Introduction

Among the widely diverse US population, certain communities and regions are at disproportionately higher risk of tobacco use and associated diseases and deaths. Disparity in tobacco use and related health and economic burden is a multidimensional phenomenon that occurs at many levels across individuals, communities, and geographies. Eliminating disparities in tobacco use across population sub-groups and geographic areas is vital for accelerating progress in the reduction in overall tobacco use across the nation and improving health.

Individual level disparities are driven by differences in individual tobacco use trajectories such as initiation, current use, duration, intensity, quit attempts, cessation, and former use, that are conditioned largely by the commercial determinants of health (e.g., tobacco industry target marketing, advertising, tobacco product innovations), mediated by the socio-demographic and economic factors and public health policies (e.g., access to health care and tobacco use cessations programs, protection from exposure to secondhand smoke). Therefore, many factors contribute to why an individual may currently smoke cigarettes or use other tobacco products. Societal level disparities, on the other hand, are determined by exposure to different tobacco control policy environment, tobacco product landscape, social norms, and major social or political events.

Tobacco use continues to disproportionately affect various subgroups within the US who have historically been marginalized. Disparities for tobacco cessation continue to exist, with non-White individuals having lower successful quit rates than white individuals, despite greater intention to quit and more attempts at cessation.¹ Additionally, many of these individuals may belong to two or more risk groups (known as "intersectionality") in tobacco use behaviors. Therefore, solutions for addressing health inequities require a multifaceted approach.

Public health initiatives must be culturally sensitive and tailored to meet the specific needs of demographic subpopulations, including those with limited incomes, limited education, and disabilities, and LGBTQ+ people, and racial and ethnic subgroups. This includes increasing access to cessation programs, providing education about the dangers of tobacco use, and implementing evidence-based tobacco control programs and policies, such as regulations on tobacco products and restrictions on their promotion and advertising. Policies that address the social determinants of health, such as improving access to healthcare, education, and economic opportunities, are also crucial in reducing tobacco-related disparities (Figure 2.1.1).² By understanding and addressing the unique challenges faced by different communities, we can move towards a more equitable and healthier society.