Smoking Cessation among Blacks R. Craig Stotts, Thomas J. Glynn, Claudia R. Baquet Journal of Health Care for the Poor and Underserved, Volume 2, Number 2, Fall 1991, pp. 307-319 (Article) Published by Johns Hopkins University Press DOI:

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Original paper


THOMAS J. GLYNN, Ph.D. CLAUDIA R. BAQUET, M.D., M.P.H. National Cancer Institute

National Institutes of Health Bethesda, Maryland 20892

Abstract: The burden of cancer on the U.S. black population has been compounded by a high prevalence of smoking among blacks. Lung cancer among blacks is a serious public health problem, with a mortality rate of 119 per 100,000 among black males compared to 81 per 100,000 for white males. Blacks, both male and female, have lower quit rates for smoking than does the general U.S. population. Why moreblacL· than whites continue tosmoke is not clear, but the National Cancer Institute has recently funded several research projects to facilitate smoking cessation among blacks. It appears from preliminary findings that smoking cessation efforts among blacks are most successful if they use broadcast media that reach black audiences, if they tailor their print materials to address the needs of black smokers, and if black community networL· are utilized.

Key words: BlacL·, ethnic, minority, smoking, smoking cessation, tobacco

Few causes of death and disease approach the magnitude of tobacco. What

was true at the time of the comprehensive Surgeon General's Report in 19791 is still true today: smoking is the number one preventable cause of death and disease in this country and is the most important public health issue of our time.2 The latest national data indicate that smoking caused 434,000 deaths in 1988, far more than the combined deaths from alcohol, illicit drug use, homicide, suicide, AIDS, and accidents.3

Black Americans have borne a disproportionate share of the burden

Journal of Health Care for the Poor and Underserved, Vol. 2, No. 2, Fall 1991


Smoking Cessation Among Blacks

inflicted by the tobacco pandemic. Blacks have had a higher smoking prevalence rate than whites for two time periods (1970-75 and 1976-80) in one study4, and for every year from 1974 tol985 in another study.5 The 1987National Health Interview Survey found that black males had the highest rate of smoking of all race/gender groups (39 percent, compared to white males' 30.5 percent, black females' 28.0 percent and white females' 26.7 percent).6 One of the results of this

high smoking rate is that blacks, compared to whites and other U.S. racial/ ethnic groups, have the highest incidence rate for all cancers combined and the highest overall cancer mortality rates.7 Specifically, for lung cancer in 1987, the annual age-adjusted incidence rate (per 100,000) for black males was 119 compared to 81 for white males; among women, the difference (30.5 for blacks and 28.2 for whites) was much smaller.7

Further, while cancer survival rates for whites have steadily improved

over the past decade, the rates for blacks have remained largely unchanged. Blacks and Native Americans have the lowest cancer survival rates among all

U.S. racial/ethnic groups.7 The quit rate (defined as the percentage of people who have ever smoked who are former smokers) for black men lags far behind that for white men (35.9 vs. 49.0, respectively). Black women's quit rates also trail those of white women (29.7 vs. 43.3).

The picture is not completely dismal. It appears that among black men, smoking prevalence and initiation are now decreasing at a faster rate than among white men, and their quit rate is increasing faster than among white men.5 Among black women, unfortunately, the rate of smoking prevalence and initiation is not declining so rapidly. A linear regression analysis found that

declines in prevalence rates were significantly different from zero in all race/sex groups except for black women. The declines in initiation rates were significant for white and black males, but were not significant for white or black females.5 If trends remain constant, prevalence rates for men and women will be about

equal in 1995, but after that a larger proportion of women will be smokers, and black women will become the racial/sex group with the largest proportion of smokers.8

Education has also been postulated as a predictor of smoking status in the year 2000. From 1974 to 1985, initiation of smoking decreased among young women with more education, while smoking initiation among those with less education increased to an all-time high. Pierce et al. believe that education is becoming more important than gender or race as a factor in smoking prevalence.9

Black smoking patterns are somewhat different from those in the general

U.S. population. Black children appear to lag behind white children in early experience and adoption of smoking behavior,1011 although this pattern may not be universal.12 The smoking habits of parents certainly appear to influence the smoking habits of their children; this may be especially true among blacks.13 In a nationally representative sample of high school seniors, Bachman et al. found a much lower prevalence of cigarette usage among blacks when

