The Impact of Tobacco Control Policies on Health Equity in the United States (R37CA214787)
Project Description
Since the mid-1900s, tobacco control policies have effectively decreased smoking prevalence in the United States. However, important disparities by socioeconomic status (SES) and race/ethnicity in smoking prevalence and tobacco-related health outcomes persist. People with relatively lower education and income are more likely to smoke than their more affluent counterparts. In addition, although non-Hispanic Blacks and non-Hispanic Whites have a similar prevalence of smoking, Blacks have lower quit rates and higher lung cancer incidence and mortality than Whites. Hispanics, on the other hand, smoke less than Blacks or Whites. This suggests that current tobacco control policies do not adequately reduce, let alone eliminate, smoking disparities in vulnerable subgroups. However, few policy evaluations address smoking disparities, and the effects of policies across different SES and racial/ethnic subgroups are mostly unknown. Moreover, tobacco control policies are generally designed with broad populations in mind, without a focus on reducing the prevalence of smoking among specific populations. As a consequence, some policies may actually be exacerbating smoking disparities, even if their net population effect is positive.
Aims
- To determine how three established tobacco control policies (i.e., taxation, smoke-free air laws, mass media campaigns) and an emerging policy (i.e., Tobacco 21) influence smoking initiation among youth by parental education and race/ethnicity, including differences in these relationships by gender.
- To determine how four established tobacco control policies (i.e., taxation, smoke-free air laws, mass media campaigns, cessation treatment) and two emerging policies (i.e., pictorial health warning labels, point-of-sale display bans) influence smoking cessation among adults by educational attainment, income, and race/ethnicity, including differences in these relationships by gender.
- To predict which combination of policies will be necessary to reduce tobacco-related health disparities over time using a tobacco policy simulation model.
MERIT Extension Aims
- To determine the extent to which taxation, smoke-free, and T21 policies interact to impact youth smoking initiation, and differences in these associations by sex, race/ethnicity, and socioeconomic status.
- To examine how taxation, smoke-free, and Tobacco 21 policies affect the use of e-cigarettes
among youth overall and by sex, race/ethnicity, and socioeconomic status.
Tobacco 21 Population Coverage Database
2024
Buszkiewicz JH, Xie Y, Cohen A, Vander Woude CA, Colston DC, Patrick ME, Elliott MR, Levy DT, Thrasher J, Fleischer NL. Interaction between state-level cigarette prices and county-level Tobacco 21 coverage on cigarette smoking outcomes among US adolescents. Journal of Adolescent Health. 2024. doi: 10.1016/j.jadohealth.2024.05.023.
Buszkiewicz JH, Henderson AK, Xie Y, Patrick ME, Fleischer NL. Generational and Sociodemographic Differences in the Impact of Educational Expectations on Bachelor’s Degree Completion: The Monitoring the Future Study. Socius. 2024. doi: 10.1177/23780231241275394.
Vander Woude CA, Buszkiewicz JH, Travis N, James LN, Fleischer NL. Tobacco control
policies and sociodemographic disparities in cigarette smoking behaviors in the US:
A systematic review protocol. AJPM Focus. 2024. doi: 10.1016/j.focus.2024.100256.
2023
Usidame B, Xie Y, Colston D, Titus AR, Henriksen L, Kelly BC, Fleischer NL. The association between local tobacco retail licensing and adult cigarette smoking by race/ethnicity, income, and education in California (2012–2019). Preventive Medicine Reports. 2023. doi: 10.1016/j.pmedr.2022.102064.
Colston DC, Cruz J, Simard B, Fleischer NL.A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the United States. AJPM Focus. 2023. doi: 10.1016/j.focus.2022.100042.
Kalousova L, Xie Y, Levy D, Meza R, Thrasher JF, Elliott MR, Titus AR, Fleischer NL. Cigarette Prices and Disparities in Cessation in the United States. Nicotine & Tobacco Research. 2023. doi: 10.1093/ntr/ntad254.
