Screening for lung cancer may have a disparity between African Americans and whites due to differences in smoking habits. This study found lower rates of both smoking cessation and number of cigarettes smoked in African Americans.1

Although cigarette smoking has been widely studied in the United States, most studies have focused on how the habit affects the population as a whole. This study focused on smoking patterns among African Americans.

Researchers used data from the National Health Interview Surveys, conducted from 1965 to 2012, to pinpoint differences in tobacco-smoking habits between African Americans and white smokers. The researchers analyzed the changes in smoking behavior that occurred after the publication of the landmark US Surgeon General’s Report on Smoking and Health in 1964, which was the first federal report to link smoking with adverse health effects and spurred a nationwide effort to curb tobacco use.

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“Racial differences in smoking initiation, cessation, and intensity give rise to substantial differences in risk for tobacco-related diseases,” said first author Theodore Holford, PhD, the Susan Dwight Bliss Professor of Public Health (biostatistics) at the Yale School of Public Health and a member of Yale Cancer Center’s Cancer Prevention and Control Program, in New Haven, Connecticut. “Further research is needed to quantify these effects for specific diseases, but this study shows that commonly used measures may give rise to disparities in access to lifesaving interventions.”

African Americans were found to be less likely than whites to start smoking in their late teen years, which is when most smoking habits start, but they are also less likely than whites to quit as they get older. They also smoked fewer cigarettes per day.

These differences lead to important and rather contradictory differences in lifetime exposure. African Americans tend to continue smoking in their later years, which results in a longer average duration of exposure. Yet, the lower intensity of smoking leads to fewer average pack-years, calculated by multiplying the number of packs smoked per day by years of smoking. Pack-years are used to determine eligibility for lung cancer screening. Therefore, fewer African Americans are eligible for screening by this criterion, yet their risk of death from tobacco-related diseases is as high or higher than that of their white counterparts.

Holford explained that the results of this study will be useful in better understanding racial disparities in several tobacco-related diseases (eg, lung cancer, heart disease, chronic obstructive pulmonary disease).

The researchers stated that their results underscore the need to consider variations in smoking habits among racial groups in developing health care policy, in particular lung cancer screening eligibility. Current guidelines that make no distinction between subsets of the population may not be the most effective use of efforts to control death from tobacco-related diseases such as lung cancer.


1. Holford TR, Levy DT, Meza R. Comparison of smoking history patterns among African American and white cohorts in the United States born 1890 to 1990. Nicotine Tob Res 2016;18(suppl 1): S16-S29. doi:10.1093/ntr/ntv274.