Stoffs, Glynn & Baquet


compared to every other ethnic group, except for Asian-Americans who had similar rates. The authors expressed concern about the validity of self-reports of drug use among adolescents, but after careful consideration of other studies, some specially designed to identify under- and over-reporting, they concluded that major differences do exist between black and white youth in use of drugs, including cigarettes. They determined, in accordance with other major national studies, thatblack youth have much lower usage rates than white youth, that the differences are smaller in early adulthood, and that by middle adulthood, drug

use rates are often higher among blacks.14 Although blacks smoke fewer cigarettes per day (Figure 1), they tend to smoke cigarettes that have higher tar yields (Figure 2). FIGURE 1 PERCENTAGE OF CURRENT SMOKERS, AGE 17+ WHO SMOKE VARYING NUMBER OF CIGARETTES, PER DAY BY RACE

Source: Reference 15.

Blacks also tend to favor menthol cigarettes. Seventy-five percent of blacks, but only 23 percent of whites, report using menthol brands.15 As Orleans et al. state, it is possible that the anesthetic effects of menthol additives enable

the smoker to tolerate deeper or more frequent inhalations. As a result, low-rate smokers may be receiving high levels of nicotine, thus becoming strongly addicted, with all of the accompanying health implications.16


Source: Reference 15.

Health education

Survey data suggest that, like the rest of the population, blacks are quite fearful of cancer. They tend to underestimate its incidence, however, and are both pessimistic about its cure and unaware of tests for early detection.17 It also appears that the overall level of knowledge about cancer tends to be lower among blacks than among whites, with myths and misconceptions about the disease being stronger among blacks. For example, Denniston reported that black women were far more likely than white women to believe that fondling or caressing the breasts can cause breast cancer.18 Even when controlling for education, sex, and age, blacks report significantly less knowledge about the relationship between race and cancer.19

Since smoking is the number one lifestyle change which can affect the high incidence of cancer and cancer deaths in blacks, black health care professionals have been viewed as potentially instrumental in encouraging and assisting black smokers to quit.20 Although physicians would have a natural role in this area, the problem of hypertension has occupied more of their time, leaving risk factors such as smoking often overlooked.20 Blacks more often than whites report that they would follow a physician's advice to reduce cancer risks, but blacks receive this type of advice less often.21

Stotts, Glynn & Baquet


A working group at a 1985 National Heart, Lung, and Blood Institute (NHLBI) workshop also stressed the importance of involving health professionals other than physicians. The working group recommended that nurses, health educators, and other health professionals would be effective at reaching smokers, but only if the professional were not a smoker. Unfortunately, the smoking rate of nurses and nursing personnel (LPNs and nursing assistants) are significantly higher than those of other health professionals and more closely resemble the rates of the general population.20 In this regard, nurses are more similar to women in the general population than male physicians and dentists are to their counterparts in the general population.2224 Smoking cessation

The rationale for attempting to quit smoking has never been more clear. The 1990 Surgeon General's Report indicated that people who quit smoking before age 50 have one-half the risk of dying in the next 15 years compared with continuing smokers. Other findings of the benefits of cessation were a significant reduction in the risk of lung cancer, coronary heart disease, stroke, chronic obstructive pulmonary disease, influenza, pneumonia, peripheral artery occlusive disease, abdominal aortic aneurysm, and stomach ulcers. Further, among persons with existing coronary heart disease, smoking cessation reduces the risk of recurrent heart attack and cardiovascular death, possibly by as much as 50 percent. The Report also describes the benefits of cessation for pregnant women and parents: the risk of a low-birthweight infant, abruptio placentae, and other unhealthy outcomes is significantly reduced if the mother quits smoking early in or before the pregnancy. After they are born, infants and children are less likely to develop respiratory infections or to have acute otitis media or persistent middle ear effusions if their parents do not smoke (but especially if the mother does not smoke).25

