Report on Tobacco Use and Health Disparities
Update on Tobacco Use and Health Disparities in the US: A New Surgeon General’s Report
By Tom Horvath, PhD
On 11/19/24, the Surgeon General released Eliminating Tobacco-Related Disease and Death, Addressing Health Disparities. This report updates the report issued in 1998, Tobacco Use Among U.S. Racial Ethnic Minority Groups. Below are some key points of the current report (the 35th on smoking and health since the landmark 1964 report), and observations about them.
Not included in the report is the fact that tobacco use has ironies that often get overlooked. Tobacco use is not a leading cause of individuals attending addiction treatment or mutual help groups, but it remains according to this report the leading cause of preventable death and disease (with over 480,000 premature deaths per year, nearly 1 in 5). Tobacco is a relatively weak substance (have you ever heard that, like alcohol, you should not drive or not sign a contract if you have been using it?) but for many people tobacco is the last and hardest substance to stop using.
Although there has been dramatic reduction in tobacco use in the US (nationwide more than 70%, from 42.4% in 1965 to 11.5% in 2021), some groups continue to have significantly higher rates of use, including low-income populations, racial and ethnic minorities, LGBTQ+ individuals, and those with mental health conditions. These groups also have higher rates of tobacco-related diseases. It appears that the tobacco industry, recognizing the higher use rates in these groups, targets them in tobacco marketing.
The report encourages the continued use of methods that may be of minor significance in themselves (increased taxation, smoking restrictions, education campaigns, smoking cessation programs), but collectively work well. The fact that many groups are not improving as much as the general population points to variables known as “social determinants of health.” These variables include racism, poverty, and access to healthcare.
It appears unlikely that we will dramatically reduce tobacco problems (or any other addictive problems) unless social determinants of health are substantially improved. It appears to me that such improvements would require such a major restructuring of how the US operates that these improvements are unlikely. For now, to a significant extent, we as individuals are on our own.
From my perspective there are also at least two lessons strongly supported by our experience of tobacco use and the difficulties reducing it. 1) Addiction treatment can be helpful but is not an essential component of change for many individuals. Addiction treatment has not been a major factor for most who resolved tobacco problems. How many residential treatment centers for tobacco use do you know of? 2) The intensity of an individual’s addictive problem is based much more on the learning that has occurred than the strength of the substance (otherwise tobacco, a weaker substance, would be relatively easy to quit).
The most important aspect of addressing an addictive problem is to decide to do so in a persistent way, and to begin by considering what benefits are obtained from the substance or activity. As benefits are better understood, we can begin to learn to replace them or live with less (or none) of them. If you get stuck in that process, addiction treatment, mutual help groups, or many other forms of outside assistance may be helpful.