3 takeaways from the National Cancer Institute report on tobacco-related health disparities

The National Cancer Institute released a report this week on a topic of increasing concern across the country: While the overall smoking rate has declined, the health burden of tobacco use remains especially high among certain groups.

“Over time, tobacco use has evolved from a mainstream behavior to one that is highly concentrated among population groups defined by socioeconomic status, race/ethnicity, sexual orientation, and other factors,” write the report’s authors. “A central challenge for cancer control is to ensure that all Americans benefit from advances in tobacco control research and practice.”

Certain populations, including racial and ethnic minorities, low-income individuals, the LGBT community, those with mental health conditions and members of the military, are disproportionately affected by tobacco use. The National Cancer Institute’s report assesses existing research on race- and income-based disparities, provides guidance for future studies and helps direct the implementation of promising strategies to reduce disparities.

Dozens of researchers, including a team from the Truth Initiative Schroeder Institute®, contributed to the analysis. Here are three main takeaways from the over 500-page report, the latest installment in the tobacco control monograph series that the institute began in 1991.

1. Tobacco use today is characterized by gaps within “enormous progress.”

The smoking rate among U.S. adults dropped more than 25 percent in the 50-year period between 1965 and 2015, from 42 percent to just over 15 percent. Overall, tobacco control efforts starting in 1964 prevented 8 million premature deaths.

While that represents “enormous progress,” the authors write, “progress in reducing tobacco use has been uneven in the United States, and substantially higher rates of tobacco use persist.” For example, smoking rates are less than 5 percent among college graduates, but nearly 40 percent among people who didn’t finish high school. Additionally, African-Americans have the highest rates of tobacco-related cancer of all races and ethnicities, and are more likely to die because of the disease.

2. Certain populations and patterns have been overlooked and more research is needed.

Researchers see many opportunities to fill gaps in tobacco control knowledge and expand prevention and cessation strategies.

A few examples: Sexual and gender minorities have disproportionately high smoking rates, yet long-term health outcomes in this group remain under-researched. Enhanced surveillance efforts are also needed to examine sub-groups within minorities and better understand how multiple risk factors interact.

Additionally, nearly half of all racial and ethnic minority smokers consume fewer than five cigarettes a day, making them “non-daily or very light” smokers. Traditional approaches to quitting, however, do not include these types of smokers. “The research community has failed to focus on the challenge of how to assist non-daily and very light smokers in quitting, and by doing so, has ignored the most prevalent smoking behavior pattern of minority populations,” the authors write.

Another area that needs more research: The tobacco product marketplace and the tobacco industry are rapidly evolving, “increasing the need for surveillance of tobacco industry communication strategies.” With changes in the communications landscape, innovative media and message strategies, along with robust research, are needed to understand how to best reach and engage minority and low-income populations with anti-tobacco communications.

3. Tobacco control strategies can significantly reduce tobacco-related health disparities.

Research shows that stronger implementation and enforcement of proven tobacco control policies, especially tax increases, stand to benefit populations most at risk for tobacco use.

For example, a $3 average increase in tobacco taxes would lower smoking rates by nearly 20 percent by 2064. Tax increases, combined with a stronger set of policies—including comprehensive marketing restrictions, smoke-free laws, strong graphic health warnings, a higher intensity media campaign, broader cessation treatment coverage and stronger youth access enforcement—would reduce the smoking rate among the bottom two-fifths of income earners by nearly a quarter in just a few years. By 2065, smoking rates among the lowest-income groups would drop by almost 45 percent, avoiding more than 1.5 million deaths.

A ban on menthol cigarettes would also save many lives, especially among African-Americans. Research shows that a menthol ban would save between 323,000 and 633,000 lives, a third of which would be African-American lives.

The authors stress that additional measures are needed to speed progress.

To read the entire report, visit the National Cancer Institute’s website. For more on this topic, watch our 2017 Warner Series panel on why tobacco is a social justice issue.