Several cross-sectional national studies since 1964 have given us a clear picture of the decline of smoking in the United States. In 1965,29.6 percent of persons who had ever smoked had quit; by 1987, this percentage had increased to 44.8, representing more than 38 million adults.25 From the Centers for Disease Control's (CDC) 1988 Behavioral RiskFactor

Surveillance System, which monitors 36 states and the District of Columbia, there appear both an age gradient and a gender gradient for quit rates. From the youngest age category of 18-34 to the oldest of 65+, the quit rate doubles. For men, the quit rate is 54.2; for women, 44.6.26 Sociodemographic factors play a significant role in smoking cessation; black smokers appear to be similar to other smokers in this regard. The most critical factors for becoming and remaining a smoker, according to several large studies, are lower educational level, unemployment, being male, unmarried, and poorer health status.6-2728 The motivations given by smokers for wanting to quit and for ex-smokers deciding to quit are also similar among blacks and the general population. The most important factors, in order, are: 1) to feel better

312______________Smoking Cessation Among Blacks physically now and to protect future health (health reasons), and 2) to have control over one's life.2829

Participants at the 1985 NHLBI workshop suggested that many blacks may not understand or know about the cycle of quitting, the effects of nicotine, the occurrence of relapse, and places to go for help.20 Another factor they believed should be considered is that there is a high degree of stress in the black community, and smoking is widely considered to be relaxing. In addition to these factors, cessation materials designed for blacks should emphasize reasons not to smoke (e.g., for the health of the family or because of the effects of passive smoking), the physical and emotional benefits of quitting, and social and economic reasons to quit.20 Gaining weight is a major concern of women smokers. Since obesity is a major health problem among black women, it must be taken into account when developing messages and strategies.20 For women with children, the message should also stress how their own smoking affects their children's health and the importance of a nonsmoking parental role model in affecting their children's future decisions regarding smoking.20 Orleans et al. found that, like the general population, black lower- to middle-income ex-smokers had quit on their own, with about 90 percent using will power and only about 10 percent usinga formal treatment program, books/

guides, or nicotine gum.28 It is interesting to note that this study also found that smokers who had tried to quit but were unsuccessful were much more likely than ex-smokers to have tried aids such as lozenges or filters and much less likely to have tried will power. One study found that although 80 percent of both blacks and whites would like to quit smoking, only 35 percent of blacks and 42 percent of whites planned to attempt quitting within the year.30 In this study, proportionally more black men reported that they planned to either reduce the number of cigarettes smoked per day, switch to a brand lower in tar or nicotine, or make no change. These differences were not seen between black women and white women.

In studies with pregnant women, Windsor et al. found that a self-help guide enabled 14 percent of the patients in a public health maternity clinic to quit

smoking.31 In summary, studies indicate that blacks have a disproportionately higher rate of smoking, a lower quit rate, a higher prevalence of myths and misconceptions about smoking and cancer, and a higher incidence of smokinginduced disease and death. NCI-funded initiatives for black smokers

These data clearly suggest the need for a more aggressive approach to reducing the toll of tobacco-induced death and disease among blacks. Before 1984, efforts in thisarea were scattered and uncoordinated. In the spring of 1984, the National Cancer Institute (NCI) convened a meeting of 20 leading researchers in the field of smoking among blacks. Their advice to the NCI resulted in a

Stoffs, Glynn & Baquet


Joint Health Venture, part of NCI's overall goal to reduce the 1980 cancer death rate by one-half by the year 2000.32 This group helped to design the requests for proposals that have made the reduction of tobacco use by blacks a major priority at the NCI. The primary means by which the NCI, as a research organization, is addressing this priority is through support of intervention research trials to reduce smoking among blacks. Table 1 briefly describes the most recent NCI-supported research projects which are focused exclusively on smoking cessation or prevention strategies for black smokers.






"Primary Prevention (Smoking) of Cancer in Black Populations"


Botvin, Gilbert, Ph.D.

Cornell University Medical College

DESCRIPTION A pilot-tested intervention was used to prevent the use of tobacco by predominantly black junior high school students in northern New Jersey." Minor modifications are currently being implemented.

