Journal of the National Cancer Institute. Monographs最新文献

There is growing acknowledgment that tobacco-related health disparities and social inequities among racialized groups in the United States are linked to colonialism. Tobacco as a cash crop helped to advance colonial economic and political wealth and control through the exploitation of people of African-descent and Indigenous people and their land for centuries. Few scholars have acknowledged or delineated the historical context of tobacco-related health disparities. This paper provides a brief overview of the history of commercial tobacco-related health disparities in the United States and describes how tobacco-fuel colonialism that began in the early 1600s influenced present-day patterns of the social determinants that are the foundation for health disparities. A discussion of the tobacco historical context helps us to understand generational structured and systemic inequalities and informs the type of public health, social, structural, cultural, and political actions that should be taken to end disparities among historically marginalized groups.

Background: Lung cancer incidence has been decreasing in the United States, largely due to smoking reductions. However, adenocarcinoma incidence has been relatively stable compared with other histological subtypes. Histology-specific lung cancer incidence varies by key sociodemographic characteristics, but trends are not well characterized.

Methods: SEER 17 registry data was used to calculate annual age-adjusted lung cancer incidence over 2000-2019 by histology stratified by individual-level sex and race/ethnicity and county-level education, poverty, or urbanicity. Histology was categorized into 4 groups: adenocarcinoma, small cell, squamous cell, and other histologies. Age-adjusted incidence rates were computed using the 2000 US Standard Population. Incidence trends were characterized using Joinpoint regression.

Results: For most histological subtypes, lung cancer incidence has been decreasing since 2000 in both sexes and all racial/ethnic groups, with some variations. However, lung adenocarcinoma incidence was relatively constant. Lung cancer incidence decreases with increasing education and income. It is lower in urban vs rural areas across histological subtypes, except for adenocarcinoma among females. Counties with higher education levels or lower poverty rates experienced faster declines in small cell and squamous cell lung cancer incidence in recent years. The incidence of small cell and squamous cell lung cancer has been decreasing more rapidly in urban than rural areas.

Conclusion: Disadvantaged groups have higher lung cancer rates and slower decreases in incidence over time for most histological subtypes, resulting in widening disparities. This highlights the need for targeted tobacco and lung cancer prevention strategies to accelerate decreases in vulnerable populations.

Little is known about how the intersections of social identities and circumstances exacerbate cigarette smoking disparities among US adults. We analyzed data from the 1995-2019 Tobacco Use Supplement to the Current Population Survey (n = 1 496 458). Participants reported current cigarette smoking status (smoking cigarettes some days or every day vs not smoking at all) and 13 social identities (eg, race, ethnicity, Hispanic heritage) and circumstances (eg, education, marital status). We applied a statistical-learning boosting algorithm that allows interactions of these identities and circumstances to identify a minimal set of social identities and circumstances within each race/ethnicity with maximum predictive accuracy for current smoking. We then used weighted logistic regression models with interaction terms to estimate predicted marginal probabilities by 3-way combinations of these identities and circumstances. We found that social identities and circumstances 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. Social identities and circumstances associated with current cigarette smoking differed somewhat by race/ethnicity (eg, citizen status was an important variable only among Hispanic and Black/African American adults). Prevalence of current cigarette smoking varied greatly by combinations of these identities and circumstances within each race/ethnicity (eg, 73.4% among 31-45-year-old American Indian adults in the Midwest whose spouse was absent vs 6.7% among American Indian adults in the South with bachelor's degrees and >$75 000 annual household income). These findings allow tobacco control researchers and practitioners to develop and deliver tailored interventions to reduce cigarette smoking disparities.

The 1998 Surgeon General's Report-Tobacco Use Among US Racial/Ethnic Minority Groups revealed a need for cessation interventions targeting the Hispanic/Latino (H/L) population. Although progress has been made in the years since the report's release, H/L tobacco users continue to have limited access to cessation medication and support services. Cultural barriers and misconceptions have also complicated cessation efforts. Furthermore, the tobacco industry continues to specifically target H/L communities and youth in smoking and vaping outreach programs. Despite these challenges, some outreach and cessation efforts have shown promising results. Text- and app-based interventions and Spanish-specific educational campaigns have been uniquely effective in engaging H/L tobacco users. Policy changes and public health initiatives at the local, state, and federal level have also been helpful. The most effective approaches have common insights, including the importance of community engagement, the value of partnerships with health-care providers, and a culturally and linguistically adapted foundation.

Background: Flavored tobacco products are associated with youth and young adult tobacco use and disparities by racial and ethnic minorities and those of lower socioeconomic status.

