We’re celebrating the decline of tobacco use among both adults and youth in the US, but unfortunately, this progress has not been equal among all demographic groups.  

In November 2024, US Surgeon General Vivek Murthy released a report exposing disparities in tobacco-related disease and death — the second-ever report by the Surgeon General to focus on this complex topic. There have been more than 30 Surgeon General reports on tobacco over the past 60 years, and a report on tobacco disparities between racial and ethnic groups was published in 1998, but this new report examines disparities relating to numerous identities and lifestyle factors.  

Dr. Murthy writes, “Tobacco-related health disparities are a social injustice, in addition to an economic and health burden… Social, structural, and commercial determinants of health—such as persistent poverty and inequitable economic and social conditions—lead to inequitable opportunities for living a life free from tobacco-related death and disease.” (Page 9) 

We combed through the more than 800-page report for the three main takeaways:  

Some demographic groups are more likely to use tobacco.  

In this report, “tobacco products” include any product made, containing, or derived from tobacco or nicotine, including combustible cigarettes, e-cigarettes, cigars, smokeless tobacco, and more (page 5).  

Despite progress in reducing tobacco use, certain communities are more likely to use tobacco products, including: 

• Some racial and ethnic groups, with American Indians and Alaska Natives having the highest overall tobacco use rate (page 66). This commercial tobacco use is distinct from the traditional tobacco use practiced by indigenous communities (page 14). 

• People living in poverty, based on household income compared to the federal poverty level (page 195) 

• LGBTQ+ individuals (page 196) 

• People with substance use disorder or any mental health condition (page 123) 

Additionally, youth, Black people, and people living below the federal poverty level are more likely to be exposed to secondhand smoke (page 196). 

These disproportionate rates of use aren’t surprising, because…  

The tobacco industry historically has disproportionately targeted certain communities.   

The report highlighted the numerous unethical marketing tactics the tobacco industry uses to target vulnerable communities. For example, all tobacco products, especially menthol cigarettes, are advertised more in predominantly Black and low-income neighborhoods than other areas (page 440).  

Another surprising finding: Members of the LGBTQ+ community, along with low-income individuals, are more likely to receive coupons and discount codes for tobacco products. “Use of coupons appears to increase the likelihood of tobacco initiation among people who have never used tobacco and to reduce the likelihood of quitting among people who use tobacco,” the report finds (page 440).  

We can work together to end the harms of the tobacco industry.  

The information in this report is sobering, but it ends with a hopeful call to action. The report offers numerous suggestions for reducing tobacco use overall and closing demographic-based disparities in tobacco prevention and treatment.  

According to the report, tried-and-true systemic tobacco prevention strategies, like smokefree policies for indoor spaces and public health campaigns, are still effective and needed (page 716).  

It also highlighted some specific interventions to reduce tobacco use among targeted groups. For example, a ban on menthol and flavored tobacco products — which has been under consideration by the FDA for several years — would likely reduce overall tobacco use, and could especially benefit the Black community. The report also calls for policies that limit and regulate tobacco retailers in neighborhoods predominately occupied by people of color and low-income individuals (page 716).  

The report also detailed some suggestions specifically targeted to youth. It called for price increases on tobacco products, noting that youth are especially price-sensitive, and this could discourage them from even experimenting with nicotine products. Another interesting finding: participating in extracurriculars and “feeling a sense of belonging at school” makes teens less likely to begin using tobacco (page 11). Making youth feel like they belong at school and in the community is a simple but meaningful way to prevent youth tobacco use.

---

Find the full report, an executive summary, and more here.