411 East 69th, Rm KB 201 New York, NY 10021

"Primary Prevention (Smoking) of Cancer in Black Populations" Darity, William, Ph.D. University of Massachusetts at


This study is developing intervention strategies to raise black smokers' level of readiness to quit, increase opportunities to stop, and provide a supportive environment in which to practice and maintain nonsmoking behavior. Different strategies are being


Amherst, MA 01003

tested for middle-income and lower-income communities.

"Primary Prevention (Smoking) of Cancer in Black Populations" Jones, Regnal, Ph.D. Illinois Institute of Technology Chicago, IL 60616


The primary goal of this project is to reduce smoking among black Head Start mothers in the Chicago public school system. A baseline study was conducted to

determine the population's knowledge, attitudes, and beliefs about smoking, and degree of motivation to stop smoking. The intervention will be transportable to many sites and will be delivered by students from the Chicago Area Health and Medical Careers Program.

"Black Physidans and Smoking Intervention Strategies" King, Gary, Ph.D. University of Connecticut Health Center

263 Farmington Ave. Farmington, CT 06030


In a national survey, black physidans were asked about their professional and demo-

graphic characteristics, the prevalence of smokers among their patients, interventions they use for counseling smoking patients, and their opinions about how to improve interventions.

Smoking Cessation Among Blacks



"Cancer Prevention Strategies Among Urban Black Women"


Manfredi, Clara, Ph.D. Division of Cancer Control

the most effective methods for helping

Illinois Cancer Council

urban black women of low sodoeconomic

36 South Wabash Ave., Suite 700 Chicago, IL 60606-2985 "Primary Prevention of Cancer in Black Populations"

This study is using varying combinations of televised smoking cessation programs, self-help manuals, and dasses to determine status to quit smoking and to use cancerpreventive diets.


This study involves the implementation and evaluation of a brief (three- to five-

Niden, Albert M.D.

minute) smoking intervention by clinic physicians in a black inner-dty population. Physidans will receive training in the use

King/Drew Medical Center 12021 South Wilmington Los Angeles, CA 90059

of simple motivational materials; clinic settings will provide environments condudve to smoking cessation. Control groups will receive the usual care.

"Community Intervention for


Cancer Prevention"

A self-help smoking cessation guide and video, both tailored to blacks, are being developed for, administered to, and evaluated with four divergent groups: Prince Hall Shriners and Daughters of Isis, two predominantly black social organizations; congregants of multidenominational black churches; tenant organization members; and policyholders of the North Carolina Mutual Life Insurance Company, the nation's largest black-owned insurance

Robinson, Robert, Dr.P.H. Fox Chase Cancer Center 7701 Burholme Ave.

Philadelphia, PA 19111

company. The use of these groups for cancer prevention education is also being analyzed. "A Self-Help Quit Smoking Program for Black Americans"


A new self-help manual designed for blacks was tested on black life-insurance

Schoenbach, Victor, Ph.D. &

policyholders. The manuals were distrib-

Orleans, C Tracy, Ph.D. Dept. of Epidemiology University of Norm CarolinaChapel Hill Chapel Hill, NC 27599

uted by life insurance agents who were

"Community Mobilization for Smoking Cessation" Syme, S. Leonard, Ph.D. & Hunkeler, Enid, MA

Kaiser Family Research Institute Division of Research 3451 Piedmont Ave.

Oakland, CA 94611-5463

trained to promote participation; a professional counselor was available through a toll-free number.


A community-wide campaign was initiated

in a largely black community, Richmond, CA. Activities induded participating in

community events, staging mass media campaigns, supporting the making of community-produced music videos with antismoking messages, and implementing new anti-smoking school curricula.

