By: Summer Bowman

The use of tobacco products and smoking-related diseases are major, ongoing concerns for health care professionals and public health officials. Tobacco use is directly linked to various chronic diseases, including but not limited to cancer, heart disease, stroke, and diabetes. These illnesses not only contribute to significant morbidity and mortality rates but also worsen existing health disparities among minority communities.

Policy, tradition, community reliance, and lack of access to cessation resources are some of the many barriers to breaking the cycle of smoking and its associated health risks. Of those most affected by Big Tobacco are the minority communities. In addition to having a higher prevalence of smoking-related diseases, minorities also face socioeconomic disparities, limited access to healthcare, and targeted advertising, all of which contribute to their continued consumption of tobacco.

The University of Alabama at Birmingham's Minority Health and Health Equity Research Center (MHERC) is actively engaged in addressing health challenges that prevent health equity. As part of its mission to translate science into better health for all, MHERC researchers explore the intersections of social, economic, and cultural factors in relation to health consequences within minority populations.

Tobacco-related diseases rank among the leading causes of preventable death across African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Hispanic and Latino populations. Exploring the historical ties between these communities and Big Tobacco is the first step to understanding its lasting impact on minority health.

Tobacco & Tradition

For centuries, tobacco has intertwined with the cultural beliefs, spiritual ceremonies, and medicinal practices of the four target minority communities mentioned above. Recognizing the historical relationship between tobacco and these minority groups helps explain their consumption patterns and the marketing strategies implemented by Big Tobacco to target each group.

African American

African Americans were first introduced to tobacco through farming in the early 1600s, as many plantation owners relied on slave labor to cultivate their land.⁹ After the Civil War, many continued tending to cash crops like tobacco, cotton, and rice through sharecropping arrangements, paving their way to financial independence.⁴ Over the years, there has been a significant change in smoking behavior among this group. According to a study on smoking prevalence and disparities from 2011–2020 by René Arrazola and colleagues, smoking prevalence decreased by 5% to 14.4% of the African American adult population.¹¹

American Indian and Alaska Native

Tobacco has deep roots within the Native American and Alaska Native cultures, spanning generations of use in traditional ceremonies. Beyond ceremonial purposes, they admired tobacco for its medicinal qualities and its association with peace. However, the United States banned the ceremonial use of traditional tobacco from 1877 to 1978 under the Indian Religious Crimes Code of 1883.³ This resulted in the substitution of cigarettes, invertedly leading to a rise in nicotine addiction. As of 2020, 27.1% of the American Indian and Alaska Native adult population are smokers.¹¹

Asian American and Pacific Islander

The relationship between the Asian American and Pacific Islander communities and tobacco was developed initially across countries in Asia and the Asian Pacific in the early 17th century with the introduction of tobacco.¹ These communities initially valued tobacco for its profitability when mixed with opium and exported to neighboring countries. Later, the plant was used as a medicinal remedy, as a heating agent on cold winter nights, a method for soothing a baby’s cry, and as a mosquito repellent.⁷ As the crop became more widely available, it served as a method for showing hospitality to guests, signifying class and sophistication. Today, only 8% of Asian American and Pacific Islander adults smoke tobacco products, illustrating a shift in cultural attitudes and practices regarding tobacco use. ¹¹

Hispanic and Latino

Leaders and shamans of the Hispanic and Latino communities throughout the Caribbean regions and Central and Southern America have long relied on tobacco for healing, ensuring fertility, inducing trances, and creating spiritual connections.¹ The use of tobacco in many religious practices and age-old traditions established its symbolic significance within the culture. Over time, the deep-rooted cultural practices have evolved, but tobacco use remains prevalent. In fact, 13.3% of Hispanic and Latino adults reported the use of tobacco products in 2020. ¹¹

Marketing to Minorities

Exploring the origins and significance of tobacco in these minority communities helps explain the strong associations formed with the crop over generations. More importantly, it sheds light on the cultural norms and practices that Big Tobacco employs in its marketing strategies to target these communities.

