Unfair and Unjust Practices and Conditions Harm African American People and Drive Health Disparities
Some U.S. historical policies and practices have led to mental and physical health risks and challenges, and related long-term health outcomes, for African American people. For example:
- For centuries, African American people have been harmed by unjust practices related to the sale of commercial tobacco*.6,7,8 For instance, enslaved people were forced to grow and harvest tobacco that would later be sold.7
- Tobacco companies have a long history of trying to influence African American people by donating to historically Black colleges and universities and sponsoring scholarships for African American students.3,6 They also give money to influential African American people, officials, and organizations.5 Tobacco companies have also advertised more heavily in magazines with larger numbers of African American readers.9
- African American people also experience discrimination and harm from systems meant to protect and improve health and well-being, including health care and medical science.10,11,12 Research shows that some African American people may hesitate to seek care because they don’t trust the government or healthcare systems13,14 that have treated African American people unfairly in the past.
- As recently as the 20th century, doctors and researchers have done studies and medical procedures on African American people without their permission or knowledge. During the Tuskegee Study of Untreated Syphilis in African American Men, researchers allowed Black men with syphilis to go untreated in order to compare their symptoms to Black men without syphilis who were also part of the study. Other times, African American women were sterilized (made unable to have children) without agreeing to it first. These actions led to mistrust of health care and medical research,15,16,17 and help to explain some of the causes of health disparities.
Other reasons—like the ones explored below—help explain why the health of African American people is affected by commercial tobacco.
The tobacco industry targets African American communities with marketing and advertising
Marketing plays a big role in whether people try or use commercial tobacco products. Being around commercial tobacco ads makes smoking appear more appealing and increases the chance that someone will try smoking for the first time or start using commercial tobacco products on a regular basis:18,19
- Neighborhoods and areas with more African American residents tend to have more stores that sell tobacco.20
- Tobacco companies advertise more heavily in stores whose customers are mostly African American people.21
- Tobacco companies use price promotions such as discounts and multi-pack coupons—which are most often used by African American people and other minority groups, women, and young people—to increase sales.22
- Tobacco companies support cultural events designed to draw in certain groups in the Black community. One recent campaign targeted at Black young adults involved pop-up concerts featuring hip-hop artists in convenience stores.23
To help protect African American people from commercial tobacco marketing and discourage tobacco use, states and communities could consider increasing prices and prohibiting price discounts, prohibiting the sale of flavored tobacco products, and either allowing fewer stores in a neighborhood to sell commercial tobacco products or prohibiting tobacco product sales altogether.24
Tobacco companies promote flavored products – especially menthol - in neighborhoods where African American people live
Menthol has a minty flavor that can mask the harsh taste of tobacco. Menthol makes cigarette smoke feel easier to inhale and can make it harder to quit smoking.25,26,27 To attract African American people as customers, tobacco companies target African American communities with advertising and sales of flavored cigarettes—especially those with menthol.6
Tobacco companies have aggressively marketed menthol cigarettes to African American people since at least the 1950s and continue to do so today.6,28
- In the 1970s and 1980s, a tobacco company’s “menthol push” included ad campaigns with messages tailored to Black people and images featuring Black models or hip-hop icons.29,30
- In 2019, about 85% of Non-Hispanic Black adults who smoked cigarettes used menthol cigarettes.31
- In 2019, about 58% African American youth aged 12 to 17 who reported smoking cigarettes used menthol cigarettes.31
- Menthol products are given more shelf space in stores that have large numbers of Black customers.32
- Stores located near schools with more Black students have been more likely to promote menthol cigarettes through advertising and discounts.33 The more Black children who live in a neighborhood, the more likely it is that menthol specific marketing will be advertised near candy displays in stores.22
- Stores in neighborhoods with more Black residents or residents with lower incomes advertise flavored little cigars and cigarillos more often and may also have more of them available to buy.34
There are actions that states and communities could take to make flavored commercial tobacco products less available, which might help more African American people quit smoking (and might keep some African American people from starting to smoke).35,36
- In 2009, the Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration the authority to ban sales of all characterizing flavors in cigarettes, except menthol. Cities, towns, and communities that have limited the sale of flavored products have seen the odds of residents (including young people) using any type of tobacco products or trying flavored tobacco products go down.37
- A 2011 study that modeled what could happen if the U.S. banned sales of menthol cigarettes nationwide estimated that, by year 2050, such a policy could save more than 600,000 lives, including nearly 250,000 Black lives.38
Stress can increase commercial tobacco use and make health problems worse
Stress, such as that caused by financial problems, discrimination, or violence, can make people in general more likely to smoke.39
Racism and discrimination are constant sources of stress for many African American people.40 In 2019, the majority of African American people said they had personally been discriminated against because of their race.41The pressure of discrimination has been associated with tobacco product use behavior that a person will begin to use tobacco42,43 and can also make it harder to quit.39
Health care itself can be a source of discrimination. One in 3 Black adults say they have personally experienced racial discrimination when going to the doctor—and many report avoiding seeking medical care because of it.44
When people experience severe or long-lasting forms of stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems like high blood pressure and diabetes.45,46 Smoking cigarettes also leads to disease and disability and harms nearly every organ of the body.47
- Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep 2022;71:397–405 [accessed 2022 May 25].
- Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1–29. [accessed 2022 May 24].
- U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General [PDF - 389KB]. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 1998 [accessed 2021 Jan 19].
- Schoenborn CA, Adams PF, Peregoy JA. Health Behaviors of Adults: United States, 2008–2010 [PDF - 3.2MB]. National Center for Health Statistics. Vital Health Stat 10(257) [accessed 2021 Jan 19].
