New York: Smoking fuels deep inequalities across communities

The New York City Department of Health has released a new report[1] highlighting the need to address health inequalities in smoking, with recommendations on how to move forward. Although smoking prevalence in New York City has declined significantly, from 22% in 2002 to 11% in 2020, inequalities remain due to aggressive tobacco industry marketing or retailer concentration in high-poverty communities.

The latest research has revealed that despite the decline in overall smoking rates in the city, 14% of adults living in very poor neighborhoods smoke, compared to 9% of adults living in more affluent neighborhoods. The report states that addressing the root causes of inequality and prioritizing communities that experience these inequalities are essential to preventing the devastating health effects of smoking, including premature death.

Significant disparities in smoking prevalence across communities

The report highlights the importance of considering the various factors that drive social inequalities in smoking. While smoking prevalence in New York City was broadly similar across ethnic groups, taking into account ethnicity, gender, and birthplace (in the United States or abroad) together revealed significant differences.

For example, in 2019-2020, U.S.-born Black and Latino men smoked at higher rates (23% and 21%, respectively) than non-U.S.-born but domestic Black and Latino men (5 % and 11 %, respectively). Similarly, smoking rates among U.S.-born Black (15%) and Latino women (14%) were more than three times higher than those among non-U.S.-born but domestic Black (4 %) and Latino women (4 %).

The report also includes data on environmental and industrial factors that can lead to inequality. These include the industry's massive marketing and the importance of product access at retailers in poorer communities. For example, differential rates of menthol smoking highlight the results of aggressive promotion of these products to communities of color. In 2020, 52 percent of all adults who smoked in New York City typically smoked menthol cigarettes, but 89 percent of Black and 68 percent of Latino smokers used menthol cigarettes, compared to only 32 percent of White and 25 percent of Asian/Pacific Islander smokers.

Efforts to restrict the number of outlets

Measures taken to reduce the number of retail outlets in New York City have led to a decrease in the overall number of tobacco retailers. Between 2018 and 2021, the city's Department of Health reports a 29% decrease in tobacco retail locations, with the largest declines in density occurring in high-poverty areas.

While there were 108 tobacco licenses issued per 100,000 people in high-poverty areas in 2018, that number fell to 68 licenses in 2021. These changes will take time to affect smoking prevalence, however, according to the city's health department.

Promote and adapt access to smoking cessation aids

The report also examines the use of smoking cessation treatments and suggests that appropriate outreach and therapeutic support should be prioritized. For example, Asian/Pacific Islander New Yorkers who smoke were less likely (9 %) to have used nicotine replacement therapy than African American (24 %), Latino (26 %), and White (20 %) adult smokers.

For Dr. Michelle Morse, the agency's chief medical officer and deputy commissioner of the Center for Health Equity and Community Wellness, it's critical to ensure all communities receive the support they need. Medications and tobacco treatment counseling can double a person's chances of successfully quitting. She adds, " It is therefore imperative that we work together to raise awareness of all the resources available to New Yorkers, such as the New York State Tobacco Quitline, comprehensive Medicaid and other insurance coverage for tobacco treatment, and the many smoking cessation programs throughout the city. ".

Keywords: New York, inequality, African Americans, Latin Americans, United States, menthol, marketing

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