Surgeon general sees sharp rise in smoking by minority teens.

Warning of a "tragic reversal for the health of American minorities," U.S. Surgeon General David Satcher in April reported that smoking rates among teenagers in the four major minority groups in the United States have begun climbing rapidly.

"Where we once saw hopeful signs of declining lung cancer among minorities in the early years of this decade, we now see striking increases in smoking by minority youth," Satcher said. "Unless we can reverse these trends, they are bound to result in more lung disease and early death for these populations."

The problem of youth smoking has become a central issue in lawsuits against the tobacco industry by states seeking reimbursement for smoking-related Medicaid expenses. Settlements in four states have included provisions for limiting the marketing of tobacco products to minors and curbing teens' access to cigarettes. Congress is considering similar restrictions in pending tobacco legislation.

The report, Satcher's first as surgeon general, examines tobacco use among four racial and ethnic minority groups that currently constitute about a quarter of the U.S. population: African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Hispanics.

Smoking among adolescents of all four groups declined substantially in the 1970s and 1980s. But the 1990s have brought new increases in tobacco use, including a striking 80 percent increase among African American teens over the last six years--a growth rate three times that recorded among white youth. The increase among Hispanic teenagers was 34 percent.

"Unless they are reversed, these increases in tobacco use are a time bomb for the health of our minority populations," Satcher said. "If tobacco use continues to increase among minority adolescents, we can expect severe health consequences to begin to be felt in the early part of the next century."

He noted that the four groups studied are growing rapidly and their members are expected to make up nearly half the U.S. population by the year 2050.

Major findings from the report:

* If current smoking patterns continue, an estimated 1.6 million African Americans who are now under 18 will become regular smokers. About 500,000 of these new smokers will die of a smoking-related illness.

* From 1978 to 1995, smoking declined among adults in all minority groups except American Indians and Alaska Natives. Nearly 40 percent of adults in this group smoke cigarettes, compared with 25 percent of adults in the general population. This was the only group to experience an increase in respiratory cancer death rates from 1990 to 1995.

* Among immigrants,"acculturation" plays a role in the development of smoking habits. For example, smoking rates among Mexican American adults increase "as they learn and adopt values, beliefs, and norms of American culture."

* Asian Americans and Pacific Islanders are the least likely of the four minority groups to smoke cigarettes. But several local surveys show high smoking rates among recent male immigrants from Southeast Asia.

The report said "culturally appropriate" antismoking programs targeting individual minority groups should be developed to reverse these trends. Programs should use the target group's native language, reflect the group's cultural values, and use strategies that group members would find acceptable.

"Addressing psychosocial characteristics such as depression, stress, and acculturation may increase the acceptance of programs by members of racial/ethnic groups," the report concluded.

Copies of the complete report, Tobacco Use Among U.S. Racial/Ethnic Minority Groups, and an executive summary of major findings are available via the Internet at http://www.cdc.gov/tobacco. The summary may also be ordered by fax by calling (800) CDC-1311.