Tobacco Control Policies to Address Tobacco-Related Disparities

Tobacco control policies are an important part of preventing and reducing tobacco use, regulating tobacco products, and eliminating and protecting people from the harms of tobacco use and secondhand smoke exposure. However, policies are not always equal in their distribution of impact and reach. Policies to end the sale of menthol cigarettes and all other flavored tobacco products show the importance of examining differential impacts on various subgroups of population, including racial/ethnic subgroups and LGBTQ+ populations, as the impacts are not always equal.^1,2,3 One contributing factor to tobacco related disparities is the targeted marketing strategies employed by tobacco companies. Historically, tobacco companies have directed their advertising campaigns towards specific racial and ethnic groups and LGBTQ+ populations. Non-Hispanic Black communities, for example, have been heavily targeted with advertisements for menthol cigarettes, which are more addictive and harder to quit than non-menthol cigarettes.⁴ Additionally, tobacco companies have sponsored events and provided financial support to cultural organizations within these communities, further promoting tobacco use.

Comprehensive tobacco control policies are needed to better address tobacco-related disparities, including smokefree air laws, tobacco tax increases, point of sale restrictions, policies to end the sale of menthol cigarettes and all other flavored tobacco products, funding for tobacco control programs, and insurance coverage of smoking cessation services at no cost to the individual seeking cessation support (Figure 2.9.1).

Tobacco related disparities need to be examined through the lens of intersectionality, recognizing that being part of multiple groups that have higher rates of tobacco use can lead to an even greater burden (Figure 2.9.2).⁵ For example, compared to those identifying as cisgender White, adolescents identifying as LGBTQ+ and communities of color have not only higher tobacco use, but also lower support for cessation, which can have impacts on mental and physical health.⁶ There are similar disparities among US adults in tobacco use across various intersections of identity.⁷ Given these disparities, intersectionality needs to be built into allocation of resources to prevention and cessation efforts, so not to exacerbate disparities.⁸ Incorporating intersectionality is imperative to reduce these preventable disparities.⁹ Some approaches recommended by the National Cancer Institute Tobacco Monograph 22 include strategies that can get to these intersections such as increasing the price of tobacco products, incorporating comprehensive smoke-free air policies in multiunit housing, workplaces, and public spaces, and increasing cessation services with a focus on groups that have historically been marginalized.¹⁰