State-Level Patterns and Trends in Cigarette Smoking Across Racial and Ethnic Groups in the United States, 2011-2018

Introduction Reducing racial/ethnic disparities in smoking is a priority for state tobacco control programs. We investigated disparities in cigarette use by race/ethnicity, as well as trends in cigarette use across racial/ethnic groups from 2011 to 2018 in 50 US states and the District of Columbia. Methods We used data from the Behavioral Risk Factor Surveillance System. In each state, smoking prevalence and corresponding 95% CIs were estimated for each racial/ethnic group in 2011, 2014, and 2018. We used logistic regression models to examine state specific linear and quadratic time trends in smoking prevalence from 2011 to 2018. Results Racial/ethnic disparities in smoking prevalence varied across states. From 2011 to 2018, compared with White adults, the odds of smoking were lower among Black adults in 14 states (odds ratio [OR] range, 0.58-0.91) and were higher in 9 states (OR range, 1.10-1.98); no differences were found in the odds of smoking in 13 states. Compared with White adults, the odds of smoking were lower among Hispanic adults in most states (OR range, 0.33-0.84) and were typically higher among Other adults (OR range, 1.19-2.44). Significant interactions between year and race/ethnicity were found in 4 states, indicating that time trends varied across racial/ethnic groups. In states with differential time trends, the decline in the odds of smoking was typically greater among Black, Hispanic, and Other adults compared with White adults. Conclusion Some progress in reducing racial/ethnic disparities in smoking has been made, but additional efforts are needed to eliminate racial/ ethnic disparities in smoking.

Automated summary

Racial/ethnic disparities in smoking prevalence varied across states in the US from 2011 to 2018, with lower odds of smoking among Black adults in some states and higher odds in others compared to White adults. Hispanic adults generally had lower odds of smoking, while Other adults had higher odds. Time trends in smoking prevalence varied across racial/ethnic groups, with declines typically greater among Black, Hispanic, and Other adults compared to White adults. Efforts are needed to eliminate racial/ethnic disparities in smoking.