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

项目摘要摘要 自20世纪中期以来，烟草控制政策有效地降低了美国的吸烟率。 各州。然而，在吸烟方面，社会经济地位(SES)和种族/民族的重要差异 流行率和与烟草有关的健康后果依然存在。教育程度和收入相对较低的人群 比他们更富裕的同龄人更有可能吸烟。此外，尽管非西班牙裔黑人和 非西班牙裔白人的吸烟率相似，黑人的戒烟率较低，肺活量较高 癌症发病率和死亡率高于白人。另一方面，拉美裔美国人比黑人或白人吸烟更少。 这表明，目前的烟草控制政策没有充分减少吸烟，更不用说消除吸烟了。 弱势群体之间的差异。然而，很少有政策评估涉及吸烟差距，而且 政策对不同经济特区和种族/族裔亚群的影响大多不得而知。此外，烟草 控制政策的设计通常考虑到广泛的人口，而不是重点减少 在特定人群中吸烟的流行率。因此，一些政策实际上可能是 加剧吸烟差距，即使它们的净人口影响是积极的。这项研究的目的是 确定美国现有的和新兴的烟草控制政策对健康公平的影响。这个 拟议的项目将：(1)确定烟草控制政策如何影响开始吸烟方面的差异 (2)确定控烟政策如何影响青少年中的戒烟差异 以及(3)预测需要哪种政策组合来减少烟草中的健康差距- 使用烟草政策模拟模型研究随时间变化的归因死亡率。目标1和目标2将系统地 分析两项具有全国代表性的大型调查，以确定烟草控制的程度 美国的政策影响开始吸烟和戒烟的差异，重点是 按教育、收入和种族/民族(即白人、黑人、西班牙裔)及其可能的情况制定的政策 与性别的交集。目标3将把目标1和目标2中开发的证据集成到模拟模型中 预测政策单独和组合将如何影响吸烟差距和未来的下游 烟草导致的死亡。这项拟议的研究将使这一领域超越描述吸烟差异的领域 提供具体的、可操作的证据，告知哪些烟草控制政策在 同时减少总体吸烟和与烟草有关的健康差距。从以下方面获得的知识 这项研究将通过以下方式指导政策制定者关于实施具体烟草控制政策的决策 强调考虑它们对与烟草有关的健康差距的贡献的重要性。

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.