||5R37CA214787-03 Interpret this number
||University Of Michigan At Ann Arbor
||The Impact of Tobacco Control Policies on Health Equity in the United States
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.
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