A new Surgeon General’s report highlights current gaps and calls for reducing tobacco-related disparities
Nearly half a million deaths in the U.S. each year – that’s 1 in 5 people – are linked to cigarette smoking or secondhand tobacco smoke exposure. While at the population level the prevalence of tobacco use has fallen dramatically since 1965 (more than 70%), certain at-risk groups continue to smoke at high rates.
American Indians and Alaska Native people have the highest rates of cigarette smoking – 25% smoked cigarettes in 2020, twice the rate of the national average of 12.5%. Black people; youth from racial and ethnic minorities; people who identify as lesbian, gay, bisexual, and transgender; individuals living in poverty or with lower educational attainment; and those with a behavioral health diagnosis are also using tobacco at higher rates.
A newly-released report from U.S. Surgeon General Vivek Murthy, Eliminating Tobacco-Related Disease and Death: Addressing Disparities—A Report of the Surgeon General, highlights the critical need to address these populations. Not only are certain groups more likely to use tobacco products, but they are also more often impacted by secondhand smoke exposure. The report highlights that poverty and discrimination are primary drivers in continued disparities.
Takeaways for Tobacco Treatment Specialists
I sat down with the Duke Smoking Cessation Program's Bolu Abe-Lathan, DHSc, PA-C, who provides tobacco cessation services to some of the patients facing the disparities highlighted in the Surgeon General’s new report to get her take on what it means for providers and others serving these at-risk communities.
What were your biggest takeaways from this new report?
It’s nice to see disparities addressed in its own singular report. I think this report reaffirmed for me things I’ve been seeing in my own practice and trying to address. For me, this report falls short with actionable things to change the disparities discussed. However, for a primary care provider or someone working outside of full-time smoking cessation, I do think it would be eye-opening and important for them to understand.
Another big takeaway for me is that we need a menthol ban. There was good information about menthol and its negative impact on these communities. A menthol ban could be a game-changer, but we have to be intentional about it. Talk to your legislator if you don’t have pre-emption laws that limit local governments from passing stronger regulations than those that exist at the state level. [North Carolina has these laws]. You can do this work in your neighborhoods and schools.
Can you give an example of who this report is discussing?
This report affects more individuals than people realize. You need to look at your family, your friends, the people you work with. It could be your cousin, who identifies as part of the LGBTQ+ community and struggles with confidence and vapes in secret. It could be your grandparents, who struggle with money but somehow come up with enough to buy cigarettes. Or maybe it’s a co-worker struggling with anxiety and using tobacco to cope with the perceived stigma related to having a mental health diagnosis. For me personally, it could be anyone in my family.
Race is important because it culturally identifies people, but these disparities are a problem that transcend race. Disparities exist among people who are unhoused or have lower socioeconomic status or less education. People living with a mental health diagnosis. Being young and vulnerable is also a disparity.
How can people working in communities facing these disparities better address their tobacco use?
The current smoking climate is a microcosm of America. The people impacted the worst don’t have the resources to fight back. It’s overwhelming as a provider. A lot of people in these communities give up because everyone around them is smoking—the people they ride the bus with or work with or family members. How do you help these people not turn to tobacco to cope with their lives? It starts with being kind to people and being aware of how trauma or the daily difficulties they face can lead to tobacco use. I start each visit by asking patients, “How can I support you? What do you need from me?”
Your patient has a story before they came to see you, and smoking is just a response to what that something was. Encouraging them to get the help that they need. Encouraging them that they can make it through this. These are messages they need to hear. You may need to repeat that message 1,000 times. Instead of scaring people with talking about the health harms, it would be nice to see more campaigns featuring people who made it, who were able to quit tobacco. We don’t give people enough hope. As a provider, we need to give them hope that quitting is possible.
Key Highlights from the Surgeon General Report
Discrimination and poverty are primary drivers of continued disparities related to tobacco use.
Menthol makes smoking/vaping more addictive and harder to quit. Restricting its use and availability in tobacco products decreases tobacco initiation and use among those groups who use menthol cigarettes at disproportionally higher levels, such as Black people and adolescents.
Tobacco companies have targeted certain at-risk communities for decades, leading to further tobacco-related health disparities.
Secondhand smoke exposure is highest among Black individuals, youth, and those from lower socioeconomic backgrounds.
To learn more about disparities in tobacco use, join our upcoming Comprehensive Tobacco Treatment Specialist Training Program (offered three times per calendar year). Our Spring session (February 24-March 4, 2025) is coming up soon! Visit www.dukeunctts.com for more information or to register.
About the Author
Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certification in Nicotine and Tobacco Treatment and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.
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