Despite significant progress in reducing cigarette smoking in the United States, the gains have not been equal across all groups, according to a recent report from the Surgeon General. The report, released on Tuesday, highlights persistent disparities in tobacco use that vary by race, ethnicity, sexual orientation, gender identity, income, education, occupation, geography, and behavioral health status, among other factors.
The data reveals that cigarette smoking and exposure to secondhand smoke contribute to nearly half a million deaths in the U.S. each year—accounting for almost one in five deaths nationwide. This stark statistic underscores the need for targeted action to address the ongoing inequalities.
“Tobacco use imposes a heavy toll on families across generations,” stated Surgeon General Vivek Murthy. “Now is the time to accelerate our efforts to create a world in which zero lives are harmed by or lost to tobacco. This report offers a vision for a tobacco-free future, focusing on those who bear the greatest burden, and serves as a call to action for everyone to play a role in realizing that vision.”
The report emphasizes that although cigarette smoking has seen a steep decline since the 1960s, when the 1964 Surgeon General’s report first linked smoking to lung cancer and heart disease, the benefits of this progress have not reached all communities equally.
In 1965, 42.4% of adults aged 18 and older reported being cigarette smokers. By 2021, that figure had dropped to 11.5%. However, significant disparities remain, especially among certain demographic groups.
In 2020, data showed that 27.1% of American Indian and Alaska Native people were current cigarette smokers. This rate was more than double that of white Americans, at 13.3%, and nearly double that of Black Americans, who reported a 14.4% smoking rate. The report highlighted these figures as evidence of how certain populations continue to suffer from higher smoking rates and their related health risks.
The report also found that economic factors play a significant role in smoking disparities. In 2020, 20.2% of individuals earning less than $35,000 per year were current smokers, compared to only 6.2% of those earning $100,000 or more annually. This suggests that lower-income communities are more vulnerable to the harmful effects of tobacco, both in terms of higher smoking rates and limited access to cessation resources.
Sexual orientation is another key factor in smoking disparities. Between 2019 and 2021, 16.3% of adults identifying as gay, lesbian, or bisexual (LGB) reported being current cigarette smokers, compared to 12.5% of heterosexual adults. Among high school students, the differences were even more pronounced: 10.4% of LGB teens reported current cigarette use, double the 5.3% of heterosexual teens.
“While there is much to celebrate, the progress has not been equal across all populations or communities,” said Adm. Rachel L. Levine, the assistant secretary for health at the Department of Health and Human Services. “Progress in tobacco-related policies, regulations, programs, research, clinical care, and other areas has not resulted in the same outcomes for everyone. We have not made progress unless we have all made progress.”
To address these disparities, the Surgeon General’s Office outlined several action steps aimed at promoting a more equitable public health environment. These recommendations include ensuring more equitable access to healthcare services, setting a maximum nicotine yield in cigarettes to reduce their addictiveness, and introducing additional measures to minimize secondhand smoke exposure.
The report also stresses the importance of culturally tailored interventions, acknowledging that a one-size-fits-all approach will not effectively serve diverse communities. By understanding the unique factors that contribute to higher smoking rates in various populations, targeted policies and programs can be developed to address these issues.
Reducing the nicotine yield in cigarettes is one of the proposed measures to curb smoking rates. Lowering nicotine content can make cigarettes less addictive, thereby encouraging more smokers to quit. This recommendation aligns with the goal of creating a healthier environment for future generations.
Another key suggestion from the Surgeon General’s report is the need for stronger policies to reduce secondhand smoke exposure. Exposure to secondhand smoke remains a major public health issue, particularly in low-income and marginalized communities. By implementing stricter regulations, such as smoke-free public spaces and housing, policymakers aim to protect vulnerable populations from the harmful effects of secondhand smoke.
Additionally, the report calls for greater investment in healthcare accessibility, particularly for underserved communities. Expanding access to smoking cessation programs, counseling, and medication can significantly impact smoking rates among high-risk groups. The Surgeon General’s Office emphasizes that these efforts should prioritize populations with the highest rates of tobacco use, ensuring that resources are allocated where they are most needed.
Education and public awareness campaigns are another critical component in addressing smoking disparities. The report highlights the success of past anti-smoking efforts in reducing smoking rates among the general population. However, it also points out that these campaigns have not always been as effective in reaching marginalized groups. Tailored messaging that resonates with diverse communities can play a vital role in decreasing smoking rates and preventing new smokers from picking up the habit.
Behavioral health is yet another factor contributing to disparities in tobacco use. The Surgeon General’s report notes that individuals with mental health conditions or substance use disorders are significantly more likely to smoke than those without such conditions. Addressing the underlying mental and behavioral health challenges that contribute to higher smoking rates is a key step in closing the gap.
The Surgeon General’s report also underscores the importance of research in understanding the root causes of smoking disparities. It calls for increased funding for studies focused on the social, cultural, and economic factors that influence tobacco use among different groups. By building a more comprehensive understanding of these issues, researchers and policymakers can develop more effective strategies to reduce smoking rates and promote health equity.
In conclusion, the Surgeon General’s report is a call to action for all sectors—healthcare professionals, policymakers, educators, and community leaders—to come together and address the persistent disparities in smoking rates. The report makes it clear that while progress has been made, there is still a long way to go to achieve a truly tobacco-free future for all Americans.