Unfair and Unjust Practices and Conditions Harm African American People and Drive Health Disparities

Overview

Some U.S. historical policies and practices have led to mental and physical health risks and challenges, and related long-term health outcomes, for African American people. For example:

• For centuries, African American people have been harmed by unjust practices related to the sale of commercial tobacco.A123 For instance, enslaved people were forced to grow and harvest tobacco that would later be sold.2
• Tobacco companies have a long history of trying to influence African American people by donating to historically Black colleges and universities and sponsoring scholarships for African American students.41 They also give money to influential African American people, officials, and organizations.5 Tobacco companies have also advertised more heavily in magazines with larger numbers of African American readers.6
• African American people also experience discrimination and harm from systems meant to protect and improve health and well-being, including health care and medical science.789 Research shows that some African American people may hesitate to seek care because they don't trust the government or health care systems1011 that have treated African American people unfairly in the past.
• As recently as the 20^th century, doctors and researchers have done studies and medical procedures on African American people without their permission or knowledge. During the Tuskegee Study of Untreated Syphilis in African American Men, researchers allowed Black men with syphilis to go untreated in order to compare their symptoms to Black men without syphilis who were also part of the study. Other times, African American women were sterilized (made unable to have children) without agreeing to it first. These actions led to mistrust of health care and medical research,121314 and help to explain some of the causes of health disparities.

Other reasons—like the ones explored below—help explain why the health of African American people is affected by commercial tobacco.

The tobacco industry targets African American communities with marketing and advertising

Marketing plays a big role in whether people try or use commercial tobacco products. Being around commercial tobacco ads makes smoking appear more appealing and increases the chance that someone will try smoking for the first time or start using commercial tobacco products regularly:1516

• Neighborhoods and areas with more African American residents tend to have more stores that sell tobacco.17
• Tobacco companies advertise more heavily in stores whose customers are mostly African American people.18
• Tobacco companies use price promotions such as discounts and multi-pack coupons—which are most often used by African American people and other minority groups, women, and young people—to increase sales.19
• Tobacco companies support cultural events designed to draw in certain groups in the Black community. One campaign targeted at Black young adults involved pop-up concerts featuring hip-hop artists in convenience stores.20

To help protect African American people from commercial 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.21

Tobacco companies promote flavored products—especially menthol—in neighborhoods where African American people live

Menthol has a minty flavor that can mask the harsh taste of tobacco. Menthol makes cigarette smoke feel easier to inhale and can make it harder to quit smoking.222324 To attract African American people as customers, tobacco companies target African American communities with advertising and sales of flavored cigarettes—especially those with menthol.1

Tobacco companies have aggressively marketed menthol cigarettes to African American people since at least the 1950s and continue to do so today.125

• In the 1970s and 1980s, a tobacco company's "menthol push" included ad campaigns with messages tailored to Black people and images featuring Black models or hip-hop icons.2627
• In 2019, about 85% of Non-Hispanic Black adults who smoked cigarettes used menthol cigarettes.28
• In 2019, about 58% of African American youth aged 12 to 17 who reported smoking cigarettes used menthol cigarettes.28
• Menthol products are given more shelf space in stores that have large numbers of Black customers.29
• Stores located near schools with more Black students have been more likely to promote menthol cigarettes through advertising and discounts.30 The more Black children who live in a neighborhood, the more likely it is that menthol specific marketing will be advertised near candy displays in stores.19
• Stores in neighborhoods with more Black residents or residents with lower incomes advertise flavored little cigars and cigarillos more often and may also have more of them available to buy.31

There are actions that states and communities can take to make flavored commercial tobacco products less available, which might help more African American people quit smoking (and might keep some African American people from starting to smoke).3233

• In 2009, the Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration the authority to ban sales of all characterizing flavors in cigarettes, except menthol. Cities, towns, and communities that have limited the sale of flavored products have seen the odds of residents (including young people) using any type of tobacco products or trying flavored tobacco products go down.34
• A 2011 study that modeled what could happen if the U.S. banned sales of menthol cigarettes nationwide estimated that, by year 2050, such a policy could save more than 600,000 lives, including nearly 250,000 Black lives.35

Stress can increase commercial tobacco use and make health problems worse

Stress, such as that caused by financial problems, discrimination, or violence, can make people in general more likely to smoke.36

Racism and discrimination are constant sources of stress for many African American people.37 In 2019, the majority of African American people said they had personally been discriminated against because of their race. 38The pressure of discrimination has been associated with starting to use tobacco 3940and can also make it harder to quit.36

Health care itself can be a source of discrimination. One in three Black adults say they have personally experienced racial discrimination when going to the doctor—and many report avoiding seeking medical care because of it.41

When people experience severe or long-lasting forms of stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems like high blood pressure and diabetes.4243 Smoking cigarettes also leads to disease and disability and harms nearly every organ of the body.44