2022
Usidame B, Xie Y, Thrasher JF, Lozano P, Elliott MR, Fong GT, Fleischer NL. Differential impact of the Canadian point-of-sale tobacco display bans on quit attempts and smoking cessation outcomes by sex, income and education: longitudinal findings from the ITC Canada Survey. Tobacco Control. 2022. doi: 10.1136/tobaccocontrol-2021-056805.
Colston DC, Xie Y, Patrick ME, Thrasher JF, Titus AR, Elliott MR, Levy DT, Fleischer
NL. Tobacco 21 laws may reduce smoking and tobacco-related health disparities among
youth in the U.S. Preventive Medicine Reports. 2022. doi: 10.1016/j.pmedr.2022.101762.
Usidame B, Meng G, Thrasher JF, Thompson ME, Fong GT, Fleischer NL. The differential
impact of the 2000 Canadian Graphic Warning Label policy on smoking prevalence by
sex and education: A Difference-In-Difference-In-Difference Model, Nicotine & Tobacco
Research. 2022. doi: 10.1093/ntr/ntac122.
Titus AR, Gamarel KE, Thrasher JF, Elliott MR, Fleischer NL. Exploring the Potential
for Smoke-Free Laws to Reduce Smoking Disparities by Sexual Orientation in the USA.
International Journal of Behavioral Medicine. 2022. doi: 10.1007/s12529-022-10099-1.
Titus AR, Thrasher JF, Gamarel KE, Emery SL, Elliott MR, Fleischer NL. Televised Anti-Tobacco
Media and Smoking Outcomes Among Heterosexual and Sexual Minority Adults in the United
States. Health Education & Behavior. 2022. doi: 10.1177/10901981221116783.
Slocum E, Xie Y, Colston DC, Emery SL, Patrick ME, Thrasher JF, Elliott MR, Fleischer
NL. Impact of the Tips from Former Smokers Anti-Smoking Media Campaign on Youth Smoking
Behaviors and Anti-Tobacco Attitudes. Nicotine & Tobacco Research. 2022. doi: 10.1093/ntr/ntac152.
Usidame B, Meng G, Thrasher JF, Thompson M, Fong GT, Fleischer NL. Examining the Effectiveness
of the 2012 Canadian Graphic Warning Label Policy Change by Sex, Income, and Education.
Nicotine & Tobacco Research. 2022. doi: 10.1093/ntr/ntac235.
2021
Titus AR, Thrasher JF, Gamarel KE, Meza R, Fleischer NL. Smoke-Free Laws and Disparities in Secondhand Smoke Exposure Among Nonsmoking Adults in the United States, 1999–2014. Nicotine & Tobacco Research. 2021. doi: 10.1093/ntr/ntab038.
Colston DC, Simard B, Xie Y, Fleischer NL, McLeod MC, Elliot MR, Thrasher JF. The
Association Between Quitline Characteristics and Smoking Cessation by Educational
Attainment, Income, Race/Ethnicity, and Gender. International Journal of Environmental
Research and Public Health. 2021. doi: 10.3390/ijerph18063297.
Colston DC*, Cho B*, Thrasher JF, Titus AR, Xie Y, Emery SL, Elliott MR, Fleischer
NL. Anti-smoking Media Campaigns and Disparities in Smoking Cessation in the United
States, 2001-2015. American Journal of Health Promotion. 2021. *Authors contributed
equally to work. doi: 10.1177/0890117120985818.
Colston DC, Titus AR, Thrasher JF, Elliott MR, Fleischer NL. Area-Level Predictors
of Tobacco 21 Coverage in the US Before the National Law: Exploring Potential Disparities.
American Journal of Preventive Medicine. 2021. doi: 10.1016/j.amepre.2020.06.026.
Colston DC, Xie Y, Thrasher JF, Emery S, Patrick ME, Titus AR, Elliott MR, Fleischer
NL. Exploring How Exposure to Truth and State-Sponsored Anti-Tobacco Media Campaigns
Affect Smoking Disparities among Young Adults Using a National Longitudinal Dataset,
2002–2017. International Journal of Environment Research and Public Health 2021. doi:
10.3390/ijerph18157803.
