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

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.

Grant Number: 5R01CA268491-04
NIH Institute/Center: NIH
Principal Investigator: STELLA BIALOUS