Stoffs, Glynn & Baquet


The findings from these initiatives are just emerging. Once all the data have been analyzed, the NCI will call upon its National Black Leadership Initiative Executive Committee to assist with the dissemination and adoption of these findings and to advise the NCI on what additional studies should be undertaken. The NCI will also work with the CDC's Office on Smoking and Health to assist communities that are interested in using the materials developed in these projects. In addition to the above initiatives, which involve more than one-half

million black Americans, the NCI is supporting many other studies in which black smokers are included33 and, in particular, two major trials involving very large black populations. The first is the Community Intervention Trial for Smoking Cessation (COMMIT), aimed at heavy smokers and funded at $10 million per year for five years (1988-1993). The second is the American Stop Smoking Intervention Trial for Cancer Prevention (ASSIST), scheduled to begin in 1991 and end in 1998. ASSIST will build upon the results of COMMIT and, in conjunction with the American Cancer Society, will fund the formation of coalitions designed to make up to 20 states smoke-free by the year 2000.34 Resources for black smokers

Few studies have been conducted to evaluate the availability and effectiveness of smoking cessation programs for blacks. Nevertheless, several categories of cessation resources appear to be helpful for black smokers. Non-print media. Several studies have shown a greater reliance by blacks on non-print media and on community networks for receiving smoking information and cessation support. For example, two studies found that blacks were more likely than whites to have learned about cancer prevention materials through broadcast media and less likely through printed sources.21-35 Another study found television to be an effective medium for delivering a smoking cessation intervention. This study evaluated the effects of a program that was broadcast twice daily during the news for 20 days. Study participants received self-help manuals, the televised broadcast, weekly support meetings, and supportive phone calls. At the four-month follow-up, 20 percent of the treatment group and nine percent of controls were abstinent. This study occurred in an impoverished, predominantly black area of inner Chicago.36 Community networks. Another study examined the value of community networks in smoking cessation efforts. This project, conducted in Buffalo, New York, among a primarily black population, delivered cancer education programs through a network where community health guides, community volunteers, and mass media were the vehicles for educating neighborhood residents. The authors found that networking was a major strategy for improving access to cancer education programs and was useful for recruiting participants to attend training sessions. In addition, the programs had an impact on


Smoking Cessation Among Blacks

participants' cancer-related knowledge and health practices about breast and lung cancer, but demonstrated a lesser impact on cancer-related beliefs. A majority of subjects either quit or reduced their smoking after the intervention.37 Other researchers have emphasized the importance of community networks as well. CardwelFand Robinson38 found thatblackscanbe reached with

cancer information through local community organizations, doctors, the black media, and schools. An expert panel convened by the NHLBI agreed that indigenous leaders such as ministers, barbers and beauticians, and community groups such as churches, fraternities, and sororities are important channels for reaching the black population.20 Specifically, the panel recommended that NHLBI develop guidelines and steps for initiating and carrying out a community anti-smoking campaign, including media kits for minority radio stations and newspapers. Self-help. Self-help guides are often helpful, even for those ex-smokers

who have stated that they quit by using will power. NCI convened an expert panel in 1988 to address the question, "What are the essential elements of selfhelp/minimal intervention smoking cessation programs?"34 Among the recommendations emanating from this meeting, the panel suggested that existing self-help/minimal interventions should be tailored to the needs of special populations—e.g., women, minorities, heavy smokers, people of low socioeconomic status—in order to enhance their adoption by these groups and subsequently to enhance quit rates.34·39 Resources available in most communities include voluntary health asso-

ciations and a toll-free telephone number ( 1 -800-4-C ANCER) for information on smoking cessation. A list of national resources is included in the Appendix. These resources are just a beginning; more materials targeting the black community need to be developed. These materials need to be more accessible and incorporated into a community-wide network intervention. Recommendations for research

The tobacco pandemic involves vast numbers of people. Yet few social phenomena of this magnitude are so poorly understood.34 The NHLBI expert panel concluded that little is known about the knowledge, beliefs, and attitudes regarding smoking by blacks.20 This working group also agreed that research is needed to identify appropriate intervention strategies. Since 1985, when the report was issued, NCI and other agencies have initiated several research projects to identify these interventions. Over the next few years, when the results of these studies are published, we hope to have a better grasp of how to motivate the black smoker to quit, how to support and enhance quitting efforts, and how to prevent recidivism. The challenge at that time, for both researchers and those involved in health care delivery systems, will be to develop systematic

mechanisms for the orderly dissemination and adoption of cessation methods that work for black smokers.


