The Impact of Tobacco Control Policies on Health Equity in the United States

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Project Summary Abstract Since the mid-1900s, tobacco control policies have effectively decreased smoking prevalence in the United States. However, important disparities by socioeconomic status (SES) and race/ethnicity in smoking prevalence and tobacco-related health outcomes persist. People with relatively lower education and income are more likely to smoke than their more affluent counterparts. In addition, although non-Hispanic Blacks and non-Hispanic Whites have a similar prevalence of smoking, Blacks have lower quit rates and higher lung cancer incidence and mortality than Whites. Hispanics, on the other hand, smoke less than Blacks or Whites. This suggests that current tobacco control policies do not adequately reduce, let alone eliminate, smoking disparities in vulnerable subgroups. However, few policy evaluations address smoking disparities, and the effects of policies across different SES and racial/ethnic subgroups are mostly unknown. Moreover, tobacco control policies are generally designed with broad populations in mind, without a focus on reducing the prevalence of smoking among specific populations. As a consequence, some policies may actually be exacerbating smoking disparities, even if their net population effect is positive. The objective of this study is to determine the health equity impact of established and emerging tobacco control policies in the US. The proposed project will: (1) determine how tobacco control policies influence disparities in smoking initiation among youth; (2) determine how tobacco control policies influence disparities in smoking cessation among adults; and (3) predict which combination of policies are needed to reduce health disparities in tobacco- attributable mortality over time using a tobacco policy simulation model. Aims 1 and 2 will systematically analyze two large, nationally-representative surveys over time to determine the extent to which tobacco control policies in the US affect disparities for smoking initiation and cessation, focusing on the differential impact of policies by education, income, and race/ethnicity (i.e., Whites, Blacks, Hispanics), and their possible intersection with gender. Aim 3 will integrate the evidence developed in Aims 1 and 2 into a simulation model to predict how policies, individually and in combination, will affect smoking disparities and future downstream tobacco-attributable deaths. The proposed study will take the field beyond describing smoking disparities to producing concrete, actionable evidence informing which tobacco control policies may be most effective in simultaneously reducing both overall smoking and tobacco-related health disparities. Knowledge gained from this study will guide policy-makers’ decisions regarding implementation of specific tobacco control policies by highlighting the importance of considering their contribution to tobacco-related health disparities.