- Robinson RG, Barry M, Bloch M, Glantz S, Jordan J, et al. Report of the Tobacco Policy Research Group on marketing and promotions targeted at African Americans, Latinos, and women. Tobacco Control, 1992 [PDF - 1.2MB];1(Suppl 1): S24-S30 [accessed 2021 Jan 19].
- Gardiner PS. The African Americanization of menthol cigarette use in the United States. Nicotine & Tobacco Research [PDF - 262KB]. 2004: V6(S1): S55–S65. [accessed 2021 Jan 19].
- Gately, Iain. Tobacco: A Cultural History of How an Exotic Plant Seduced Civilization. New York: Grove Press, 2001.
- Edmund S. Morgan, American Slavery, American Freedom: The Ordeal of Colonial Virginia (New York: Norton, 1975), pp. 154–157.
- McCandless, P. M., Yerger, V. B., & Malone, R. E. (2012). Quid pro quo: Tobacco companies and the black press. AJPM, 2012;102(4):739-750 [accessed 2021 Jan 19].
- Prather C, Fuller TR, Jeffries WL 4th, et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity. 2018;2(1):249-259. [accessed 2021 Jan 19].
- Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press, 2013 [accessed 2021 Jan 19].
- Institute of Medicine (US) Committee on the Consequences of Uninsurance. Care Without Coverage: Too Little, Too Late. Washington (DC): National Academies Press, 2002 [accessed 2021 Jan 19].
- Scharff, DP et al. More than Tuskegee: understanding mistrust about research participation. Journal of health care for the poor and underserved, 2010;21(3): 879-97 [accessed 2021 Jan 19].
- Armstrong K, Ravenell KL, McMurphy S, and Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Preventive Med 2007;97(7): 1283–1289 [accessed 2021 Jan 19].
- U.S. National Library of Medicine. Native Voices: Timeline: Government admits forced sterilization of Indian Women, 2011 [accessed 2021 Jan 19].
- Stern AM. Sterilized in the name of public health: race, immigration, and reproductive control in modern California. Am J Public Health 2005;95(7):1128-38 [accessed 2021 Jan 19].
- Novak NL, Lira N, O’Connor KE, Harlow SD, Kardia SLR, Stern AM. Disproportionate Sterilization of Latinos Under California’s Eugenic Sterilization Program, 1920-1945. Am J Public Health. 2018;108(5):611-613 [accessed 2021 Jan 19].
- Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Preventive Medicine 2005;41(2):511-20 [accessed 2021 Jan 19].
- Charlesworth A and Glantz S. Smoking in the movies increases adolescent smoking: A review. Pediatrics 2005;116(6): 1516-28 [accessed 2021 Jan 19].
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- U.S. Federal Trade Commission. Federal Trade Commission Cigarette Report for 2017 [PDF - 361KB]. 2019 [accessed 2021 Jan 19].
- Lee JG, Henriksen L, Rose SW, Moreland-Russell S, and Ribisl KM. A systematic review of neighborhood disparities in point-of-sale tobacco marketing. Am J Public Health, 2015;105(9): e8-e18 [accessed 2021 Jan 19].
- National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention, 2012 [accessed 2021 Jan 19].
- Ganz O, Rose SW, Cantrell J. Swisher Sweets ‘Artist Project’: Using musical events to promote cigars. Tobacco Control 2018;27: e93-e95 [accessed 2021 Jan 19].
- Robertson L, McGee R, Marsh L, and Hoek J. "A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine & Tobacco Research 2015;17(1): 2-17 [accessed 2021 Jan 19].
- Ton HT, Smart AE, Aguilar BL, et al. Menthol enhances the desensitization of human alpha3beta4 nicotinic acetylcholine receptors. Mol Pharmacol 2015;88(2):256-64 [accessed 2021 Jan 19].
- Oliver AJ, Jensen JA, Vogel RI, Anderson AJ, and Hatsukami DK. Flavored and nonflavored smokeless tobacco products: Rate, pattern of use, and effects. Nicotine Tob Res 2013;15(1):88-92 [accessed 2021 Jan 19].
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- Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004-2014. Tob Control. 2016;25:ii14-ii20. [accessed 2021 Jan 19].
- U.S. Food and Drug Administration. Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol Versus Nonmenthol Cigarettes. Rockville, MD [accessed 2021 Jan 19].
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- Center for Public Health Systems Science. Point-of-Sale Strategies: A Tobacco Control Guide [PDF - 7.8MB]. St. Louis: Center for Public Health Systems Science, George Warren Brown School of Social Work at Washington University in St. Louis and the Tobacco Control Legal Consortium, 2014 [accessed 2021 Jan 19].
- Kong AY, Queen TL, Golden SD, Ribisl KM. Neighborhood Disparities in the Availability, Advertising, Promotion, and Youth Appeal of Little Cigars and Cigarillos, United States, 2015. Nicotine Tob Res. 2020 [accessed 2021 Jan 19].
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- Giovino GA, Villanti AC, Mowery PD et al. Differential Trends in Cigarette Smoking in the USA: Is Menthol Slowing Progress? Tobacco Control, 2015;24(1):28-37 [accessed 2021 Jan 19].
- U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General [PDF - 9.8MB]. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2020 [accessed 2021 Jan 19].
- Levy DT, Pearson JL, Vilanti AC, Blackman K, Vallone DM, Niaura RS, Abrams DB. Modeling the Future Effects of a Menthol Ban on Smoking Prevalence and Smoking-Attributable Deaths in the United States. American Journal of Public Health, 2011;101: 1236-1240 [accessed 2021 Feb 17].
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