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Data on tobacco use among California (CA) Black adults stem from statewide, random digit-dial telephone surveys (RDDTS) such as the California Adult Tobacco Survey and the California Health Interview Survey. These reveal that smoking rates for CA Black and White adults have been similar 1990-2001, and currently are at about 19%. Although reliable, the validity of the findings for Blacks is questionable because Black RDDTS samples are biased and non-representative. Specifically, low-income Blacks are more likely than other groups to lack landline telephones and so cannot participate in RDDTS; hence Black RDDTS samples tend to consist of the higher socioeconomic status (SES) members of the community – i.e., those with low smoking rates. Moreover, the majority of Blacks are distrustful of health researchers and so refuse to participate in telephone surveys. Those who do participate are a small, highly-educated, high SES group of mostly women who have low smoking rates as a function of SES and gender. Consequently, Black (but not White) smoking rates are significantly higher when they are interviewed in person (e.g., in the National Health Interview Survey) than by telephone (e.g., in the Behavioral Risk Factor Surveillance Survey). Indeed, Black smoking rates are 2 to 3 times higher when Blacks are interviewed in person, by other Blacks, in their communities than when interviewed by telephone, by (assumed) Whites, in RDDTS: In New York , Black smoking prevalence was 44% for in-person vs. 24% for phone interviews in the same communities – and was 61% among those interviewed in person who lacked phones. In Chicago, the rate was 34% for in-person vs. 21% for phone interviews – and 44% for those without phones. Such data have led many (e.g., the CDC) to conclude that the RDDTS method yields smoking rates that significantly underestimate Black population prevalence, and that an alternative – i.e., community-based sampling (CBS) – is needed. For CA, such data mean that the true prevalence of smoking among CA Black adults is unknown, and is probably significantly higher than CA RDDTS studies indicate. Thus, the purpose of this CA Black Health Network-San Diego State University CARA proposal is to acquire basic data on CA Blacks’ tobacco use from a random, stratified, statewide, probability sample of 4,000 Black adults surveyed in-person, in their communities, by Blacks from those communities (CBS). With those data in hand, our Specific Aims are 1). to test the hypothesis that this community-based sample is more representative of the CA Black population than CA RDDTS samples insofar as it will vary more in age, gender, SES and (its correlated) landline phone ownership, and will more closely match the Blacks in the CA Census; 2). to test the hypothesis that this community sample has significantly higher tobacco use rates than Black and than White CA RDDTS samples, these even higher among Blacks who lack landline telephones; and 3). to fully explore and exploit the data from this sample by testing a variety of sophisticated statistical models to clarify the nature of CA Blacks’ use of tobacco products (i.e., cigarettes, cigars, blunts, bidis), and elucidate the potentially unique community (e.g., neighborhood-level segregation and SES), social (e.g., racial discrimination) and cultural (e.g., acculturation) factors affecting that use. |
