Racial convergence in cigarette use from adolescence to the mid-thirties.

Smoking among non-Hispanic whites and African Americans differs strikingly across ages. On one hand, African Americans smoke considerably less than whites during the teen years (Ellickson et al. 2004). According to the 2004 Monitoring the Future (MTF) survey (Johnston et al. 2005:633–634), 27.6 percent white, but only 10.7 percent of African American, high school seniors smoked–a 16.9 percentage point gap. This racial difference in teen smoking has widened considerably over the last several decades. In 1978, the prevalence of smoking among white and African American high school seniors equaled, respectively, 37.6 and 32.7 percent–a gap of 5.9 percentage points. Cigarette use has become one component of health behavior that gives African American teens a distinct advantage over white teens. On the other hand, adult African Americans smoke at rates similar to, or slightly higher than, those of adult whites. For example, figures computed from the 2005 National Health Interview Survey for persons ages 40–59 show current smoking of 23.8 percent among non-Hispanic whites and 25.9 percent among African Americans (National Center for Health Statistics 2007). The slightly higher figure for African Americans stems in part from the influence of socioeconomic status (SES). Over the past several decades, cigarette use has become concentrated among lower education, occupational prestige, and income groups (Barbeau, Krieger, and Soobader 2004; Honjo et al. 2006). Since the social and economic disadvantage of African Americans should raise their smoking prevalence, adjusting for education reduces the gap reported in the NHIS data to near zero (also see Kiefe et al. 2001). However, the near-identical smoking levels among adults still contrast markedly from the African American advantage among teens, a fact noted in the literature (Edelan, Tucker, and Ellickson 2007; Gardiner 2001; Geronimus, Neidert, and Bound 1993; Moon-Howard 2003; Trinidad et al. 2004). Less clear is how this racial convergence in smoking might have emerged. In general terms, the convergence involves changes in smoking that can be viewed from a life-course perspective (Bachman et al. 2002; Graham et al. 2006; Lynch, Kaplan, and Salonen 1997). Racial patterns of smoking reflect varying pathways or trajectories through early adolescence, young adulthood, and later adulthood. A life-course perspective suggests that these pathways reflect different social experiences during the transitions from adolescence to early and middle adulthood (Alwin and Wray 2005; Yu 2006). Describing better the trajectories in smoking seems crucial to understanding racial disparities in health. Given the well-known standing of cigarette use as the largest source of premature mortality in high-income nations (Department of Health and Human Services (DHHS) 2004), efforts to reduce smoking among African Americans can do much to improve their health and longevity and to counter racial disparities in mortality (Fagan et al. 2004; Lauderdale 2001). The NIH Strategic Plan to Reduce and Ultimately Eliminate Health Disparities (NIH 2000) thus gives prominent attention to tobacco use. Knowing more about the life-course pathways that eliminate a potential African American advantage in smoking can help identify key strategies for change (Kandel et al. 2004).