Titus AR, Xie Y, Thrasher JF, Levy DT, Elliott MR, Patrick ME, Fleischer NL. A longitudinal
analysis of smoke-free laws and smoking initiation disparities among young adults
in the United States. Addiction. 2021. doi: 10.1111/add.15658.
Titus AR, Xie Y, Colston DC, Patrick ME, Elliott MR, Levy DT, Thrasher JF, Fleischer
NL. Smoke-Free Laws and Disparities in Youth Smoking in the U.S., 2001−2018. American
Journal of Preventive Medicine. 2021. doi: 10.1016/j.amepre.2021.05.013.
Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. Cigarette Pack
Price and Its Within-Person Association With Smoking Initiation, Smoking Progression,
and Disparities among Young Adults. Nicotine & Tobacco Research. 2021. doi: 10.1093/ntr/ntab210.
Colston DC, Xie Y, Thrasher JF, Patrick ME, Titus AR, Emery S, McLeod MC, Elliott
MR, Fleischer NL. Examining Truth and State-Sponsored Media Campaigns as a Means of
Decreasing Youth Smoking and Related Disparities in the US. Nicotine & Tobacco Research.
2021. doi: 10.1093/ntr/ntab226.
2020
Titus AR, Gamarel KE, Thrasher JF, Meza R, Fleischer NL. State-Level Structural Stigma and Smoking Among Sexual Minority Adults in the USA, 2012–2014. Annals of Behavioral Medicine. 2020. doi: 10.1093/abm/kaaa086.
Kalousova L, Levy D, Titus AR, Meza R, Thrasher J, Elliott MR, Fleischer NL. Cigarette
Taxes, Prices, and Disparities in Current Smoking in the United States. SSM-Population
Health. 2020. doi: 10.1016/j.ssmph.2020.100686.
Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. Tobacco Taxation
and Its Prospective Impact on Disparities in Smoking Initiation and Progression Among
Young Adults. Journal of Adolescent Health. 2020. doi: 10.1016/j.jadohealth.2020.08.031.
Titus AR, Gamarel KE, Thrasher JF, Emery SL, Elliott MR, Fleischer NL. Are sexual
minority adults differentially exposed to smoke-free laws and televised anti-tobacco
media campaigns compared to the general US population? A descriptive analysis. Tob
Control. 2020. doi: 10.1136/tobaccocontrol-2020-055893.
Fleischer NL, Donahoe JT, McLeod MC, Thrasher JF, Levy DT, Elliott MR, Meza R, Patrick
ME. Taxation reduces smoking but may not reduce smoking disparities in youth. Tob
Control. 2020 Apr 8. doi: 10.1136/tobaccocontrol-2019-055478.
Abrams LR, Kalousova L, Fleischer NL. Gender differences in relationships between
sociodemographic factors and e-cigarette use with smoking cessation: 2014-15 current
population survey tobacco use supplement. J Public Health (Oxf). 2020 Feb 28;42(1):e42-e50.
doi: 10.1093/pubmed/fdz017.
Gamarel KE, Watson RJ, Mouzoon R, Wheldon CW, Fish JN, Fleischer NL. Family Rejection
and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA. Int
J Behav Med. 2020 Apr;27(2):179-187. doi: 10.1007/s12529-019-09846-8.
2019
Donahoe JT, Norton EC, Elliott MR, Titus AR, Kalousová L, Fleischer NL. The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers. Am J Prev Med. 2019 Dec;57(6):e203-e210. doi: 10.1016/j.amepre.2019.07.004.
Titus AR, Kalousova L, Meza R, Levy DT, Thrasher JF, Elliott MR, Lantz PM, Fleischer
NL. Smoke-Free Policies and Smoking Cessation in the United States, 2003-2015. Int
J Environ Res Public Health. 2019 Sep 2;16(17). doi: 10.3390/ijerph16173200.
Fleischer NL, Lozano P, Wu YH, Hardin JW, Meng G, Liese AD, Fong GT, Thrasher JF.
