Essay 4606

From The New York Times…

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The Smoking Scourge Among Urban Blacks

By ERIK ECKHOLM

BALTIMORE — Outside subway stops and bars in parts of this blighted city, slouching hustlers mutter “loosies, loosies” to passers-by, offering quick transactions, 50 cents a stick or three for a dollar.

Their illegal, if rarely prosecuted vocation: selling loose Newport cigarettes to those who do not have $4.50 to buy a pack.

In small corner markets, customers sometimes use code words like “bubble gum” or “napkins” to receive individual cigarettes wrapped in a napkin. Or they buy a flavored Black and Mild, the latest smoking craze here, from an opened five-pack.

Out-of-package sales are common in the poor areas of many cities, an adaptation to meager, erratic incomes and rising cigarette taxes. But researchers say they are just one facet of a high smoking rate among low-income urban blacks.

Even as antismoking campaigns have sharply reduced tobacco use in society at large, smoking has remained far more common among the poor of all races.

Still, officials here said they were surprised when a recent study suggested that more than half of poor, black young adults smoke cigarettes — almost always menthol, almost always Newports.

In the latest twist, the study also found that nearly one in four of them also smoke candy-flavored cigarillos, often inhaling despite the danger posed by higher tar and nicotine levels.

Alarmed by the findings, the city’s health commissioner, Dr. Joshua Sharfstein, on Monday convened health experts, community leaders and high school students to discuss the spreading use of Black and Milds, plastic-tipped cigarillos that come in flavors like wine, cream and apple and are often seen in hip-hop videos and the HBO series “The Wire,” which is set in Baltimore.

Jamila Wilson, 17, said at the meeting that she had started smoking Black and Milds at 15 and now smoked several a day, inhaling.

“If you smoke the wine flavor, it gives you a buzz, ” Jamila said, adding that if she goes too long without, “I get light-headed.”

Amid violence and drug problems, smoking may seem a comparatively harmless vice. “But if you take a step back,” Dr. Sharfstein said, “it’s the smoking that will end up killing a lot of these kids, maybe not next week but well ahead of their time.”

In a stepped-up antismoking campaign, Baltimore officials are offering free nicotine patches or gum and are considering stronger measures to control sales of loosies, which are easily available to youngsters.

“The whole issue here is that the social norms haven’t changed the way they have in most of society,” said Frances Stillman of the Johns Hopkins School of Public Health, co-author of the study of smoking habits among Baltimore’s poor, which was published in August in the American Journal of Public Health. “Everybody smokes, and everybody thinks it’s O.K.”

In this latest study, researchers interviewed 160 blacks ages 18 to 24 who were enrolled in job training. In the group, 60 percent smoked cigarettes and 24 percent had recently smoked cigarillos.

A survey of 1,021 low-income blacks in Detroit, published in 2005 in the American Journal of Preventive Medicine, found that 59 percent of men and 41 percent of women smoked, a finding that “shocked everybody,” said the chief author, Jorge Delva of the University of Michigan School of Social Work.

It has long been known that smoking rates are higher among the poor and least educated of all races, but Mr. Delva and other experts said the rates recently found among inner city blacks were surprisingly high, possibly indicating that they were undercounted in broad standard surveys.

For a mix of cultural reasons as well as targeted marketing, menthol cigarettes are particularly favored by blacks: 75 percent of blacks nationwide smoke them, compared with less than 30 percent of whites.

In the 1960s, Kools dominated the market. But Newports, with a lower menthol level that many say feels smoother, and backed by marketing including the green “Newport Pleasure!” posters in nearly every deli and gas station here, have taken a strong lead in many cities.

“All my friends smoke, and they all smoke Newports,” said Collin Mazick, 24, a resident of northeast Baltimore who is studying to become a geriatric nursing assistant.

In recent years, the promotion budgets of major cigarette companies have been disproportionately devoted to menthols, said Gregory N. Connolly, director of tobacco control research at the Harvard School of Public Health. “It appears the industry is targeting the most vulnerable groups through advertising and manipulation of menthol levels,” Mr. Connolly said.

In an e-mailed response to questions, the Lorillard Tobacco Company, maker of Newports, said its marketing was directed at “all adult smokers,” although 51 percent of Newport buyers are blacks.

In Montebello, a tough section of northeast Baltimore, Newports are shared, sometimes for cash by people trying to recoup the cost of a pack.

“Everybody here smokes who can afford it,” said Eddie Johnson, 54, who broke a heroin addiction during a recent jail stay and is now training to be a drug counselor. Mr. Johnson said he smoked 10 to 20 cigarettes a day.

Scientists have not found that menthol cigarettes per se are more dangerous, but they say that menthol may make it easier to start smoking and harder to quit, and that it intensifies the effect of nicotine.

A resident of the Montebello alleys, Antonio Stokes, 39, who was vague about how he made money, agreed. Of the Newport he bummed off a friend the other evening, he said: “It’s worse than crack. They should have a detox center for these things, too.”