Minority Status as a Determinant of Tobacco-Caused Health Inequalities: A Global Perspective

Brock, Malcolm

Minority Status as a Determinant of Tobacco-Caused Health Inequalities: A Global Perspective

Tuesday, 19 August 2014

Exhibit hall (Dena'ina Center)

Solange E Cox , The Johns Hopkins University School of Medicine, Baltimore, MD

Dan C Li , The Johns Hopkins University School of Medicine, Baltimore, MD

Alicia Hulbert , Johns Hopkins Sydney Kimmel Cancer Center, Baltimore, MD

Mario D Teran , The Johns Hopkins University School of Medicine, Baltimore, MD

Craig M Hooker , The Johns Hopkins University School of Medicine, Baltimore, MD

Ning Wang , Peking University Cancer Hospital, Beijing, China

Anjum Memon , Brighton and Sussex Medical School, Sussex, United Kingdom

Jonathan M Samet , University of Southern California Institute for Global Health, Los Angeles, CA

Anthony Alberg , Medical University of South Carolina, Charleston, SC

Malcolm Brock , The Johns Hopkins University School of Medicine, Baltimore, MD

INTRODUCTION: Tobacco is a leading global cause of premature morbidity and mortality producing worldwide health disparities. These disparities are often attributed to differences in tobacco use due to socioeconomic inequality, but in many countries, wealthier and more educated minorities inexplicably smoke more than the less fortunate majority. We hypothesized that the embodiment of high levels of perceived and/or experienced psychosocial distress as a member of a minority group drives increased tobacco smoking, and therefore increased risk of lung cancer.

METHODS: We collected age-adjusted lung cancer incidence rates and smoking prevalence for minority and majority groups from 32 countries, representing 60% of the world’s population; and estimated relative risk (RR) of lung cancer and smoking for minority versus majority groups.

RESULTS:

The minority versus majority RRs were in the direction of significantly increased risk in 80% of the comparisons for lung cancer incidence rates (p<0.0001; 90% for the largest minority group; 37% of the RRs were ≥1.5), and in 85% of the comparisons for smoking prevalence (p<0.0001; 93% for the largest minority group; 29% of the RRs were ≥1.5).This association was consistently observed whether minority status was defined by race/ethnicity, religion, language spoken, indigenous affiliation, immigrant status, or whether the minority population had lower or higher socioeconomic status than the majority.

CONCLUSIONS:

Minority status is a strong determinant of smoking prevalence and risk of lung cancer. This is a global phenomenon and not limited to minority status defined by race/ethnicity, but also generalizes to minority status defined by religious, linguistic or nativity criteria; and it is applicable regardless of the economic or educational status of the minority group. The vulnerability of minority groups to increased tobacco smoking warrants specifically targeted strategies to reduce smoking in these populations.