Article

Identifying health disparities across the tobacco continuum

National Cancer Institute, Bethesda, MD 20892-7337, USA.
Addiction (Impact Factor: 4.6). 11/2007; 102 Suppl 2:5-29. DOI: 10.1111/j.1360-0443.2007.01952.x
Source: PubMed

ABSTRACT Few frameworks have addressed work-force diversity, inequities and inequalities as part of a comprehensive approach to eliminating tobacco-related health disparities. This paper summarizes the literature and describes the known disparities that exist along the tobacco disease continuum for minority racial and ethnic groups, those living in poverty, those with low education and blue-collar and service workers. The paper also discusses how work-force diversity, inequities in research practice and knowledge allocation and inequalities in access to and quality of health care are fundamental to addressing disparities in health.
We examined the available scientific literature and existing public health reports to identify disparities across the tobacco disease continuum by minority racial/ethnic group, poverty status, education level and occupation.
Results indicate that differences in risk indicators along the tobacco disease continuum do not explain fully tobacco-related cancer consequences among some minority racial/ethnic groups, particularly among the aggregate groups, blacks/African Americans and American Indians/Alaska Natives. The lack of within-race/ethnic group data and its interactions with socio-economic factors across the life-span contribute to the inconsistency we observe in the disease causal paradigm.
More comprehensive models are needed to understand the relationships among disparities, social context, diversity, inequalities and inequities. A systematic approach will also help researchers, practitioners, advocates and policy makers determine critical points for interventions, the types of studies and programs needed and integrative approaches needed to eliminate tobacco-related disparities.

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Available from: Deirdre (Dee) Lawrence Kittner, Nov 14, 2014
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    • "This is due in part to smoking restrictions, clear air rules, non-smoking norms, and insurance initiatives at full-time higher-income workplaces that reduce the availability and acceptability of smoking (Bauer et al. 2005; Sorensen et al. 2004). Moreover, individuals with higher income, who have health insurance, and/or are employed full-time have an increased sense of self-efficacy and personal control (Mirowsky and Ross 2007) and are able to afford and access more effective nicotine cessation programs (Cokkinides et al. 2005; Fagan et al. 2007a, b; Lillard et al. 2007; Manley et al. 2003); these factors deter smoking initiation, reduce smoking dependence, and promote smoking cessation. Additionally, low income and poverty, lack of health insurance, and un/under-employment are each related to increased stress (Arnetz et al. 2010; Finkelstein et al. 2012), in part because SES advantaged individuals are more likely to participate in stress-reducing activities (e.g., counseling services, physical activity) (Baker et al. 2004; Biddle and Mutrie 530 C. Reczek et al. 2008; Wang et al. 2005). "
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    • "For the past 25 years, RDDTS and household surveys alike have found that smoking rates are 2–6% points higher among Blacks than Whites (28), a finding replicated here when comparing RDDTS Blacks and Whites (Table 4). This finding is troublesome because the difference is too small to account for large Black-White disparities in smoking-related cancers and diseases, and too small to indicate a need for targeted tobacco-cessation programs for Blacks (28). The data here suggest that the Black-White smoking-prevalence difference might be as large as 19% points, a difference that (if consistent for prior generations) might explain racial disparities in incidence of smoking-related diseases. "
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    • "In particular, African Americans have the highest lung cancer incidence and mortality rates when compared to other racial/ethnic groups, as well as the highest overall rates of tobacco-related morbidity and mortality (Fagan et al., 2007). African Americans experience tobacco-related health disparities despite reports of lower daily smoking rates and later onset of smoking (Fagan et al., 2007), and they are less likely to quit smoking than individuals of other racial/ethnic backgrounds (Fagan et al., 2007). Notably, African Americans report substantially lower SES than Whites and other racial/ethnic groups in the U.S. (DeNavas-Walt et al., 2010; Ostrove & Feldman, 1999), and a large body of research indicates that socioeconomic disadvantage has a negative influence on health behavior and health (Adler & Ostrove, 1999). "
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