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Sherry L. Mills, MD, MPH

Abt Associates, Inc, Bethesda, Md

The rapidly shifting demographics of the United States demand that traditional public health practices be reexamined, retooled, and redeployed to optimally address the cultures, behaviors, and practices of our increasingly diverse society. This issue of the Journal features papers presented at the National Conference on Tobacco and Health Disparities held in Tampa Bay, Fla, in December 2002. This event was cosponsored by the National Cancer Institute, the Office on Smoking and Health of the Centers for Disease Control and Prevention, the American Legacy Foundation, the Robert Wood Johnson Foundation, the Campaign for Tobacco-Free Kids, the American Cancer Society, the National Latino Council on Alcohol and Tobacco Prevention, and the National African-American Tobacco Prevention Network. It provided a key forum for public health leaders, practitioners, and researchers to identify gaps in current knowledge to better support communities that bear an undue share of the burden of tobacco-related diseases and premature deaths.

The health disparities movement offers the tobacco control community an opportunity to participate in this vital national public health agenda by documenting, monitoring, and elucidating reasons for these differences and by restructuring, reworking, and reinvigorating approaches for diverse communities to eliminate tobacco-related health disparities. Accordingly, Fiore et al. (p205) propose a national action plan for tobacco cessation and Fagan et al. (p211) note the breadth of research needed, from basic biology to public policy.

In examining health disparities, it is essential to recognize the disproportionate toll of tobacco-related illness on racial and ethnic minorities, which is exacerbated by persistent and intertwined relationships with socioeconomic disadvantage, gender, sexuality, acculturation, and geographic location. Sorenson et al. (p230) provide a social contextual model for reducing tobacco use among working populations, while Barbeau et al. (p269) examine socioeconomic disadvantage, race/ethnicity, gender, and smoking simultaneously in a recent national survey. In recognition of the increasing numbers and diversity of migrants to the United States, Shelley et al. (p300) examine acculturation and tobacco use behaviors among Chinese Americans.

A matrix of interventions, public policies, and resource allocations is needed for effective tobacco control. It is also imperative to train researchers and practitioners from historically affected communities and to be mindful of the social, cultural, and political challenges they face. To meaningfully engage communities in tobacco control, we need to ensure that they play an integral role in shaping the research agenda, carrying out the studies, diffusing the results in a timely manner, and implementing solutions using best practices tailored to affected populations.

The articles in this issue provide hope through research that has been conducted across the life course. Sturm et al. (p308) examine the effects of environmental tobacco smoke exposure in middle-school children; Ellickson et al. (p293) look into racial/ethnic disparities in smoking from adolescence through young adulthood; Mendez and Warner (p251) discuss declining rates of smoking among adults. Nonetheless, much more remains to be accomplished, as particularly vulnerable groups such as teenagers (Horn et al., p181) and Native Americans (Hodge et al., p260) are both helped and targeted.

The National Conference on Tobacco and Health Disparities was an important step in comprehensively addressing these challenges, as numerous funding agencies, practitioners, researchers, and communities worked together to forge a research agenda. One size does not fit all. The tobacco control effort needs to account for the diversity of our society if it is to live up to its vital mandate to eliminate the alarming and persistent health disparities brought about by tobacco use.

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				B J Fox Framing tobacco control efforts within an ethical context Tob. Control, August 1, 2005; 14(suppl_2): ii38 - ii44. [Abstract] [Full Text] [PDF]

This Article Extract Full Text (PDF) Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Mills, S. L. Search for Related Content PubMed Articles by Mills, S. L.