Key points are not available for this paper at this time.
U. S. smoking-related disparities persist, but data evaluating how smoking patterns across diverse populations have changed by birth cohort are lacking. Worldwide, smoking continues to exact harm, especially to low- and middle-income nations with less historical data for smoking analyses. The Cancer Intervention and Surveillance Modeling Network Lung Working Group previously generated smoking histories for the whole U. S. population using an age, period, and birth cohort methodologic framework. These inputs have been used in numerous models to simulate future patterns of smoking and to evaluate the potential impact of policies. However, the absence of detailed model-ready inputs on smoking behaviors for diverse U. S. populations has been a barrier to research evaluating future trends in smoking-related disparities or the projected impacts of policies across sociodemographic groups. This supplement issue provides new estimates of smoking behaviors with detailed historical data by race/ethnicity, by educational attainment, by family income, and for each of the 50 U. S. states and Washington, District of Columbia. All-cause mortality RRs associated with smoking by race/ethnicity and educational attainment are also available for the first time. Finally, the supplement issue presents comprehensive smoking histories for Brazil, showing the application of this methodology to resource-limited settings. Collectively, these data aim to offer insight into future U. S. and global smoking disparities and accelerate research on tobacco control policies that advance health equity. This effort will allow tobacco simulation models to account comprehensively for population diversity, thereby enabling researchers to develop more sophisticated analyses of tobacco use and control interventions. Since the publication of the first Surgeon General's Report on Smoking and Health in 1964, 1U. S. Department of Health Education and Welfare. Smoking and health: report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: U. S. Department of Health, Education, and Welfare, Public Health Service. https: //www. govinfo. gov/app/details/GPO-SMOKINGANDHEALTH. Published 1964. Accessed October 21, 2022. Google Scholar the U. S. has benefited from major improvements to health and life expectancy, partly owing to decades of progress in tobacco prevention and control that drastically reduced smoking and consequently smoking-related morbidity and mortality in the population. 2Holford TR Meza R Warner KE et al. Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964–2012. JAMA. 2014; 311: 164-171https: //doi. org/10. 1001/jama. 2013. 285112Crossref PubMed Scopus (218) Google Scholar Social norms around smoking changed dramatically over this time period; as Americans grew to understand the harms of smoking and secondhand smoke exposure, many quit and quit in droves, and many fewer young people started to smoke. 1U. S. Department of Health Education and Welfare. Smoking and health: report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: U. S. Department of Health, Education, and Welfare, Public Health Service. https: //www. govinfo. gov/app/details/GPO-SMOKINGANDHEALTH. Published 1964. Accessed October 21, 2022. Google Scholar As public health progress unfolded, differences in how communities experienced that progress came to light, and in 1998, Surgeon General's Report on smoking disparities was published, “Tobacco Use among U. S. Racial/Ethnic Minority Groups, ” focused on 4 groups: African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics. 3U. S. Department of Health and Human Services. Tobacco use among U. S. racial/ethnic minority groups: a report of the Surgeon General. Atlanta, GA: HHS, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health https: //www. cdc. gov/tobacco/sgr/1998/completeᵣeport/pdfs/completeᵣeport. pdf. Published 1998. Accessed December 14, 2016. Google Scholar Since then, research examining smoking disparities has proliferated, expanding beyond race/ethnicity to encompass disparities by SES, geographic region, and other sociodemographic characteristics or comorbid health conditions. 