Disentangling the roles of point-of-sale ban, tobacco retailer density and proximity
on cessation and relapse among a cohort of smokers: findings from ITC Canada Survey.
Tob Control. 2019 Jan;28(1):81-87. doi: 10.1136/tobaccocontrol-2017-054081.
Donahoe JT, Titus AR, Fleischer NL. Key Factors Inhibiting Legislative Progress Toward
Smoke-Free Coverage in Appalachia. Am J Public Health. 2018 Mar;108(3):372-378. doi:
10.2105/AJPH.2017.304244.
2024
Vander Woude CA, Xie Y, Cook S, Buszkiewicz JH, Patrick ME, Thrasher JF, Fleischer NL. The Interaction of Smoke-free Workplace and Hospitality Laws and Tobacco 21 Laws on Smoking Behaviors Among US Youth. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2024; Edinburgh, Scotland.
2023
Buszkiewicz JH, Xie Y, Cohen AL, Colston DC, Patrick ME, Fleischer NL. Interaction of Tobacco 21 and Taxation Policies on Youth Cigarette Smoking Outcomes. Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2023; San Antonio, TX.
Vander Woude CA, Xie Y, Patrick ME, Fleischer NL. The Interaction of Smoke-free Workplace and Hospitality Laws and Cigarette Taxation Among Youth. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2023; San Antonio, TX.
Buszkiewicz JH, Xie Y, Cohen AL, Colston DC, Patrick ME, Fleischer NL. Interaction of Tobacco 21 and Taxation Policies on Youth Cigarette Smoking Outcomes. Poster presentation at: Annual Meeting of the Society for Epidemiologic Research; June 2023; Portland, OR.
Vander Woude CA, Xie Y, Buszkiewicz JH, Patrick ME, Fleischer NL. The Interaction of Smoke-free Workplace and Hospitality Laws and Cigarette Taxation Among Youth. Oral presentation at: Annual Meeting of the Society for Epidemiologic Research; June 2023; Portland, OR.
2022
Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. Cigarette Pack Price and its Within-Person Association With Smoking Initiation, Smoking Progression, and Disparities Among Young Adults. Poster presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.
Slocum E, Xie Y, Colston DC, Emery S, Patrick ME, Thrasher JF, Elliott MR, Fleischer
NL. Impact of the Tips From Former Smokers Anti-Smoking Media Campaign on Youth Smoking
Behaviors and Anti-Tobacco Attitudes. Poster presentation at: Annual Meeting of the
Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.
Usidame B, Meng G, Thrasher JF, Thompson M, Fong GT, Fleischer NL. The differential
impact of the 2000 Canadian Graphic Warning Label policy on smoking prevalence by
sex and education: A Difference-In-Difference-In-Difference Model. Pre-Recorded Paper
“Plus” presentation at: Annual Meeting of the Society for Research on Nicotine and
Tobacco; March 2022; Baltimore, MD.
Usidame B, Meng G, Thrasher JF, Thompson M, Fong GT, Fleischer NL. The Sociodemographic
Impact of the 2012 Canadian Graphic Warning Label Policy on Smoking Prevalence: A
Difference-In-Difference-In-Difference Model. Poster presentation at: Annual Meeting
of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore, MD.
Usidame B, Xie Y, Colston D, Titus A, Henriksen L, Fleischer NL. The Association between
Local Tobacco Retail Licensing Ordinances and Adult Cigarette Smoking by Race/Ethnicity,
Income, and Education (2012-2019): The Case in California. Poster presentation at:
Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2022; Baltimore,
MD.
2021
Colston DC, Cho B, Thrasher J, Titus A, Xie Y, Emery SL, Elliott MR, Fleischer NL.
Anti-Smoking Media Campaigns and Disparities in Smoking Cessation in the United States,
2001-2015. Poster presentation at: Annual Meeting of the Society for Research on Nicotine
and Tobacco; February 2021; Virtual.
