Tobacco and Health Equity: Why Smoking Harms Some Groups More

Health equity means everyone has a fair and just chance to be as healthy as possible — including the chance to be free from commercial tobacco. Not everyone has it: race or ethnicity, where people live and the jobs they do all shape who uses tobacco, who quits, and who gets sick.

Commercial tobacco means the harmful products tobacco companies make and sell — not the traditional tobacco some Indigenous groups use in religious or ceremonial practice.

Where people live and work

CDC.

Social determinants of health are the conditions where people live, learn, work and play. For tobacco they include:

• Retail: how many stores sell tobacco in a neighborhood, and where products are displayed and advertised inside them.
• Education and income: poorer schooling can make health information harder to act on and good jobs with health insurance harder to get; people with lower incomes may have less access to care for smoking-related illness.
• Stress: money problems, discrimination or unsafe neighborhoods make quitting harder and can increase tobacco use. Long-lasting stress keeps stress hormones high, which over time can lead to high blood pressure or type 2 diabetes.

These factors help explain high rates of tobacco-related disease and death in groups such as Hispanic and Latino people and people with behavioral health conditions.

Targeted marketing

Tobacco companies spend billions of dollars a year on marketing, and for decades have aimed it at particular groups — youth; people who are African American, Hispanic, American Indian and Alaska Native, Asian or LGBTQ+; and people in low-income communities. Tactics include:

• donations, scholarships and giveaways;
• nightlife marketing in bars and clubs;
• discounts, coupons and special sales;
• product placement;
• more tobacco retailers in racial and ethnic communities and lower-income neighborhoods;
• sponsoring sports, parades and cultural events.

Marketing makes smoking look appealing, and makes trying it — and keeping at it — more likely.

What states and communities can do

CDC.

• Raise prices and ban discounts.
• Ban flavored tobacco products.
• Allow fewer stores to sell tobacco, or end sales altogether.
• Make all workplaces and public places smokefree, with no exceptions — protecting nonsmokers, prompting quits and preventing starts. Where states have no such law, some communities have passed their own; not everyone is equally protected yet.
• Encourage smokefree rules in apartments, homes and cars, and teach people about secondhand smoke.

Getting help to quit

CDC.

FDA-approved medicines and counseling work, but where people live, their jobs, their insurance — and sometimes race or culture — can stand in the way. States, communities and health systems can:

• cover proven quit treatments without barriers, and promote that coverage;
• screen and treat tobacco use in every health care setting;
• offer quit services that fit different cultures and languages;
• tailor health messages to groups with the greatest disparities.

Sources

Based on "Improving Tobacco-Related Health Disparities," Office on Smoking and Health, Centers for Disease Control and Prevention; a work of the United States government in the public domain. A stock photo collage is not reproduced.