4U. S. NIH, National Cancer Institute. A socioecological approach to addressing tobacco-related health disparities. Bethesda, MD: HHS, NIH, National Cancer Institute. https: //cancercontrol. cancer. gov/brp/tcrb/monographs/monograph-22. Published 2017. Accessed May 6, 2018. Google Scholar, 5Doogan NJ Roberts ME Wewers ME et al. A growing geographic disparity: rural and urban cigarette smoking trends in the United States. Prev Med. 2017; 104: 79-85https: //doi. org/10. 1016/j. ypmed. 2017. 03. 011Crossref PubMed Scopus (122) Google Scholar, 6Williams JM Steinberg ML Griffiths KG Cooperman N. Smokers with behavioral health comorbidity should be designated a tobacco use disparity group. Am J Public Health. 2013; 103: 1549-1555https: //doi. org/10. 2105/AJPH. 2013. 301232Crossref PubMed Scopus (99) Google Scholar From 2000 to 2022, 1, 306 articles related to smoking disparities have been indexed through PubMed (Query: Smoking (MeSH Major Topic) AND Disparities). Research related to smoking disparities was synthesized in a 2017 National Cancer Institute Tobacco Control Monograph detailing how smoking disparities have been shaped by multiple factors at the individual, interpersonal, community, and societal levels across the life course. 4U. S. NIH, National Cancer Institute. A socioecological approach to addressing tobacco-related health disparities. Bethesda, MD: HHS, NIH, National Cancer Institute. https: //cancercontrol. cancer. gov/brp/tcrb/monographs/monograph-22. Published 2017. Accessed May 6, 2018. Google Scholar At the societal level, tobacco control interventions such as tobacco taxation, smoke-free air laws, and access to smoking cessation treatment improved public health, but low SES and racial/ethnic minority groups were less likely to benefit. 4U. S. NIH, National Cancer Institute. A socioecological approach to addressing tobacco-related health disparities. Bethesda, MD: HHS, NIH, National Cancer Institute. https: //cancercontrol. cancer. gov/brp/tcrb/monographs/monograph-22. Published 2017. Accessed May 6, 2018. Google Scholar Meanwhile, sophisticated tobacco industry marketing campaigns contributed directly to disparities by targeting women, racial/ethnic minorities, homeless people, and other vulnerable groups. 7Iglesias-Rios L Parascandola M. A historical review of R. J. Reynolds’ strategies for marketing tobacco to Hispanics in the United States. Am J Public Health. 2013; 103: e15-e27https: //doi. org/10. 2105/AJPH. 2013. 301256Crossref PubMed Scopus (36) Google Scholar, 8D'Silva J O'Gara E Villaluz NT Tobacco industry misappropriation of American Indian culture and traditional tobacco. Tob Control. 2018; 27: e57-e64https: //doi. org/10. 1136/tobaccocontrol-2017-053950Crossref PubMed Scopus (24) Google Scholar, 9Brown-Johnson CG England LJ Glantz SA Ling PM. Tobacco industry marketing to low socioeconomic status women in the U. S. A. Tob Control. 2014; 23: e139-e146https: //doi. org/10. 1136/tobaccocontrol-2013-051224Crossref PubMed Scopus (90) Google Scholar, 10Smith EA Thomson K Offen N Malone RE. If you know you exist, it's just marketing poison”: meanings of tobacco industry targeting in the lesbian, gay, bisexual, and transgender community. Am J Public Health. 2008; 98: 996-1003https: //doi. org/10. 2105/AJPH. 2007. 118174Crossref PubMed Scopus (75) Google Scholar, 11Apollonio DE Malone RE. Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill. Tob Control. 2005; 14: 409-415https: //doi. org/10. 1136/tc. 2005. 011890Crossref PubMed Scopus (112) Google Scholar, 12Toll BA Ling PM. The Virginia Slims identity crisis: an inside look at tobacco industry marketing to women. Tob Control. 2005; 14: 172-180https: //doi. org/10. 1136/tc. 2004. 008953Crossref PubMed Scopus (96) Google Scholar, 13Cruz TB Rose SW Lienemann BA et al. Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: a review of the literature. Tob Induc Dis. 2019; 17: 68https: //doi. org/10. 18332/tid/111397Crossref PubMed Scopus (38) Google Scholar Beyond the U. S. , global context also matters: both the WHO Framework Convention on Tobacco Control and international trade agreements have shaped tobacco policies across different countries. 14Jarman H. Normalizing tobacco? The politics of trade, investment, and tobacco control. Milbank Q. 2019; 97: 449-479https: //doi. org/10. 1111/1468-0009. 12393Crossref PubMed Scopus (7) Google Scholar, 15Appau A, Drope J, Labonté R, Stoklosa M, Lencucha R. Disentangling regional trade agreements, trade flows and tobacco affordability in sub-Saharan Africa. Global Health. 2017;13 (1): 81. https: //doi. org/10. 