Methods: We used Truth Longitudinal Cohort of 19 341participants aged 15-21 years (9 waves, 2014-2019) examining policy exposure impacts on tobacco use. Participants' current any and menthol cigarette and/or flavored cigar use were linked to living in a jurisdiction with a flavored sales restriction and/or comprehensive smoke-free policy based on home address at wave. We estimated risk ratios using Poisson regression for any tobacco product and menthol cigarettes and/or flavored cigar use with interactions of policy and wave by race and ethnicity and financial situation.

Results: Policy exposure to flavored sales restrictions rose from 1% of participants at wave 1 to 13% at wave 9. Respondents in areas with flavor plus comprehensive smoke-free policy reduced tobacco use risk by 13% (adjusted relative risk [RR] = 0.87, 95% confidence interval [CI] = 0.77 to 0.99) and no flavor plus comprehensive smoke-free by 8% (adjusted RR = 0.92, 95% CI = 0.87 to 0.98) vs those in no flavor plus noncomprehensive smoke-free policies areas. There were no statistically significant relationships between policy and menthol cigarette and/or flavored cigar use, but most policies in this period exempted menthol and/or mint-flavored tobacco product from the policy thus allowing for sales of menthol cigarettes and menthol and/or mint-flavored cigars. No interactions of policy by race and ethnicity or socioeconomic status were statistically significant.

Conclusions: Flavor and comprehensive smoke-free policy exposure compared with exposure to neither policy were prospectively associated with reduced any tobacco use. The impact of flavor policy exposure on any tobacco use was consistent across diverse racial and ethnic groups and socioeconomic position. As flavor policies have strengthened and spread, they have potential for reducing risk of tobacco use among youth and young adults from all populations, including those experiencing tobacco-related health disparities.

Tobacco use is related to persistent health disparities and is the leading preventable cause of death worldwide. The negative effects of tobacco on health have been a longstanding public health issue. Historically, the US response to the detrimental impact of smoking has been related to taxes and public bans. Although these interventions have reduced overall smoking rates, little has been done to reduce tobacco-related disparities, especially among racial and ethnic minority groups, low-income groups, and rural populations. As the immediate past president of the National Medical Association, I am deeply committed to addressing the toll that tobacco use has taken on marginalized communities. Tobacco-related disparities have created a public health crisis that disproportionately affects marginalized communities. It is time we shift the paradigm in how we approach these disparities and seek innovative, community-centered solutions to reduce tobacco use and improve health outcomes within a structured timeline.

The US surgeons general have been at the forefront of directing global attention to tobacco-caused cancers and related health disparities. We conducted an in-person interview with M. Joycelyn Elders, MD, MS, 15th surgeon general of the United States, to understand her perspective on (1) the progress we have made toward eliminating tobacco-related health disparities, (2) progress we hope to make, and (3) actions that must be taken to eliminate disparities. Dr Elders indicated that banning cigarette smoking on planes and in public places resulted in substantial gains. She stated that educational efforts must be made in a way that people understand and that all people must be involved in eliminating disparities, including the federal government, which can reduce the availability of menthol cigarettes. Dr Elders indicated that surgeons general must continue to promote diversity, equity, and inclusion and advance the global mission to improve health.

Although numerous US jurisdictions restrict the sale of flavored tobacco products, the comprehensiveness of policies varies greatly. This study assesses differences in tobacco product use and flavored tobacco use among youth and young adults residing in areas with and without flavored tobacco restriction policies other than federal-level restrictions, by strength of policy. Cross-sectional data come from Wave 1 (October 2022) of the nationally representative Tobacco Epidemic Evaluation Network (TEEN+) Study of US youth and young adults (N = 10 255). Respondents' latitude and longitude were used to assign flavor policy coverage as no policy (80.9%), partial policy (major exemptions, 11.1%), or strong policy (minor/no exemptions, 8.0%). Policy coverage varied by several demographic characteristics, including race and ethnicity (P < .001), household smoking (P < .01), and household e-cigarette exposure (P < .01). Compared with living in an area with no flavor policy, a lower prevalence of any tobacco product use (aPR = 0.76, P < .001) and a lower prevalence of any flavored tobacco product use (aPR = 0.70, P < .001) were observed for those covered by strong flavor policies in multivariable Poisson regressions, adjusting for other individual- and state-level covariates. Living in an area with a partial flavor restriction was not significantly associated with different prevalence of either outcome in adjusted models compared with living in an area with no flavor policy. However, currently only 1 in 12 young people are protected by strong flavored tobacco sales restrictions, with notable gaps by race and ethnicity. Strong flavored tobacco sales restrictions that protect everyone, everywhere might help accelerate declines in youth and young adult tobacco use.