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

项目摘要 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。 States.然而，吸烟的社会经济地位（SES）和种族/民族的重要差异 烟草流行率和与烟草有关的健康结果依然存在。受教育程度和收入相对较低的人 比富裕的同龄人更有可能吸烟。此外，虽然非西班牙裔黑人和 非西班牙裔白人有类似的吸烟率，黑人戒烟率较低，肺功能更强。 癌症发病率和死亡率高于白人。另一方面，西班牙裔人吸烟比黑人或白人少。 这表明，目前的烟草控制政策不能充分减少吸烟，更不用说消除吸烟了 弱势群体的差距。然而，很少有政策评估涉及吸烟差异， 政策对不同社会经济地位和种族/族裔亚组的影响大多是未知的。此外，烟草 控制政策的设计通常考虑到广泛的人群，而不是重点减少 吸烟在特定人群中的流行程度。因此，有些政策实际上可能 加剧了吸烟的差异，即使他们的净人口效应是积极的。本研究的目的是 确定美国现有和新出台的烟草控制政策对健康公平的影响。的 拟议的项目将：（1）确定烟草控制政策如何影响吸烟开始的差异 （2）确定烟草控制政策如何影响青年人戒烟的差异; 成人;（3）预测减少烟草健康差异所需的政策组合- 使用烟草政策模拟模型对一段时间内的归因死亡率进行分析。目标1和2将系统地 分析两项大型的、具有全国代表性的调查，以确定烟草控制的程度。 美国的政策影响了吸烟开始和戒烟的差异，重点是 按教育、收入和种族/民族（即，白人，黑人，西班牙裔），以及他们可能的 与性别的交集。目标3将把目标1和2中提出的证据纳入一个模拟模型 预测政策如何，单独和组合，将影响吸烟差异和未来的下游 烟草引起的死亡这项拟议中的研究将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可能最有效， 同时减少总体吸烟和与烟草有关的健康差距。获得的消息 这项研究将通过以下方式指导决策者关于实施具体烟草控制政策的决定： 强调必须考虑到他们对烟草相关健康差距的贡献。

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.