1186/s12992-017-0305-x. Google Scholar, 16Chung-Hall J Craig L Gravely S Sansone N Fong GT. Impact of the WHO FCTC over the first decade: a global evidence review prepared for the Impact Assessment Expert Group. Tob Control. 2019; 28: s119-s128https: //doi. org/10. 1136/tobaccocontrol-2018-054389Crossref PubMed Scopus (106) Google Scholar, 17Craig L Fong GT Chung-Hall J Puska P WHO FCTC Impact Assessment Expert Group. Impact of the WHO FCTC on tobacco control: perspectives from stakeholders in 12 countries. Tob Control. 2019; 28: s129-s135https: //doi. org/10. 1136/tobaccocontrol-2019-054940Crossref PubMed Scopus (17) Google Scholar, 18Drope J Lencucha R. Tobacco control and trade policy: proactive strategies for integrating policy norms. J Public Health Policy. 2013; 34: 153-164https: //doi. org/10. 1057/jphp. 2012. 36Crossref PubMed Scopus (20) Google Scholar In the U. S. , public health authorities have continued to emphasize the importance of understanding smoking disparities and achieving health equity goals for racial/ethnic minorities. American Indian and Alaska Natives have the highest smoking rates of any racial/ethnic group, individuals of low SES continue to bear the brunt of tobacco-related disease and death, 19Health disparities related to commercial tobacco and advancing health equityCenters for Disease Control and Prevention. 2022; (Updated June 27. Accessed Scholar and differences by have been by the of tobacco control policies in the and Lung of tobacco control policies to and tobacco American Lung Published Accessed 2022. Google Scholar tobacco control interventions have been to smoking J et in cigarette smoking in the United Cancer J 2018; PubMed Scopus Google Scholar from campaigns for racial/ethnic and other from Centers for Disease Control and Prevention. Accessed 2022. Google N A review of tobacco prevention and cessation interventions for minority 14: PubMed Scopus (36) Google Scholar impact on smoking disparities will to be sociodemographic differences in cigarette smoking will over the decades will on smoking and across populations and that used to policy and analyses are to understanding the smoking in U. S. As each birth cohort of age, and policy life to smoking young and cessation and an in was by a different tobacco and policy and a different of norms smoking as a the from in have been at smoking the and Major and have the and the behaviors of birth the of smoking and are by the were to American as smoking in birth K The impact of on health: evidence from and PubMed Scopus Google by the to improved and smoking among used N The the use of the from the and Med. 2018; PubMed Scopus Google and the were by to Virginia to young BA Ling PM. The Virginia Slims identity crisis: an inside look at tobacco industry marketing to women. Tob Control. 2005; 14: 172-180https: //doi. org/10. 1136/tc. 2004. 008953Crossref PubMed Scopus (96) Google Scholar In more the National in 2000 as a smoking prevention educational reduced smoking among in the J The of the National on smoking J Med. PubMed Scopus Google Scholar a cohort researchers in smoking patterns to of a the impact of in the of different understand how public health interventions are the smoking behaviors of to and by birth cohort or people in the people in the have smoking by birth cohort for the U. S. population J TR et and mortality in the United from to a Med. 2018; PubMed Scopus Google TR et of birth smoking J Med. 2014; PubMed Scopus Google Scholar but the cohort has been from the smoking disparities This has trends in by but such analyses from multiple birth into a or thereby trends as across in and potential disparities by birth and a more In analyses of a people of low by across birth the population by birth cohort provides a more comprehensive that societal of have the of women and racial/ethnic in as as for future historical time U. S. Accessed 2022. Google Scholar the birth cohort of people with a has a different from that of the birth cohort with in this the educational in future over such as patterns of Institute. December Accessed 6, Scholar with differences in birth United States, for Disease Control and Prevention. 