The tobacco industry began to segment its audience and push targeted marketing campaigns toward minority communities, exploiting their cultural beliefs and social norms. Several studies have highlighted the purposeful placement of advertisements in neighborhoods with high racial and ethnic populations, the use of culturally relevant symbols and names in advertising, and the sponsorship of cultural events and community organizations. One study discovered that Asian American neighborhoods had the highest proportion of tobacco billboards at 13%, followed by African American neighborhoods at 9.6%, Hispanic neighborhoods at 4.7%, and White neighborhoods at just 1.1%.⁶

In addition to increased visibility, tobacco companies strategically offer products featuring symbols and names with cultural significance at a discounted price. Advertisements for menthol cigarettes, for example, were disproportionately placed in publications aimed at African Americans, featuring curated messages and images of African American icons. Other examples include brand names with special meanings, such as Uptown among African Americans or Rio and Dorado among Hispanics and Latinos. Similarly, the American Spirit brand features an image of an American Indian smoking a peace pipe to appeal to the American Indians and Alaska Natives.¹

Stanford Research into the Impact of Tobacco Advertising (SRITA) Ref. 12

More subtle tactics included support of significant events and festivals related to the history and heritage of these communities, such as Black History Month, Hispanic Heritage Month, Asia/Pacific American Heritage Month, and Lunar New Year celebrations. Additionally, the industry contributed to minority-focused political, cultural, and community organizations. This support included funding for events like pow-wows and rodeos, special donations to Historically Black Colleges and Universities, and financial support for scholarship programs benefiting Hispanic and Latino individuals, all of which reinforced its positive connotation with these groups.

In understanding the marketing tactics employed by Big Tobacco to target these groups, one can begin to understand their impact. These strategies perpetuate tobacco consumption within minority groups and increase the burden of tobacco-related health issues they experience.

Tobacco’s Toll on Minority Health

Despite similar or lower smoking rates compared to Caucasian Americans, tobacco-related illnesses such as heart disease, lung cancer, stroke, and diabetes are the leading causes of death across minority communities.⁵ Among health concerns, minorities also face challenges, including discrimination, targeted marketing, public policies, and socioeconomic factors like poverty and limited access to healthcare. For example, there are fewer protections in place to reduce the exposure of secondhand smoke to American Indian and Alaska Native people, increasing smoking-related diseases.² These protections include smokefree laws and policies prohibiting the smoking of tobacco products in public and private spaces such as restaurants, bars, worksites and outside many shopping centers.¹⁰ Additionally, the Hispanic and Latino communities have developed a sense of distrust in the American healthcare system following the disproportionate sterilization of Hispanic and Latino men and women under the eugenic sterilization laws of the early 1900s.⁸

After generations of discrimination and mistreatment, minority communities have begun to develop distrust in public officials, making health equity and cessation efforts considerably more challenging.

Breathe Freely: The Path to Cessation

When developing cessation strategies, it is important to consider the past experiences and cultural norms to ensure that the materials and efforts are informed, appropriate, and accessible to each group. Insurance coverage, communication limitations, and a lack of culturally sensitive cessation resources are among some of the many barriers these groups face. Despite these challenges, minority communities continue to show a strong desire to quit smoking.

In fact, according to the Centers for Disease Control and Prevention, compared to the 68% of white adults interested in quitting¹³, 73% of African Americans, 56% of American Indians and Alaska Natives, 70% of Asian Americans and Pacific Islanders, and 67% of Hispanics and Latinos also say they want to quit.² In an effort to address these concerns, promising community-based coalitions and campaigns have been developed, such as Stop the Sale of our Image: Don’t Buy the Lie and Keep Tobacco Sacred, which help raise awareness of targeted marketing tactics and promote cultural sensitivity.² Other programs, like the Asian Smokers’ Quitline, offer free counseling services tailored to specific language needs.²

Birmingham Health District

In Birmingham’s Southside area, the Birmingham Health District is a collaborative effort among local government and health-focused organizations to promote cessation resources and reduce secondhand exposure. Together, these organizations passed an ordinance prohibiting smoking on public property. As part of this commitment, UAB has established a vape, tobacco, and smoke-free campus. This policy supports the Health District’s goal by promoting a healthier environment for students, faculty, staff, patients, and visitors.

