Serving Disparate Populations in Pennsylvania
Reflecting back to 2020, it has been called a year of uncertainty, year of disruption, and a year for change. These descriptions have been brought to us by a pandemic, Black Lives Matter and climate change, among other challenges. A common thread among these issues has been a focus on racial equity and social justice, which have spotlighted health disparities across many areas of American life.
Heightened awareness and a new sensitivity around an old problem have engendered a new focus on why we have had disparities at the systems level and new frameworks for talking about them. The public health community has recognized tobacco product related disparities for at least 20 years. The 1998 Surgeon General’s Report, Tobacco Use Among U.S. Racial/Ethnic Minority Groups, was the first report to focus exclusively on tobacco use among members of African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders and Hispanics. Many studies have evaluated how to address tobacco product related disparities over the years, but 2020 has brought us to new recognition, understanding and preferences for framing this and other health equity issues.
This document brings together some of the old “tried and true” advice on tobacco product related disparities in addition to some of the new guidance on mapping, describing, and solving them. We recognize the value of both kinds of information. As yet, many of public health’s most current data and analyses are not yet framed or described using newer or more sensitive terms, but they are included to broaden the understanding of the audience.
Overview and Framework
The Pennsylvania Tobacco Prevention and Control Strategic Plan 2018-2022 includes a goal to identify and eliminate tobacco products disparities. This is consistent with the Centers for Disease Control (CDC) recommendation that “identifying and eliminating tobacco-related disparities among population groups” should be a primary goal of every state tobacco control program. Despite decades of efforts to reduce and eliminate health disparities, they persist—and in some cases, they are widening. Such disparities do not have a single cause. They are created and maintained through multiple, interconnected, and complex pathways. There is no single solution. As such, this compendium of material goes from broad to specific and addresses both policy and direct service interventions.
This Overview and Framework Section provides a plan and information that is helpful across all U.S. populations experiencing tobacco-related disparities. It includes an overview of drivers of health disparities in general, as well as specific to tobacco use. It includes a Quick Reference Checklist that synthesizes the literature’s suggestions on how to partner effectively with most populations affected by tobacco-related disparities and the organizations that serve them. It then builds on the Quick Reference Checklist by sharing additional insight into entities with whom to partner, tools and techniques to address cultural competency, and resources available that might be useful across disparate populations.
Following this section is a Data Prevalence Section that compiles national and Pennsylvania-specific (where available) prevalence information for each of sixteen unique populations that have been identified as those with higher incidence of tobacco use or those who encounter barriers to treatment or cessation in Pennsylvania.
Disparities and health inequity are not caused by higher prevalence, rather prevalence can be a symptom of systemic inequities. As such, this data can be an important source of information and a way to measure progress.
Finally, for each of the populations with tobacco products related disparities, included in the Data Prevalence Section, there is a unique Priority Populations stand-alone section that details five categories of information:
1. Why it Matters describes the tobacco product-related disparity in terms of prevalence, cessation, secondhand smoke, and other factors
2. What We Know About What Works provides evidence-based or best and promising practices
3. What’s Relevant in Pennsylvania gives state specific statistics and program descriptions
4. What Other States are Doing offers descriptions of other state programs
- African American/Black
- Asian American / Native Hawaiian / Pacific Islander
- Behavioral Health Population
- Chronic Conditions/ Diseases
- Hispanic / Latinx
- People Experiencing Homelessness
- Justice Involved Individuals
- LGBTQA / Sexual Gender Minority (SGM)
- Low Income Individuals
- People in the Military or Veterans
- Older Tobacco Users
- People with Disabilities (PWD)
- Pregnant Women
- Rural Geographic Areas / Amish and Mennonite
- Smokeless Tobacco Products
- Youth and Young Adult Nicotine Consumption and Tobacco Use