2022; (Updated Accessed October Scholar that among U. S. have from women, the of Hispanics in the This into birth more Hispanics birth U. S. for Washington, DC: Research Published Accessed October 2022. Google Scholar the cohort of smoking by sociodemographic groups that be in and data and trends in smoking used to evaluate smoking progress in the population and the of and groups. However, smoking a of multiple at the smoking histories across the started smoking and smoking how people smoke continue to the with smoke and quit and These behavioral different for and of progress and disparities in smoking across populations and across time and smoking estimates for and Americans Americans smoking at but have less with TR Meza R. of smoking patterns among African American and in the United to PubMed Scopus Google Scholar Americans to have smoking and a of TR Meza R. of smoking patterns among African American and in the United to PubMed Scopus Google Scholar, and differences in how by differences in smoking Control. 17: PubMed Scopus Google Scholar, et and models and Cancer 103: PubMed Scopus Google Scholar, et differences in in the cohort an Cancer 2019; PubMed Scopus Google Scholar Americans are more to other racial/ethnic smoke fewer et and differences in the smoking-related of J Med. PubMed Scopus Google as a Americans are less for the of and differences in how by differences in smoking Control. 17: PubMed Scopus Google R J et of the and harms of with for the U. S. PubMed Scopus Google Scholar, et use and of by and Surveillance 2022; PubMed Scopus Google Scholar, Lung health 2018; PubMed Scopus Google Scholar, of among African American in 2019; PubMed Scopus Google Scholar, et for in N J Med. J Med. 2013; PubMed Scopus Google Scholar These contributed to the by the U. S. to to people have fewer et for U. S. PubMed Scopus Google Scholar A comprehensive of historical smoking patterns and behaviors each U. S. future health equity to policy or treatment interventions for groups by age, and sociodemographic factors race/ethnicity, The Cancer Intervention and Surveillance Modeling Network Lung Working Group has previously age, period, and birth cohort models for the whole U. S. smoking using data from the National Health J TR et and mortality in the United from to a Med. 2018; PubMed Scopus Google TR et of birth smoking J Med. 2014; PubMed Scopus Google Scholar These analyses generated estimates of the of for smoking and smoking cessation by age, and birth with the in Collectively, these are by trends in smoking in the U. S. These estimates are a comprehensive of the smoking for groups. presents smoking by birth cohort for the U. S. population generated by the Lung Working Group. The approach be across different sociodemographic thereby of smoking patterns across groups for age, period, and cohort This historical of the smoking by race/ethnicity, SES, and geographic thereby a more of the and smoking disparities. Research in this to develop strategies that aim to tobacco and health equity but have to The smoking are and cohort and the of inputs that have been to future smoking trends for the population as a whole are used as inputs for simulation models of tobacco tobacco control and for the U. S. J TR et and mortality in the United from to a Med. 2018; PubMed Scopus Google P J et of smoking cessation interventions in the a simulation Cancer PubMed Scopus Google Scholar, P et of in the United a Med. 2019; PubMed Scopus Google Scholar, J J et the of tobacco control policies in the through a 2018; Scopus Google Scholar, R et deaths in by with Control. 2018; 27: PubMed Scopus Google Scholar, E et public health of levels in in the United J Med. 2018; PubMed Scopus Google Scholar, of a in the by smoking to the African American population over Control. Google Scholar These models have been used to evaluate the potential impact of tobacco policies on smoking and J TR et and mortality in the United from to a Med. 2018; PubMed Scopus Google J J et the of tobacco control policies in the through a 2018; Scopus Google E et public health of levels in in the United J Med. 2018; PubMed Scopus Google TR et of reduced tobacco smoking on mortality in the United Cancer 104: PubMed Scopus Google Scholar, J et health of in the the smoking and simulation Health PubMed Scopus Google Scholar, of Health of the for Tobacco The National Washington, Accessed December 14, 2016. Google Scholar the and harms of different R J et of the and harms of with for the U. S. PubMed Scopus Google Meza R et and harms of a for the U. S. Med. 2014; PubMed Scopus Google Scholar, R K et of and models that of the and 2014; PubMed Scopus