Addressing disparities in tobacco-related diseases by understanding the tobacco industry strategies

摘要 烟草使用是导致死亡的主要可预防原因， 我们烟草引起的疾病和死亡率分布不均。种族、族裔、性别和性 少数民族，以及生活在贫困线以下和教育水平较低的人， 烟草使用率高得不成比例，烟草引起的癌症发病率高。控烟 迄今为止的政策没有充分解决这些不平等问题。烟草业是烟草的载体- 造成的差异。因此，减少烟草引起的不平等负担需要了解如何 该行业以少数民族社区为目标，并培养有利的社会、政策和监管环境 烟草使用。随着烟草产品格局的不断演变，这种理解变得越来越重要 随着烟草公司迅速扩大其产品组合，并将自己重新定位为 减少烟草危害。烟草和尼古丁产品的数量和多样性正在增加， 电子香烟、电子容器装置、加热烟草产品和其它尼古丁蒸发器。烟草 电子烟公司也在向大麻业务扩张。这样做的影响 目前尚不清楚这种扩大是否会加剧与烟草有关的现有差距。决策者面临新挑战 促进与烟草有关的健康公平：应对烟草业反对管制， 制定适合新型烟草产品的干预措施，并越来越多地针对 同样的公司。但是，地方政策创新正在实施。我们将探讨如何 决策者考虑采取不同的政策，试图减少健康差距。我们将利用工业 文件，关键线人访谈，公开的政策文件（例如，公开听证会）， 报告和新闻媒体，追求三个具体目标：1）分析不断变化的烟草业战略， 与第三方和相关行业合作，影响公共卫生政策和烟草产品 2）了解烟草行业的营销策略， 寻求尼古丁使用正常化（包括在新烟草和尼古丁产品中），并传达 降低风险，以及这些措施如何针对种族/族裔少数群体和其他弱势群体;以及3）分析 创新的地方和州一级烟草和大麻政策，以了解这些政策的传播 它们之间的相互作用可以支持减少与烟草有关的健康差距， 股权这一独特的科学贡献可以为未来的公共卫生计划，政策和监管提供信息。 战略涉及不断发展的行业和产品，同时注重健康公平。

ABSTRACT Tobacco use is the leading preventable cause of death and is responsible for a third of cancer deaths in the US. Tobacco-induced diseases and mortality are not equally distributed. Racial, ethnic, gender and sexual orientation minorities, as well as those living below the poverty line and with lower levels of education, have disproportionately higher rates of tobacco use and higher rates of tobacco-induced cancers. Tobacco control policies to date have not adequately addressed these inequities. The tobacco industry is the vector of tobacco- induced disparities. Therefore, reducing the burden of tobacco-induced disparities requires understanding how the industry targets minority communities and cultivates social, policy, and regulatory environments favorable to tobacco use. This understanding is ever more important as the landscape of tobacco products is evolving rapidly as tobacco companies expand their portfolio of products and reposition themselves as providers of tobacco harm reduction. The number and diversity of tobacco and nicotine products is increasing to include electronic cigarettes, electronic pod devices, heated tobacco products, and other nicotine vaporizers. Tobacco and the electronic cigarette companies are also expanding into the cannabis business. The impact of this expansion in exacerbating existing tobacco-related disparities is unknown. Policymakers face a new challenge in promoting tobacco-related health equity: responding to tobacco industry opposition to regulation while developing interventions appropriate for novel tobacco products, and increasingly, cannabis products sold by the same companies. However, local policy innovations are being implemented. We will explore how policymakers consider different policies in attempting to decrease health disparities. We will use industry documents, key informant interviews, publicly available policy documents (e.g., public hearings), published reports, and news media, to pursue three Specific Aims: 1)Analyze evolving tobacco industry strategies, in collaboration with third parties and allied industries, to influence public health policies and tobacco product regulations in ways that exacerbate health disparities; 2)Understand tobacco industry marketing strategies that seek to normalize nicotine use (including in new tobacco and nicotine products) and communicate claims of reduced risk, and how these target racial/ethnic minorities and other vulnerable groups; and 3) Analyze innovative local- and state-level tobacco and cannabis policies to understand how diffusion of these policies and interaction between them can support the reduction of tobacco-related health disparities and promote equity. This unique scientific contribution can inform future public health programmatic, policy, and regulatory strategies addressing the evolving industry and products while focusing on health equity.