In line with these efforts is UAB's Live HealthSmart Alabama initiative, which is committed to reducing obesity, high blood pressure, diabetes, and high cholesterol through education, prevention and wellness, good nutrition, and physical activity. By providing resources that encourage smoking cessation, Live HealthSmart Alabama promotes a healthy, smoke-free lifestyle for all Alabamians.

Quit Today:

By raising awareness, promoting cultural understanding, and developing targeted cessation programs, we can address health disparities and advance health equity, effectively reducing tobacco-related death and disease in minorities. To take the first step toward a smoke-free life, explore the cessation resources below.

• UAB Medicine: www.uabmedicine.org/specialties/smoking-cessation
• Quitlines: Free and confidential services available nationwide and in Canada to help individuals quit tobacco use. These services help overcome barriers like transportation and childcare to increase success rates through counseling, medications, and additional support.
  • Call 1-800-QUIT-NOW (U.S.) and 1-866-366-3667 (CANADA) or visit www.quitnowalabama.com. Services are also available in other languages.
• Smokefree.gov: Access professional assistance and general information on how to quit smoking, with resources designed specifically for veterans, women, teens, smokers over 60, and Spanish speakers: www.smokefree.gov
• Take Down Tobacco Alabama: https://sites.google.com/view/takedowntobaccoalabama/home
  

Resources:

1. U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998.
2. Centers for Disease Control and Prevention. “Tobacco-Related Disparities.” Health Disparities Related to Commercial Tobacco and Advancing Health Equity. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2022, www.cdc.gov/tobacco/health-equity/index.htm.
3. Centers for Disease Control and Prevention. Tobacco Where You Live: Native Communities. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2022.
4. Public Broadcasting Service. “Sharecropping.” Slavery by Another Name, Public Broadcasting Service, 2021, www.pbs.org/tpt/slavery-by-another-name/themes/sharecropping.
5. Centers for Disease Control and Prevention. “Leading Causes of Death.” Minority Health. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Health Equity, 2019, www.cdc.gov/minorityhealth/lcod/index.htm
6. Elder, John P., et al. “Independent Evaluation of the California Tobacco Education Program.” Public Health Reports (1974), vol. 111, no. 4, 1996, pp. 353–58.
7. “News Analysis.” Tobacco Control, vol. 2, no. 1, 1993, pp. 7-, https://doi.org/10.1136/tc.2.1.7.
8. Lira, Natalie. “Latinos and the Consequences of Eugenics.” The Eugenics Crusade, Public Broadcasting Service, 2018, www.pbs.org/wgbh/americanexperience/features/eugenics-latinos-and-the-consequences-of-eugenics.
9. National Park Service. “Historic Jamestown.” Tobacco: Colonial Cultivation Methods, National Park Service, 2019, https://www.nps.gov/jame/learn/historyculture/tobacco-colonial-cultivation-methods.htm.
10. Centers for Disease Control and Prevention. “Preventing Exposure to Secondhand Smoke in the Community” Smoking and Tobacco Use. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2024, https://www.cdc.gov/tobacco/secondhand-smoke/community.html.
11. Arrazola, René A., et al. “US Cigarette Smoking Disparities by Race and Ethnicity – Keep Going and Going.” Preventing Chronic Disease, vol. 20, 2023, pp. E45-E45, https://doi.org.10.588/pcd20.220375.
12. Stanford University. “Research into the Impact of Tobacco Advertising (SRITA).” Cigarette Advertising Themes, www.tobacco.stanford.edu/cigarettes/.
13. University of California San Francisco. “Racial/Ethnic Minorities.” Smoking Cessation Leadership Center, www.smokingcessationleadership.ucsf.edu/racialethnic-minorities.