Google Scholar, Meza R et from many from the National Lung using 2014; PubMed Scopus Google Scholar and P et of in the United a Med. 2019; PubMed Scopus Google P J Meza R. of and harms of for a 2022; PubMed Scopus Google Scholar, K P et of the U. S. for PubMed Scopus Google Scholar, K et impact of on the of J 2017; PubMed Scopus Google Scholar as as the of smoking cessation in R P J et of and cessation interventions the new of the U. S. 2022; 17: PubMed Scopus Google P L et of a Smoking in the Cancer 2022; PubMed Scopus Google Scholar Tobacco simulation models are for and policy analyses have to such models for and in smoking disparities by income, and health NIH, National Cancer Institute. A socioecological approach to addressing tobacco-related health disparities. Bethesda, MD: HHS, NIH, National Cancer Institute. https: //cancercontrol. cancer. gov/brp/tcrb/monographs/monograph-22. Published 2017. Accessed May 6, 2018. Google of a in the by smoking to the African American population over Control. Google J Warner KE K Meza R. The potential impact of cessation treatment for with J Med. PubMed Scopus Google J K Warner KE Meza R. Modeling mortality among with major in the United States. Prev Med. PubMed Scopus Google Scholar However, models are as as the smoking inputs and the of detailed data inputs for in a and has the of and to progress health equity these mortality inputs that differences by smoking status for estimates for mortality by smoking status are available for the U. S. et trends in smoking-related mortality in the United J Med. 2013; PubMed Scopus Google Scholar, et of and smoking with mortality in the United PubMed Scopus Google Scholar, The health of of a report of the Atlanta, GA: HHS, Centers for Disease Control and National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Published Accessed December 14, 2016. Google Scholar the of such estimates for different sociodemographic groups also an to health equity research This supplement presents the detailed and comprehensive historical of U. S. smoking patterns and disparities to decades of data from the National Health and a the Lung Working Group the smoking histories for U. S. as by race/ethnicity, family income, of educational attainment, and of As the data more the methodologic more presents of the methodology in previously and to new sociodemographic groups this supplement of the in this supplement issue U. S. populations: 4 examining smoking histories for and a examining mortality associated with smoking by age, race/ethnicity, and these the to harms by smoking commercial and tobacco used for traditional or et the will be into a traditional tobacco J Public Health. PubMed Scopus Google Scholar The used to to and with that be used to to factors and for factors such as or both in PubMed Scopus Google Scholar are have as of Meza et R P J et of birth smoking histories by and in the J Med. 2022; Google Scholar of smoking patterns by race/ethnicity presents a major historical smoking histories by age, and birth cohort for American Indian and Alaska that the of health harms by cigarette the the first smoking are also available for the and Asian and Pacific of and P J J et disparities by of educational attainment and birth cohort in the J Med. 2022; Scholar of smoking-related disparities by SES an the of major of smoking less individuals have smoking more individuals have However, analyses of birth cohort smoking patterns by of educational attainment among with the levels of in the U. S. in smoking disparities by of family or of to owing to data the of a and on family the U. S. Accessed December 2022. Google Scholar of et J P et smoking patterns by family in the J Med. Scopus Google Scholar was the methodologic The data to The an historical of smoking behaviors across U. S. birth as by status to and researchers and will from detailed smoking in this supplement issue by and TR L J et histories by in the J Med. Scopus Google Scholar The generated comprehensive smoking histories for each of the 50 U. S. states and the District of Columbia. detailed historical each smoking as shaped by the societal and policy norms of for smoking behaviors are to analyses for mortality estimates are also The mortality of et J et by race/ethnicity, and J Med. Scopus Google Scholar to this the presents detailed of mortality estimates by race/ethnicity and and to smoking The and J et by