Understanding and reducing tobacco-related health disparities through social and behavioral research

National Institute On Minority Health And Health Disparities

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Abstract

In FY25, the Tobacco Related Disparities and Control Lab authored 10 manuscripts to advance its goals. We summarize the findings below: Social factors and tobacco use: It is known that race and/or ethnicity, sex, socioeconomic status, and other sociodemographic factors are independently associated with tobacco product use. However, less is known about how combinations of these factors are associated with tobacco product use in the US, and how they vary by race and/or ethnicity. By applying a machine-learning boosting algorithm to the data from the 1995-2019 Tobacco Use Supplement to the Current Population Survey (n=1,496,458), we found that sociodemographic factors used in this study predicted current cigarette smoking with varying degrees of accuracy by race/ethnicity, with highest accuracy among White adults and lowest accuracy among American Indian adults. We also found that sociodemographic factors that predicted cigarette smoking also varied somewhat by race and/or ethnicity. Finally, we found that the prevalence of cigarette smoking varied greatly within each race and/or ethnicity. These findings highlight the importance of expanding the sociodemographic variables routinely collected in public health surveillance and provide critical information on who we need to focus tobacco control efforts. Cigar smoking causes cancer and pulmonary and cardiovascular diseases. Black young adults have higher prevalence of cigar smoking than the general population. We conducted a qualitative study with Black young adults interested in cigar smoking to explore their beliefs by cigar type (large cigars, little cigars, and cigarillos). We found that Black young adults in the study reported more positive beliefs for cigarillos and large cigars than for little cigars. Little cigars were seen related to nicotine-related physical effects and relaxation. These findings provide information on beliefs that potentially draw Black young adults to cigar products and inform media messages needed to discourage cigar smoking in this population. Tobacco marketing and tobacco use disparities: Tobacco price promotions (e.g., providing discount coupons and in-store discounts for tobacco products) are a major tobacco marketing strategy used by the tobacco industry. Our previous research has shown that female adults and those with lower socioeconomic status are more likely to use these price promotions. To further investigate the sociodemographic factors associated with tobacco price promotion use, we employed a machine learning approach to analyze data from 35,749 US adults participated in the 1995-2019 Tobacco Use Supplement to the Current Population Survey. We found that prevalence of tobacco price promotion use varied greatly by combination of sociodemographic factors, from about 2% among Black or African American adults living in US South, to almost 40% among Asian female adults living in US Midwest. These findings further highlight subgroups of the US population impacted by these tobacco marketing strategies. During the pandemic, the US Federal Trade Commission reported the first increase in cigarette sales in the last two decades, in part because cigarette companies increased their spending on providing price promotions. We conducted a survey with US adults who use tobacco products and found that female adults who used tobacco products and those who reported financial hardship (e.g., having difficulties paying rent/mortgage, food, utilities, etc.) were more likely to increase the use of tobacco price promotions during the pandemic. These findings suggest that during difficult times, female adults and those who face financial challenges would turn to these price promotions provided by the tobacco industry to sustain their tobacco product use. Launching new products is another marketing strategy used by the tobacco industry. In light of states and localities banning menthol cigarette sales, cigarette companies launched new types of cigarettes replacing menthol with synthetic cooling agents that deliver a similar cooling sensation, (i.e., synthetic cooling agent menthol-mimicking cigarettes). We surveyed US adults to assess their awareness, use, and susceptibility to these new cigarettes. We found that American Indian or Alaska Native and Black or African American adults were more likely than White adults to know about these new cigarettes; those who currently used menthol cigarettes were more likely than those who used nonmenthol cigarettes to currently use these new cigarettes; and Black or African American adults were more likely than White adults to be willing to try these cigarettes. These findings demonstrate how cigarette companies circumvent menthol cigarette bans and the populations of whom these new cigarettes impact. Social media platforms have become a pervasive marketing channel for tobacco companies to reach the US population, especially young people. Using a lab-based eye-tracking study, we examined what elements of e-cigarette advertisements on social media platforms attract young adults’ attention, and how these elements were related to product perceptions. We found that product descriptors, social media accounts associated with the posts, and fruit/candy descriptors attracted the longest attention from young adults. We also found that the attention paid to fruit/candy descriptors and price promotions elements in the advertisements was associated with positive perceptions toward e-cigarettes. These findings suggest that certain features in social-media e-cigarette advertisements may promote e-cigarette use among young people, and restricting e-cigarette advertising may protect young people from e-cigarette use.