Unfair and Unjust Practices and Conditions Harm People with Behavioral Health Conditions and Drive Health Disparities

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People with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco.

People with behavioral health conditions are subject to more negative judgements and stigmatization than people with physical health conditions.15

People with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco*.5

african american couple looking concerned

People with behavioral health conditions have also been harmed by unjust practices related to the sale of commercial tobacco.

Tobacco companies funded research to support ideas that have been proven to be untrue, including the hypothesis that people with schizophrenia could not develop lung cancer, and the idea that people with mental health conditions need cigarettes to treat their symptoms.16 Tobacco industry lobbyists have cited this disproven research to resist efforts to promote smokefree policies in psychiatric hospitals.17 Misperceptions that smoking could alleviate symptoms of mental health conditions may affect mental health providers’ willingness to offer smoking cessation treatments to people with behavioral health conditions.18

Tobacco companies have created marketing plans that target population groups, including people who use illicit substances. One example was “Project SCUM” (Sub-Culture Urban Marketing), a 1990’s marketing strategy that attempted to co-brand tobacco as part of drug culture through product placement in shops that sold related paraphernalia.17

People with behavioral health conditions have also experienced discrimination and harm from systems meant to protect and improve health and well-being, including health care and medical science.

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  • Until the passage of the Education for All Handicapped Children Act in 1975 it was legal to exclude children with behavioral health conditions from schools. Before the passage of the law, Congress found that four million children with disabilities were either excluded from public school services or served inappropriately.19
  • The Americans with Disabilities Act – passed in 1990 – did not fully or evenly protect people with behavioral health conditions from workplace discrimination until clarifications were adopted in 2008.19,20
  • Health insurance coverage for behavioral health conditions has historically been less generous than coverage for medical care. Protections have expanded over time, starting with the Mental Health Parity Act of 1996 and the Mental Health Parity and Addiction Equity Act of 2008. There was no requirement that all insurance plans cover behavioral health conditions until the Patient Protection and Affordable Care Act of 2010.19,21

There are also current reasons—like the ones explored below—that help explain why commercial tobacco affects the health of people with behavioral health conditions.

The tobacco industry targets people with behavioral health conditions with marketing and advertising

Marketing plays a big role in whether people try or use commercial tobacco products. Commercial tobacco ads make smoking seem more appealing and increase the chance that someone will try smoking for the first time or start using commercial tobacco products regularly.22,23,24,25

Tobacco companies spend billions of dollars each year to aggressively market their products. They also target specific populations, including people who have behavioral health conditions, with commercial tobacco advertising.17 For example:

    • vape shop sign

      Tobacco companies market and advertise tobacco products to people with behavioral health conditions.

  • Advertisements for commercial tobacco products often incorporate images of carefree people who are smoking, socially engaged, and with freedom from stress and anxieties.17
  • In one study of a large, metropolitan area, people who had a serious mental health condition were twice as likely as those without a serious mental health condition to live in a neighborhood with more tobacco retailers and more advertisements for commercial tobacco product.26
  • Commercial tobacco brands use donations to civic groups as a way of generating influence and bolstering their public image. The industry has a history of making financial contributions to organizations that work with people with behavioral health conditions and have given free or discounted cigarettes to psychiatric facilities.16,17

To help protect people with behavioral health conditions from tobacco marketing and discourage tobacco use, states and communities could consider increasing prices and prohibiting price discounts, prohibiting the sale of flavored tobacco products, and either allowing fewer stores in a neighborhood to sell commercial tobacco products or prohibiting tobacco product sales altogether.27

*“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes.
Next Section: Commercial Tobacco Product Use and Behavioral Health Conditions Can Affect Each Other >
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