race/ethnicity, and J Med. Scopus Google Scholar mortality with the smoking by Meza et R P J et of birth smoking histories by and in the J Med. 2022; Google Scholar and and P J J et disparities by of educational attainment and birth cohort in the J Med. 2022; Scholar offer a of data to and for race/ethnicity and groups. analyses of mortality estimates by and family The methodology has been to numerous U. S. for and geographic across the and for et A A TR Smoking patterns on histories from to with to PubMed Scopus (7) Google Scholar have the to smoking histories for the population of using data from to fewer data are available for this be to this methodology to other especially low- and middle-income nations that are by the global of In people into to public has progress but as the in over et al. Tobacco secondhand smoke and to tobacco in of the National Health and Google Scholar people smoke in this This supplement issue provides the first of the methodology to The Lung Working Group and at the National Cancer Institute detailed smoking histories of the population for birth from to fewer historical data available from the National and National Health and the approach for J, M, et of Smoking in Brazil, J In Scholar The the of this methodology to a resource-limited that be in other with The U. S. race/ethnicity, income, and but future smoking be to evaluate such as racial/ethnic groups by As the smoking generated for the population be to differences the by region, race/ethnicity, or analyses are to estimates for more American and The of should be as offer a health equity has been in by the of to understand smoking behaviors This supplement issue to accelerate tobacco control progress and research on tobacco-related health disparities and impacts on The data generated in this supplement issue are available for to and through an at The data be used to future smoking different for or status or policies that impact smoking Tobacco of Health of the for Tobacco The National Washington, Accessed December 14, 2016. Google P L et of a Smoking in the Cancer 2022; PubMed Scopus Google Scholar or J J et of smoking and mortality associated with health on cigarette in the U. S. from to Health PubMed Scopus Google Scholar also use the data to evaluate in smoking disparities groups over time and to the impacts of different policy interventions on population research evaluating policies as impact tobacco use disparities for diverse populations Impact of population tobacco control interventions on socioeconomic in a review and of future research Control. PubMed Scopus Google Scholar, ME et al. Tobacco smoking and tobacco-related health disparities among in the 2022; PubMed Scopus Google Scholar, et and campaigns as a of smoking and related disparities in the United 2022; PubMed Scopus (7) Google Scholar, et al. A of smoke-free and smoking disparities among young in the United 2022; PubMed Scopus Google Scholar, et and disparities in smoking in the U. S. , J Med. PubMed Scopus Google Scholar, L et and disparities in smoking in the United Health. PubMed Scopus Google Scholar, L Meza R et policies and smoking cessation in the United States, J Public Health. 2019; PubMed Scopus Google Scholar, L The and Smoking among J Med. 2019; PubMed Scopus Google Scholar, S impact of interventions and policies to smoking in Control. 2014; 23: PubMed Scopus Google Scholar, S impact of interventions and policies to smoking in a 2014; PubMed Scopus Google Scholar, Tobacco and impact on disparities in smoking and among young in J Health. J Health. Scholar, S Impact of public smoking on in to tobacco smoke at an 2019; PubMed Scopus Google Scholar are for researchers to the smoking in this supplement issue with research on the impacts of tobacco policies or for vulnerable and policy to from such Finally, the application of to other and should analyses of historical smoking patterns and the of in the of policies aimed at smoking-related morbidity and mortality but also smoking-related disparities The in this are that of the and the policy of the This was through National Cancer Institute and and also from also by the National Institute on an of the were by the of this This of a supplement of Smoking by Group in the U. S. , by the National Cancer Institute and also from The and in this are of the and the of review review review review review review
Tam et al. (Sat,) studied this question.