letters

Mortality attributable to smoking accounts for more than half the health inequalities in the UK. 'Restricted access' (pages 2224, 7 June) highlighted the lack of attention given to addressing ethnic minorities' needs. The recent Health Development Agency report, Tobacco and England's Ethnic Minorities, shows a clear gap in services for smokers in minority ethnic communities, and that the antitobacco message is not reaching ethnic communities. Bangladeshi and Caribbean men have higher levels of smoking than men in the general population (44 and 35 per cent respectively, compared to 27 per cent 1).The young people interviewed believe being healthy in other ways - for example, by taking exercise or eating a healthy diet - would offset the ill-effects of smoking. Younger Indians and Pakistanis cite food and stress as more risky than smoking.

While they are aware smoking would harm their future health, like other young adults in the general population they believe their smoking behaviour would change later in life and there is no need to stop smoking 'now'.

Older Bangladeshis make little reference to the association between ill health and smoking.

Instead, they believe their ill health is derived from the different living conditions in Britain compared to Bangladesh.

South Asians report often using tobacco as an indigestion aid, and while women smoking is frowned on in Asian and African Caribbean communities, women chewing paan is acceptable in Bangladeshi communities (26 per cent of Bangladeshi women compared to 19 per cent of Bangladeshi men - the highest tobacco use by women in any ethnic group).

1Recommendations include using Asian media to disseminate health information, giving information on the dangers of tobacco chewing, and printing health information in simple and culturally familiar ways. Peergroup members could have a key role in communicating health promotion messages face-toface. The report also calls for further research into the influence of religious and cultural practices.

Understanding cultural attitudes towards tobacco and ethnic communities' level of knowledge of the impact of tobacco use is an essential first step to reducing tobacco-related health inequalities.

Yve Buckland Chair Health Development Agency