Tobacco-Related Health Disparities
Tobacco use continues to cause disproportionately high rates of morbidity and mortality and reduced quality of life for California priority groups. Traditional (e.g., cigarettes, cigarillos) and new tobacco products (e.g., e-cigarettes, flavored cigars) continue to be widely available and more affordable to purchase in communities with high concentrations of poverty, racial/ethnic minorities, and in densely populated urban communities. Tobacco-related health disparities (TRHDs) affect individuals, families, communities, and the economy in devastating ways. TRDRP focuses this research priority on studies aimed at preventing and reducing tobacco use and tobacco-related disease among the following priority groups (alphabetical listing).
- Active military and veterans
- Blue-collar workers
- Children, adolescents, and young adults
- Incarcerated and formerly incarcerated individuals
- Individuals with mental illness including addictive disorders
- Migrant agricultural workers
- People of low socioeconomic status including the homeless
- People with disabilities
- People with limited education including high school non-completers
- People with mental illness
- Racial/ethnic minorities (e.g., African Americans, American Indians and Alaska Natives, Asian Americans, Latinos, Native Hawaiians and other Pacific Islanders, and individuals identifying with multiple racial groups)
- Rural residents
- Sexual/gender minorities (e.g., Lesbian, Gay, Bisexual, Transgender people)
Multiple complex factors contribute to TRHDs and innovative research that fosters collaboration across disciplines and organizations is needed to promote health equity. We encourage proposals that emphasize engaging community organizations and advocates, community residents, and policymakers at all levels of the research process. Research projects with potential to obtain impactful findings to reduce TRHDs in the following areas are considered responsive to this priority.
California’s recently passed tobacco control laws and the FDA deeming rules have implications for research addressing TRHDs. For example, what does enactment and enforcement of the new state laws mean for TRHDs affecting California priority groups? Are there indications that the laws will increase or decrease TRHDs among priority groups? Further, will enactment of the laws and deeming regulation reduce or increase the price and availability of certain tobacco products in low-income communities? Additionally, research that addresses the public health impact of flavorings including menthol remains a need, as federal legislators and regulators have not been able to move forward with policies restricting access to sweet, candy and fruit flavored tobacco products that are in high demand and high supply in marginalized communities in the U.S.
Best practices are needed to effectively communicate tobacco prevention messages using cultural- and language-appropriate tools for California’s diverse population. Healthcare providers, social media, news media, online resources, and traditional print are widely accessed for health information by diverse groups. Studies are also needed to develop and disseminate effective communication strategies to counter tobacco industry marketing and advertising of traditional and new tobacco products to priority groups. Best practices are also needed to synthesize and communicate scientific evidence on TRHDs in a manner that can inform policy decisions at the local, state, and federal level.
Evidence-based tobacco treatments remain underutilized by priority groups. Provisions in the Patient Protection and Affordable Care Act have expanded access to FDA-approved cessation medications for Medi-Cal patients and public/private insurance covers medications at low or no cost. Strategies are needed to increase access to cessation resources, educate smokers about the appropriate use of cessation medications, permit exploration of multiple cessation aids that considers negative side effects, and monitor and overcome barriers to utilization. We encourage research that aims to improve the uptake of evidence-based tobacco treatments in settings accessed by priority groups.
Research is needed to improve the science of tobacco/nicotine cessation interventions for priority groups, particularly for youth and young adults, and to determine if evidence-based programs developed for the general population are sufficient to reduce tobacco use in priority groups, the cost effectiveness of tailored interventions and non-tailored interventions, and for which priority groups tailoring improves effectiveness. Interventions focused on cessation should build on existing theories and evidence-based treatments and strive to promote the generalizability of intervention effects within and across priority groups.
Cessation Medications: Applicants proposing to use a cessation medication with adult smokers in their study may be able to obtain study medication at no cost through a TRDRP arrangement with a pharmaceutical company. Contact the Program for details.
On June 9, 2016, California became the second state in the U.S. to increase the minimum age to 21 to purchase tobacco products including e-cigarettes. Military personnel 18-20 years old with valid military IDs will be able to purchase tobacco products. With the increased uptake of electronic cigarettes and little flavored cigars among youth, research is needed that addresses the effect the age 21 law has on youth access to tobacco products, including monitoring of unintended consequences with potential to exacerbate TRHDs in priority groups. Even with the enactment of the age 21 law, internet purchases of tobacco products are easy, common, and age violations are rarely punished for internet sales. Research is still needed in the following areas:
- interventions to prevent youth access to all forms of tobacco whether it is aerosolized, combusted or mixed with marijuana leaf or hash oil
- strategies to counter tobacco industry advertising that promotes initiation and daily use and publicizes misleading health messages
- effective communications for school age youth on the impact of aerosolizing and combusting tobacco products with and without marijuana
Political, economic, and environmental conditions in which priority groups reside play a major role in sustaining TRHDs. For example, discrimination, stigma, and acculturation are linked to tobacco use and TRHDs for some priority groups. Research that elucidates innovative strategies to modify social and physical environments that promote tobacco-free lifestyles is highly encouraged.
The impact of TRHD research findings is expanded through genuine collaborations between academic investigators and community organizations that engage local residents in the research process. We strongly encourage applications that include community engagement at all levels of the research process (development, implementation, dissemination).
Surveillance of Tobacco Use: Surveillance-based epidemiological studies should only focus on priority groups for which there are no or limited surveillance data available. Proposals solely focused on elucidating prevalence rates in priority groups for which representative data have been collected are considered not responsive to this priority. Through a review of Letters of Intent (LOI), surveillance proposals that focus solely on elucidating prevalence rates where representative data have been previously collected and publicly available will not be invited to submit full applications.
Multiple linked surveillance datasets are encouraged as new tobacco control regulations are implemented at the local, state, and federal levels, and most population-level surveillance datasets include too few respondents from some priority groups (e.g., American Indians, Pacific Islanders) to examine statistical relationships. Research projects proposing to collect surveillance data should plan to link with existing surveillance datasets to extend the effort and improve the ability to detect meaningful statistical relationships within and across priority groups.
Secondary data: Proposals submitted under this priority for the High Impact Pilot Awards and High Impact Research Project Award must not solely focus on the analysis of secondary, archived, or collected data. Through a review of Letters of Intent (LOI), proposals under this priority for the award types that solely focus on the analysis of secondary, archived, or collected data will not be invited to submit full applications.