Cigarette smoking has plunged more than 70% among Americans since a landmark 1965 surgeon general’s report linked tobacco use to cancer. But last week, the nation’s top doctor issued a report that found that people of color, people with low incomes, and members of the LGBT community still have disproportionately high smoking rates.
Despite decades of strict anti-tobacco-related laws and a historic lawsuit intended to punish the tobacco industry, disparate smoking rates in marginalized communities have increased since 2000, the report finds.
Authored by Surgeon General Vivek Murthy, the report calls out Big Tobacco as a key driver of the disparities, pointing to decades of aggressive, highly specific marketing aimed at those communities.
Socially and economically marginalized groups “have been subjected to decades of inequitable treatment and manipulative tactics that impact tobacco-related health consequences,” according to the report. It also noted that smoking is a significant factor in disparate health outcomes between white people and people of color.
Anti-smoking advocates welcomed the report.
Harold Wimmer, president of the American Lung Association, said in a statement that Murthy’s findings show the tobacco industry harmed vulnerable people and communities through “the use of tobacco, exposure to secondhand smoke, and the death and disease that disproportionately affects” them.
“Achieving health equity requires knowing where these disparities exist and acting to eliminate them,” he said.
Poverty, racism, and the tobacco industry’s marketing strategies are major roadblocks to progress.
Murthy’s report is the latest in a series of surgeon general’s reports on tobacco use among U.S. racial and ethnic groups. Besides identifying the problem, it proposes ways to eliminate these disparities and advance health equity in the U.S.
“Tobacco use imposes a heavy toll on families across generations. Now is the time to accelerate our efforts to create a world in which zero lives are harmed by or lost to tobacco,” Murthy said in a statement. “This report offers a vision for a tobacco-free future, focused on those who bear the greatest burden, and serves as a call to action for all people to play a role in realizing that vision.”
Cigarette smoking and secondhand smoke exposure continue to cause roughly 20% of all U.S. deaths each year.
To be sure, the tobacco settlement and the anti-smoking movements triggered a drop in overall smoking rates and substantial reductions in secondhand smoke exposure in the overall U.S. population.
Still, poverty, racism, and the tobacco industry’s marketing strategies are major roadblocks to progress and are responsible for the differing rates of smoking by various demographic groups, according to the report.
As a result, cigarette smoking and secondhand smoke exposure continue to cause roughly 20% of all U.S. deaths each year — a total of half a million victims. Cigarette smoking is also a major cause of heart disease — the number one killer of U.S. adults —and is directly linked to lung cancer. Black men have the highest incidence and death rate due to lung cancer of any racial and ethnic group of men or women.
To curb those disparities, the report calls for government policies that increase access to health care, education, and safe, smoke-free housing and workplaces. It also calls for restricting flavored tobacco product sales, which the U.S. Food and Drug Administration has yet to do. Health organizations continue to call for action on this front and suggest state and local governments pick up the slack.
“Among its many findings, the report concludes that menthol flavored tobacco products increase the likelihood of tobacco initiation, addiction, and sustained use; and are target marketed and used disproportionately by certain population groups, including Black people and people who identify as lesbian, gay, or bisexual,” ALA’s Wimmer said.
“Following the Biden administration’s failure in 2023 to finalize the lifesaving rules to end the sale of menthol cigarettes and flavored cigars across the country, the American Lung Association urges cities and states across the U.S. to pass policies to end the sale of all flavored tobacco products, including menthol cigarettes, flavored cigars and flavored e-cigarettes,” Wimmer said.
