetforTV(BW) UseofMaleActorswithmoreBlackfeatures TripledCigareOeAdverPsinginEbony Mentholsgotabrandnewbag CoolJazz;CoolLexicon Philanthropy (Gardiner,2004) 1970Ebonymagazineadver3sement 5

6 12/8/15 KOOL Cigarette Packs TheUl3mateCandyFlavoring;Menthol HelpsThePoisonGoDownEasier ChiefConsPtuentofPeppermintOil;MintyFCandyTaste;Masksthe HarshnessofSmoking CoolingSensa3on;acPvatestastebuds;coldreceptors;increases throatgrab Anesthe3ceffects;MimicsBronchialDilata3on IndependentSensoryAc3va3onNeurotransmicers IncreasesSalivaryFlow;TransbuccalDrugabsorp3on GreaterCellPermeability(Ferris,2004;Benowitz,2004) AlltobaccoProductsContainSome Menthol MentholcontentofU.S.tobaccoproducts Product Menthol(mg) Regular(nonFmenthol)cigareOes MentholcigareOes(weakeffect) MentholcigareOes(strongeffect) Pipetobacco 0.3 Chewingtobacco (Hopp,1993) Focusvs.NonFocusCommuni3es (Wright,2009)! FocusCommuniPes:InnerFcity,ColoredandPoor Lessexpensive,moredesirablepromoPons! Buy1,GetXFree! Summer/Holidays! NonFfocusCommuniPes:Upscale,suburban,ruraland white Moreexpensive,lessdesirablepromoPons! Buy2,GetXFree! Buy3,GetXFree! MentholCigareOesCheaper NonFfocusF50centsoff/pack($5.00off/ctn) FocusF$1.00F$1.50off/pack($10.00F15.00off/ctn) PredatoryMarkePngPaOerns(Henriksen, 2011) Asthe%AfricanAmericanstudentsincreased,proporPonmentholadsincreased: 6

7 12/8/15 MentholCigareces:Cheaperfor AfricanAmericans For each 10% increase in the proportion of African American students: Newportdiscount1.5Pmesgreater The proportion of menthol advertising increased by 5.9%, Newport promotion were 42% higher and The cost of Newport was 12 cents lower. (Henriksen, et al., 2011) StorefrontCigareceAdver3sing DiffersbyRacial/EthnicCommunity BrooklineDorchesterp"value( n=4256 %% Retailerw/Ads <0.001 SmallAds LargeAds MentholAds AveragePrice$4.94$4.55 (Seidenberg,etal.,2010) Brazentosaytheleast hcp://mentholchoice.com/index.html WhousesMentholCigareces? 1.1millionunderageadolescentssmoked mentholcigareoes 18.1millionadults 52.2%ofallmentholsmokersarewomen (NSDUH,2004F2008) PercentMentholCigareceUseamongPastMonth CigareceSmokersAged 18Years,byRace/Ethnicity: 2004\2008(NSDUH,2004\2008) AfrAmer Hawaiian MulPracial Hispanic Asian AIAN White Overall 7

8 12/8/ AreMentholatedCigarecesaStarter ProductforYouth? 2002NYTSHersey,2006 [PercentagesforyouthsmokingausualbrandofcigareOes.] 51.1 Middle School Less than a year High School More than a year LessExperienced smokersinmiddle schoolaremorelikely tosmokementhol(p= 0.002) ThesamepaOern existsforsmokersin highschool(butn.s.) PercentMentholCigareceUseamongPast MonthCigareceSmokersAged12\17Years, byrace/ethnicity:2004\2008(nsduh,2004\2008) Afr.Am. MulPracial Asian Hispanic NatHawaiian White AIAN Overall MentholatedCigarecesUseisHighestamongMinorityGroups 2002NYTS [PercentagesforyouthsmokingausualbrandofcigareOes.]Hersey, African American Hispanic Asian White Middle School High School PrevalenceofMentholSmoking AmongEverSmokers;HispanicOrigin (Delnevo,2011), ) ( ( ( ) ) ( ) ) ( HawaiiYouthTobaccoSurvey, 2000,2003and2009(HawaiiStateDepartmentofHealth,2009) CigareOe Prevalenc e Middle School High School Menthol Brand: Kools FilipinosandMenthol MentholcigareOesconsPtuted55%ofthe cigareoemarketin2007 MarlboroMentholLights;PhilipMorris Menthols CigareOesinthePhilippineswerefoundto contain8%morenicopneand76%moretar thanimportedbrands (EuromonitorCigareOeReport,2008) 8

9 12/8/15 ReasonstoBanMenthol Mentholcigarecesarestarterproductsfor Youth Mentholcigareceshavegreateraddic3on poten3algiventheiruniquesensory S3mula3onProper3es TheUl3mateCandyFlavoring:Ithelpsthe poisongodowneasier ReasonstoBanMenthol BogusHealthMessages;MassDisinforma3on Campaign(s) HealthieralternaPve;soothessorethroats Refreshing;AlivewithPleasure AfricanAmericansmokersthinkmentholsare healthierandsaferthanregularcigareoes (TiborKoevesAssocites,1968;Hymowitz,1995;Richter,2008;Unger, 2010) ReasonstoBanMenthol Cessa3onInhibitor;RelapsePromoter MentholCigareOesareHardertoQuitandeasier totakebackup(harrisetal,2004;pletcheretal,2006; Okuyemi2003,2004,2007;Gandhietal,2009) Notallstudies(Fuetal.,2008;Hylandetal.,2002;Murray, 2007) MentholHardertoQuit! QuitAOempts%Difference NonFMenthol 38.1% Menthol41.4%+8.8% CessaPon(>3mo.)%Difference NonFMenthol21.2% Menthol18.3%\13.8% (Levy,etal.,2011) ReasonstoBanMenthol:It sasocial Jus3ceIssue! PredatoryandRelentlessMarke3ngToward themostvulnerablepopula3ons AfricanAmericans NaPveHawaiians Filipinos Women Youth (Appleyardetal,2001;Gardiner,2004;SuOonandRobinson, 2004;Yerger,2007;Healton,2009) SocialJus3ceIssue ThedisproporPonatemarkePngandtargePng candyfflavoredpoisontoafricanamericans andotherspeciallyoppressedsectorsofour society,isoutfrightdiscriminatoryand genocidal. Poorest;leastinformed;fewestresources;indeed thedefiniponofpreyingonthemostvulnerable secponsofoursociety. 9

10 12/8/15 IfMentholWereBanned100,000sof Liveswouldbesaved AllMentholSmokersBlackMentholSmokers 10% 323,107 91,744 20% 478, ,465 30% 633,252 (Levy,etal.,2011) 237,317 FollowChicago slead! Enact500y.BarriersaroundallSchoolsto prohibitthesaleofflavoredtobaccoproducts includingmenthols: BalPmore,Minneapolis,andBeyond DeltaResoluPon/NaPonal,RegionalandLocal OrganizaPons HostMentholSunday s DistributeMentholFactSheets PassResoluPons ThankYou! TRDRP ResearchforaHealthierCalifornia phillip.gardiner@ucop.edu GrantFunding CunngEdgeResearch ScienPficConferences DisseminaPonofResearchFindings 10