Voluntary Health Associations

Minority Outreach Initiative American Lung Assodation

Director, Spedal Group Relations Cancer in the Sodoeconomically Disadvan-

1740 Broadway New York, NY 10019-4374

taged Initiative American Cancer Sodety

Phone: (212) 315-8700

National Office 1599 Clifton Rd, NE Atlanta, GA 30329 Phone: 1-800-ACS-2345

American Heart Assodation 7320 Greenville Ave. Dallas, TX 75231 Phone: (214) 822-9380

Government Agendes Public Inquiries Section

Cancer Information Service

Office of Cancer Communications National Cancer Institute

National Cancer Institute National Institutes of Health

National Institutes of Health

Phone (Continental U.S.): 1-800-4-CANCER

Phone: 1-800-422-6237

Alaska only: 1-800-638-6070 Hawaii only: 1-800-524-1234

Information Spedalist (Minority Spedalist) NHLBI Smoking Education Program Information Center

Phone: (301) 951-3260 (health proferssionals only) REFERENCES 1. Smoking and health: A report of the Surgeon General. Washington, DC: U.S. Dept. of Health, Education, and Welfare, 1979. (DHEW publication no. (PHS) 79-50066.)

2. Office on Smoking and Health. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. Washington, DC: U.S. Dept. of Health and Human Services, 1989. (DHHS publication no. (CDQ 89-8411.) 3. Schultz JM. Smoking-attributable mortality and years of potential life lost-United States, 1988. MMWR 1991 Feb l;40(4):62-3,69-71

4. Covey LS, Mushinski MH, Wynder EL. Smoking habits in a hospitalized population: 19701980. Am J Public Health 1983 Nov;73(ll):1293-7. 5. Fiore MC, Novotny TE, Pierce JP, et al. Trends in dgarette smoking in the United States: The changing influence of gender and race. JAMA 1989 Jan 6;261(l):49-55. 6. SchoenbornCA,BoydG. Smokingandothertobaccouse:UnitedStates,1987. National Center

for Health Statistics. Vital Health Stat 1989,10(169). (DHHS publication no. (PHS) 89-1597.)

7. Baquet CR, Ringen K, Pollack ES, et al. Cancer among blacks and other minorities: Statistical profiles. Bethesda, MD: National Cancer Institute, 1986. (NIH publication no. 86-2785.) 8. Pierce JP, Fiore MC, Novotny TE, et al. Trends in dgarette smoking in the United States: Projections to the year 2000. JAMA 1989 Jan 6;261(l):61-5. 9. Pierce JP, Fiore MC, Novotny TE, et al. Trends in dgarette smoking in the United States: Educational differences are increasing. JAMA 1989 Jan 6;261(l):56-60. 10. Hunter SM, Webber LS, Berenson GS. Cigarette smoking and tobacco usage behavior in children and adolescents: Bogalusa Heart Study. Prev Med 1980 Nov,-9(6):701-12. 11. Botvin GJ, Batson HW, Witts-Vitale S, et al. A psychosocial approach to smoking prevention


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for urban black youth. Public Health Rep 1989 Nov-Dec;104(6):573-82. 12. Sussman S, Dent CW, Flay BR, et al. Psychosocial predktors of dgarette smoking onset by white, black, Hispanic, and Asian adolescents in Southern California. MMWR 1987 Jul 3;36(4S):11S-16S.

13. Correa P, Johnson, WD. Cancer and lifestyle in Louisiana. J La State Med Soc 1983 Mar;135(3):4-6.

14. Bachman J, Wallace JW, O'Malley PM, et al. Radal/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-1989. Am J Public Health 1991 Mar;81(3):372-7.

15. Office on Smoking and Health. Adult use of tobacco, 1986. Washington, DC: U.S. Department of Health and Human Services, 1990. (DHHS publication no. (OM) 90-2004.) 16. Orleans CT, Strecher VJ, Schoenbach VJ, et al. Smoking cessation initiatives for black Americans: Recommendations for research and intervention. Health Ed Res 1989 Jan;4(l):1325.

17. Cardwell JJ, Collier WV. Radal differences in cancer awareness: What black Americans know and need to know about cancer. Urban Health 1981 Od;10(8):29-32.

