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Grant Details

Grant Number: 5R37CA214787-03 Interpret this number
Primary Investigator: Fleischer, Nancy
Organization: University Of Michigan At Ann Arbor
Project Title: The Impact of Tobacco Control Policies on Health Equity in the United States
Fiscal Year: 2020


Abstract

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.



Publications

Smoke-Free Laws and Disparities in Secondhand Smoke Exposure Among Nonsmoking Adults in the United States, 1999-2014.
Authors: Titus A.R. , Thrasher J.F. , Gamarel K.E. , Meza R. , Fleischer N.L. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2021-08-18; 23(9), p. 1527-1535.
PMID: 33690865
Related Citations

A longitudinal analysis of smoke-free laws and smoking initiation disparities among young adults in the United States.
Authors: Titus A.R. , Xie Y. , Thrasher J.F. , Levy D.T. , Elliott M.R. , Patrick M.E. , Fleischer N.L. .
Source: Addiction (Abingdon, England), 2021-08-03; , .
EPub date: 2021-08-03.
PMID: 34342916
Related Citations

Exploring How Exposure to Truth and State-Sponsored Anti-Tobacco Media Campaigns Affect Smoking Disparities among Young Adults Using a National Longitudinal Dataset, 2002-2017.
Authors: Colston D.C. , Xie Y. , Thrasher J.F. , Emery S. , Patrick M.E. , Titus A.R. , Elliott M.R. , Fleischer N.L. .
Source: International journal of environmental research and public health, 2021-07-23; 18(15), .
EPub date: 2021-07-23.
PMID: 34360096
Related Citations

State-Level Structural Stigma and Smoking Among Sexual Minority Adults in the USA, 2012-2014.
Authors: Titus A.R. , Gamarel K.E. , Thrasher J.F. , Meza R. , Fleischer N.L. .
Source: Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2021-06-02; 55(6), p. 557-570.
PMID: 33196079
Related Citations

Anti-Smoking Media Campaigns and Disparities in Smoking Cessation in the United States, 2001-2015.
Authors: Colston D.C. , Cho B. , Thrasher J.F. , Titus A.R. , Xie Y. , Emery S. , Elliott M.R. , Fleischer N.L. .
Source: American journal of health promotion : AJHP, 2021 06; 35(5), p. 658-668.
EPub date: 2021-01-08.
PMID: 33415988
Related Citations

Taxation reduces smoking but may not reduce smoking disparities in youth.
Authors: Fleischer N.L. , Donahoe J.T. , McLeod M.C. , Thrasher J.F. , Levy D.T. , Elliott M.R. , Meza R. , Patrick M.E. .
Source: Tobacco control, 2021 05; 30(3), p. 264-272.
EPub date: 2020-04-08.
PMID: 32269173
Related Citations

Tobacco Taxation and Its Prospective Impact on Disparities in Smoking Initiation and Progression Among Young Adults.
Authors: Parks M.J. , Patrick M.E. , Levy D.T. , Thrasher J.F. , Elliott M.R. , Fleischer N.L. .
Source: The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2021 04; 68(4), p. 765-772.
EPub date: 2020-10-08.
PMID: 33041205
Related Citations

The Association between Quitline Characteristics and Smoking Cessation by Educational Attainment, Income, Race/Ethnicity, and Sex.
Authors: Colston D.C. , Simard B.J. , Xie Y. , McLeod M.C. , Elliott M.R. , Thrasher J.F. , Fleischer N.L. .
Source: International journal of environmental research and public health, 2021-03-23; 18(6), .
EPub date: 2021-03-23.
PMID: 33806747
Related Citations

Area-Level Predictors of Tobacco 21 Coverage in the U.S. Before the National Law: Exploring Potential Disparities.
Authors: Colston D.C. , Titus A.R. , Thrasher J.F. , Elliott M.R. , Fleischer N.L. .
Source: American journal of preventive medicine, 2021 01; 60(1), p. 29-37.
EPub date: 2020-11-05.
PMID: 33160795
Related Citations

Cigarette taxes, prices, and disparities in current smoking in the United States.
Authors: Kalousova L. , Levy D. , Titus A.R. , Meza R. , Thrasher J.F. , Elliott M.R. , Fleischer N.L. .
Source: SSM - population health, 2020 Dec; 12, p. 100686.
EPub date: 2020-11-05.
PMID: 33241103
Related Citations

Are sexual minority adults differentially exposed to smoke-free laws and televised anti-tobacco media campaigns compared to the general US population? A descriptive analysis.
Authors: Titus A.R. , Gamarel K.E. , Thrasher J.F. , Emery S.L. , Elliott M.R. , Fleischer N.L. .
Source: Tobacco control, 2020-09-23; , .
EPub date: 2020-09-23.
PMID: 32967984
Related Citations

Family Rejection and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA.
Authors: Gamarel K.E. , Watson R.J. , Mouzoon R. , Wheldon C.W. , Fish J.N. , Fleischer N.L. .
Source: International journal of behavioral medicine, 2020 Apr; 27(2), p. 179-187.
PMID: 31925674
Related Citations

Gender differences in relationships between sociodemographic factors and e-cigarette use with smoking cessation: 2014-15 current population survey tobacco use supplement.
Authors: Abrams L.R. , Kalousova L. , Fleischer N.L. .
Source: Journal of public health (Oxford, England), 2020-02-28; 42(1), p. e42-e50.
PMID: 31220294
Related Citations

The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers.
Authors: Donahoe J.T. , Norton E.C. , Elliott M.R. , Titus A.R. , Kalousová L. , Fleischer N.L. .
Source: American journal of preventive medicine, 2019 12; 57(6), p. e203-e210.
PMID: 31753273
Related Citations

Smoke-Free Policies and Smoking Cessation in the United States, 2003-2015.
Authors: Titus A.R. , Kalousova L. , Meza R. , Levy D.T. , Thrasher J.F. , Elliott M.R. , Lantz P.M. , Fleischer N.L. .
Source: International journal of environmental research and public health, 2019-09-02; 16(17), .
EPub date: 2019-09-02.
PMID: 31480698
Related Citations

Key Factors Inhibiting Legislative Progress Toward Smoke-Free Coverage in Appalachia.
Authors: Donahoe J.T. , Titus A.R. , Fleischer N.L. .
Source: American journal of public health, 2018 03; 108(3), p. 372-378.
EPub date: 2018-01-18.
PMID: 29345998
Related Citations




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