Tobacco-Related Health Disparities across the Cancer Care Continuum

Abstract

Background Use of tobacco is the leading preventable cause of death in the United States. Racial/ethnic minorities and individuals of low socioeconomic status disproportionately experience tobacco-related disease and illness. Unique challenges and circumstances exist at each point in the cancer care continuum that may contribute to the greater cancer burden experienced by these groups. Methods We reviewed tobacco-related disparities from cancer prevention to cancer survivorship. We also describe research that seeks to reduce tobacco-related disparities. Results Racial/ethnic minorities and low-income individuals experience unique social and environmental contextual challenges such as greater environmental cues to smoke and greater levels of perceived stress and social discrimination. Clinical practice guidelines support the effectiveness of pharmacotherapy and behavioral counseling for racial and ethnic minorities, yet smoking cessation rates are lower in this group when compared with non-Hispanic whites. Superior efficacy for culturally adapted interventions has not yet been established. Conclusions To reduce health disparities in this population, a comprehensive strategy is needed with efforts directed at each point along the cancer care continuum. Strategies are needed to reduce the impact of contextual factors such as targeted tobacco marketing and social discrimination on smoking initiation and maintenance. Future efforts should focus on increasing the use of evidence-based cessation treatment methods and studying its effectiveness in these populations. Attention must also be focused on improving treatment outcomes by reducing smoking in diverse racial and ethnic patient populations.

Effect of rural and urban geography on larynx cancer incidence and survival

“…Remedies for disparities in care necessarily depend on the nature of the disparities. Strategies to decrease cancer incidence rates would be distinct from those targeting differences in mortality rates that potentially reflect disparities in access to healthcare, timely diagnosis, and effective treatment …”

“…Strategies to decrease cancer incidence rates would be distinct from those targeting differences in mortality rates that potentially reflect disparities in access to healthcare, timely diagnosis, and effective treatment. 4 In this work, we observed that the age-adjusted incidence of larynx cancer is almost twice as high in rural SEER counties, where the supply of otolaryngologists is less than one-quarter that of urban areas. Rural residents are significantly more likely than their urban counterparts to be current or former smokers from lower socioeconomic status.…”

“…The larynx cancer burden, like other tobacco‐related malignancies, is disproportionately borne by groups from lower socioeconomic strata, rural populations, and racial and ethnic minorities . Tobacco cessation programs over the last few decades have yielded dramatic declines in the incidence of tobacco‐related malignancies, but the substantial burden of larynx cancer incidence and mortality remains problematic . An estimated 13,360 new cases of larynx cancer will occur in 2017, of which 3,660 patients will succumb to the disease .…”

“…2,3 Tobacco cessation programs over the last few decades have yielded dramatic declines in the incidence of tobacco-related malignancies, but the substantial burden of larynx cancer incidence and mortality remains problematic. 4 An estimated 13,360 new cases of larynx cancer will occur in 2017, of which 3,660 patients will succumb to the disease. 5 The prevalence of smoking is higher in populations at risk for developing and dying from larynx cancer; these populations are otherwise highly heterogeneous, affecting different geographic regions, as well as racial and socioeconomic groups.…”

Polytobacco Use Among a Nationally-Representative Sample of Black High School Students

“…Tobacco use is the single largest contributor to preventable deaths in the United States and is responsible for a considerable portion of excess morbidity and mortality among Black Americans (1)(2)(3)(4)(5)(6). Racial/ethnic differences in smoking-related health problems stem from a variety of factors, including smoking prevalence, types of products smoked (e.g., menthol cigarettes), differences in the nicotine metabolism rate, and social adversity that makes quitting more di cult for some racial/ethnic groups such as Black Americans (7)(8)(9)(10).…”