18. Denniston RW. Cancer knowledge, attitudes, and practices among black Americans. In: Mettlin C, Murphy G, eds. Cancer among black populations. New York: Alan R. Liss, 1981. 19. Michielutte R, Diseker RA. Radal differences in knowledge of cancer: A pilot study. Soc Sd Med 1982 Jun;16(3);245-52.

20. NHLBI Smoking Education Program, Office of Prevention, Education, and Control, National Heart, Lung, and Blood Institute. Strategy devdopment workshop for minorities: Summary report. Bethesda, MD: U.S. Dept. of Health and Human Services, 1985. 21. National Cancer Institute. Cancer prevention awareness survey wave II: Management summary. Washington, DC: U.S. Department of Health and Human Services, 1987. (DHHS publication no. 87-2908.) 22. Center for Disease Control. Survey of health professionals: Smoking and health, 1975. Washington, DC: U.S. Government Printing Office, 1976. 23. Garfinkel L, Stellman SD. Qgarette smoking among physidans, dentists, and nurses. CA1986 Jan-Feb;36(l):2-8.

24. Harvey A. Smoking behavior among partidpants in the Nurses' Health Study. Paper

presented at the Fifth World Conference on Smoking Winnipeg Canada, 1983. 25. Office on Smoking and Health. The health benefits of smoking cessation. Washington, DC: U.S. Department of Health and Human Services, 1990. ( DHHS publication no. (CDC) 908416.) 26. Anda RF, Waller MN, Wooten KG, et al. Behavioral risk factor surveillance, 1988. MMWR CDC Surveill Summ 1990 Jun;39(2):l-21.

27. Novotny TE, Warner KE, Kendrick JS, et al. Smoking by blacks and whites: Sodoeconomic and demographic differences. Am J Public Health 1988 Sep;78(9):l 187-9. 28. Orleans CT, Schoenbach VJ, Salmon MA, et al. A survey of smoking and quitting patterns among black Americans. Am J Pub Health 1989 Feb;79(2):176-81. 29. Eisinger RA. Psychosodal predictors of smoking behavior change. Soc Sd Med 1972 Feb;6(l):137-44.

30. Hahn LP, Folsom AR, Sprafka JM, et al. Cigarette smoking and cessation behaviors among urban blacks and whites. Public Health Rep 1990 May-Jun;105(3):290-5. 31. Windsor RA, Cutter G, Morris J, et al. The effectiveness of smoking cessation methods for smokers in public health maternity clinics: A randomized trial. Am J Public Health 1985 Dec;75(12):1389-92.

32. DeVitaVT. Cancer prevention awareness program: Targeting black Americans. Public Health Rep 1985 May-Jun;100(3):253-4. 33. National Cancer Institute. Smoking, tobacco, and cancer program: 1985-1989 status report. Bethesda, MD: U.S. Dept. of Health and Human Services, 1990. (NIH publication no. 90-3107.) 34. Glynn TJ, Boyd GM, Gruman JC. Essential elements of self-hdp/minimal intervention strategies for smoking cessation. Health Ed Q1990 Fall;17(3):329-45. 35. Parker DF, Enterline JP, White JE. Differences between black and white responses to Cancer Information Service promotion mechanisms. In: Issues in cancer screening and communica-

Stoffs, Glynn & Baquet____________________319 tion. New York: Alan R. Liss, 1982.

36. Jason LA, Tait E, Goodman D, et al. Effects of a televised smoking cessation intervention among low-income and minority smokers. Am J Community Psychol 1988 Dec;16(6);863-76. 37.

Roberson NL. A cancer control intervention for black Americans in Buffalo, New York.

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38. Robinson R. Tobacco and health: Strategies for black communities. In: Proceedings of The Pennsylvania Consensus Conference on Tobacco and Health Priorities. Harrisburg: Pennsylvania Department of Health, 1986. 39. Glynn TJ, Boyd GM, Gruman JC. Self-guided strategies for smoking cessation: A program planner's guide. Bethesda, MD: Smoking and Tobacco Control Program, National Cancer Institute, U.S. Dept. Health and Human Services, 1990.

Smoking cessation among blacks.

The burden of cancer on the U.S. black population has been compounded by a high prevalence of smoking among blacks. Lung cancer among blacks is a seri...
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