Assistant professor at the School of Public Health at the University of Minnesota, Dana Mowls Carroll, recently co-authored a commentary in Preventive Medicine discussing how commercial tobacco policies contribute to inequality, including unequal burden of tobacco-related diseases and deaths within racialized populations. The article also addresses the issue of injustice in tobacco-related burdens.
Researchers explain that policies allowing the continued sale of menthol cigarettes – especially through targeted marketing – increase the risk of tobacco use among Black or African American (B/AA) and Native American adult populations. Meanwhile, policies prohibiting flavored e-cigarettes to prevent youth initiation have received considerable attention. These policies disproportionately benefit white youth, who have higher rates of e-cigarette use than B/AA youth. While preventing youth e-cigarette use is crucial, the support, urgency, and messaging around prohibiting flavored e-cigarettes outweigh those for banning menthol cigarettes, exacerbating inequalities in how regulation benefits different groups.
The author asserts that creating equal opportunities for healthy living is no longer just an afterthought or a secondary goal for decision-makers. The author calls for a health equity perspective to be integrated into the regulation of commercial tobacco products, and offers suggestions at both the individual and systemic levels to place health equity at the forefront of regulation and research.
Their suggestions include:
The FDA should directly address health equity issues in its national regulation of commercial tobacco products, while evaluating regulations and prioritizing research on how regulations or lack thereof increase or decrease tobacco-related health disparities experienced by Black/African American and Native American communities. Community engagement is crucial and public health professionals must be prepared. This approach allows for real contact with those at greatest risk for tobacco-related illnesses and ensures their voices are prioritized during policy formation and implementation. More Black/African American and Native American tobacco regulatory scientists should be guided, recruited, and supported in training. This work must begin with an understanding of the roots of inequality. All researchers must educate themselves on the cultural and historical backgrounds of their academic and community institutions and their impact on Black/African American and indigenous communities. Carol states, "Efforts to provide the highest possible health standards for all mean that we must educate ourselves on the true roots of inequality, particularly racism, and identify public health methods and policies to counter it." "I am interested in how populations that bear the greatest burden of smoking are benefiting or even being harmed by the implementation or lack of tobacco-related policies compared to socially privileged populations.
This research was supported by the National Institute on Drug Abuse and the National Institute on Minority Health and Health Disparities of the National Institutes of Health, as well as the Center for Tobacco Products of the United States.
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