Abstract
In 2009, flavored cigarettes (except menthol) were banned in the United States, but other flavored tobacco products (FTPs) were allowed. Women, populations of color, youth, sexual minority, and low–socioeconomic status populations disproportionately use FTPs. Localities have passed sales restrictions on FTPs that may reduce disparities if vulnerable populations are reached. This study assessed the extent to which FTP restrictions reached these subgroups (“reach equity”). We identified 189 U.S. jurisdictions with FTP policies as of December 31, 2018. We linked jurisdictions with demographics of race/ethnicity, gender, age, partnered same-sex households and household poverty, and stratified by policy strength. We calculated Reach Ratios (ReRas) to assess reach equity among subgroups covered by FTP policies relative to their U.S. population representation. Flavor policies covered 6.3% of the U.S. population (20 million individuals) across seven states; 0.9% were covered by strong policies (12.7% of policies). ReRas indicated favorable reach equity to young adults, women, Hispanics, African Americans, Asians, partnered same-sex households, and those living below poverty. Youth, American Indians/Alaska Natives (AIAN) and Native Hawaiians/Pacific Islanders (NHPI) were underrepresented. Strong policies had favorable reach equity to young adults, those living below poverty, Asians, NHPIs, individuals of 2+ races, and partnered same-sex households, but unfavorable reach equity to women, youth, Hispanic, AIAN, and African American populations. U.S. flavor policies have greater reach to many, but not all, subgroups at risk of FTP use. Increased enactment of strong policies to populations not covered by flavor policies is warranted to ensure at-risk subgroups sufficiently benefit.
| Original language | English |
|---|---|
| Pages (from-to) | 44S-53S |
| Journal | Health Promotion Practice |
| Volume | 21 |
| Issue number | 1_suppl |
| DOIs | |
| State | Published - Jan 1 2020 |
Bibliographical note
Funding Information:44S 53S © 2019 Society for Public Health Education 2019 Society for Public Health Education In 2009, flavored cigarettes (except menthol) were banned in the United States, but other flavored tobacco products (FTPs) were allowed. Women, populations of color, youth, sexual minority, and low–socioeconomic status populations disproportionately use FTPs. Localities have passed sales restrictions on FTPs that may reduce disparities if vulnerable populations are reached. This study assessed the extent to which FTP restrictions reached these subgroups (“reach equity”). We identified 189 U.S. jurisdictions with FTP policies as of December 31, 2018. We linked jurisdictions with demographics of race/ethnicity, gender, age, partnered same-sex households and household poverty, and stratified by policy strength. We calculated Reach Ratios (ReRas) to assess reach equity among subgroups covered by FTP policies relative to their U.S. population representation. Flavor policies covered 6.3% of the U.S. population (20 million individuals) across seven states; 0.9% were covered by strong policies (12.7% of policies). ReRas indicated favorable reach equity to young adults, women, Hispanics, African Americans, Asians, partnered same-sex households, and those living below poverty. Youth, American Indians/Alaska Natives (AIAN) and Native Hawaiians/Pacific Islanders (NHPI) were underrepresented. Strong policies had favorable reach equity to young adults, those living below poverty, Asians, NHPIs, individuals of 2+ races, and partnered same-sex households, but unfavorable reach equity to women, youth, Hispanic, AIAN, and African American populations. U.S. flavor policies have greater reach to many, but not all, subgroups at risk of FTP use. Increased enactment of strong policies to populations not covered by flavor policies is warranted to ensure at-risk subgroups sufficiently benefit. public policy health equity health disparities tobacco control vulnerable populations typesetter ts1 Authors’ Note: The authors thank Mark Meaney at the Tobacco Control Legal Consortium for assistance in reviewing policies and Joseph Lee for assistance in conceptualizing and calculating estimates for same-sex households. All authors declare no conflicts of interest. This article was supported by Truth Initiative. Dr. Rose was supported in part by a grant from the National Cancer Institute (R21CA208206). Dr. Chen-Sankey was supported by the National Institute on Minority Health and Health Disparities Division of Intramural Research. The views and opinions expressed in this article are those of the authors only and do not necessarily represent the views, official policy, or position of the U.S. Department of Health and Human Services or any of its affiliated institutions or agencies. Supplement Note: This article is part of the Health Promotion Practice supplement, “Tobacco and Health Equity: Interventions, Research, and Strategies to Address Tobacco Use Among Diverse Populations,” developed under the guidance of the Society for Public Health Education (SOPHE). SOPHE received funding from the Food and Drug Administration’s Office of Minority Health and Health Equity (Grant number HHSF223201820377A) to support printing and open access dissemination. The views and findings expressed in these manuscripts are those of the authors and do not imply endorsement or reflect the views and policies of the U.S. Government. The entire supplement issue is available open access at https://journals.sagepub.com/toc/hppa/21/1_suppl . ORCID iDs Shyanika W. Rose https://orcid.org/0000-0002-4200-1197 Adam F. Benson https://orcid.org/0000-0001-8111-5464 Randall Simpson https://orcid.org/0000-0001-8645-8204
Publisher Copyright:
© 2019 Society for Public Health Education.
Keywords
- health disparities
- health equity
- public policy
- tobacco control
- vulnerable populations
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Nursing (miscellaneous)