Colston DC, Xie Y, Thrasher J, Patrick ME, Titus A, Emery SL, McLeod MC, Fleischer
NL. Examining Truth and State-Sponsored Media Campaigns as a Means of Decreasing Youth
Smoking and Tobacco-Related Health Disparities in the US. Poster presentation at:
Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2021;
Virtual.
Colston DC, Patrick ME, Fleischer NL. Impact of Tobacco 21 Policies on Youth Smoking
Disparities, Takeaways for the National Policy. Oral presentation at: Annual Meeting
of the Society for Research on Nicotine and Tobacco; February 2021; Virtual.
Titus AR, Xie Y, Thrasher JF, Levy DT, Elliott MR, Patrick ME, Fleischer NL. A Longitudinal
Analysis of Smoke-Free Laws and Smoking Disparities among Young Adults in the United
States. Oral presentation at: Annual Meeting of the Society for Research on Nicotine
and Tobacco; February 2021; Virtual.
Titus AR, Thrasher JF, Gamarel KE, Meza R, Fleischer NL. Smoke-Free Laws and Disparities
in Secondhand Smoke Exposure among Nonsmoking Adults in the United States, 1999-2014.
Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco;
February 2021; Virtual.
Usidame B, Xie Y, Thrasher JF, Lozano P, Fong GT, Fleischer NL. The differential impact
of the POS ban on quit attempts and smoking cessation by sex, income, and education.
Oral presentation at: Annual Meeting of the Society for Research on Nicotine and Tobacco;
February 2021; Virtual.
2020
Colston DC, Patrick ME, Fleischer NL. Impact of tobacco 21 policies on youth smoking disparities: Takeaways for the national policy. Poster presentation at: Annual Meeting of the American Public Health Association; October 2020.
Colston DC, Titus AR, Thrasher JF, Elliott MR, Fleischer NL. Area Level Predictors
of Tobacco 21 Coverage in the United States Prior to the National Law: Exploring Potential
Disparities. Poster presentation at: Annual Meeting of the Society for Research on
Nicotine and Tobacco; March 2020; New Orleans, LA.
Titus AR, Gamarel KE, Thrasher JF, Emery SL, Elliott MR, Fleischer NL. Exposure to
Smoke-free Laws and Televised Anti-Tobacco Media Campaign Ads among Sexual Minorities
Compared to the General Population. Oral presentation at: Annual Meeting of the Society
for Research on Nicotine and Tobacco; March 2020; New Orleans, LA.
Titus AR, Gamarel KE, Thrasher JF, Meza R, Fleischer NL. Examining sexual orientation
smoking disparities through the lens of structural stigma. Poster presentation at:
Annual Meeting of the Society for Research on Nicotine and Tobacco; March 2020; New
Orleans, LA.
2019
Fleischer NL, Donahoe JT, Thrasher JF, Levy DT, Meza R, Patrick ME. Higher cigarette taxes unlikely to reduce socioeconomic and racial/ethnic disparities in smoking among US adolescents. Society for Research on Nicotine and Tobacco Annual Meeting, San Francisco, CA, February 2019.
2018
Titus AR, Kalousova L, Meza R, Levy DT, Thrasher JF, Lantz PM, Fleischer NL. Smoke-free laws and disparities in smoking cessation in the United States, 2003-2015. Society for Epidemiologic Research Annual Meeting, Baltimore, MD, June 2018.
Fleischer NL, Lozano P, Wu Y-H, Hardin JW, Meng G, Liese AD, Fong GT, Thrasher JF. Disentangling the roles of point-of-sale tobacco display bans, tobacco retail density, and tobacco retail proximity on smoking cessation behaviors among a cohort of smokers in Canada. Society for Research on Nicotine and Tobacco Annual Meeting, Baltimore, MD, February 2018.
Titus A, Kalousova L, Meza R, Levy DT, Thrasher JF, Lantz PM, Fleischer NL. Smoke-free laws and disparities in smoking cessation in the United States, 2001-2015. Society for Research on Nicotine and Tobacco Annual Meeting, Baltimore, MD, February 2018.