Tobacco use is not an equal opportunity killer. Smoking disproportionately affects those most in need such as the poor, the homeless, racial minorities, LGBT persons and those suffering from mental illness and substance use disorders. While there have been declines in both youth and adult tobacco use in America, gaps in health equity persist. These trends are well documented, having been the subject of many policy statements, academic analyses, and the subject of the 1998 Surgeon General’s report, Tobacco Use among U.S. Racial/Ethnic Minority Groups.
The facts are compelling. Americans with lower levels of education and income are significantly more likely to smoke than more affluent or educated Americans. Smoking prevalence is 50% higher among LGBT Americans compared with straight Americans. Those grappling with mental illness comprise nearly a third of all adult smokers. Even among populations who smoke less than the general population (such as African American adults), death and disease is greater than among the general population, partially due to lack of cessation resources and treatment options. Moreover, those groups most impacted by the tobacco epidemic have consistently been targets of marketing by the tobacco industry designed to hook them on their deadly product.
To end the tobacco epidemic in America, all populations must be included in developing policies and practices designed to reduce tobacco use, increase cessation, and improve access to treatment for tobacco-related disease. Below is a summary of key facts on prevalence, cessation, health effects, and marketing among demographic groups most severely impacted by the tobacco epidemic.