Targeted Tobacco Harms: Disparities Impacting Black Americans

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://empathymh.org/our-team/
Staff Research and Content Writer

The US Surgeon General’s latest report, Eliminating Tobacco-Related Disease and Death: A Report of the Surgeon General, was released in November 2024. The report delves into the racial and ethnic disparities that persist despite the US’s significant progress in reducing tobacco use and related mortality.

Black and African American people continue to shoulder a disproportionately high burden of tobacco use and tobacco-related morbidity and mortality. On a high level, the report details that Black Americans:

Are more likely to smoke menthol cigarettes, which are more difficult to quit
Have higher rates of secondhand smoke exposure than other racial groups,
Make more quit attempts but are less successful in quitting tobacco than White and other racial groups,
Face higher levels of tobacco-related health harms than other racial groups and
Have higher rates of polytobacco use and co-use of tobacco and cannabis products.

Rates of Tobacco Use among Black Americans

Past-month and ever-use of tobacco products has increased among Black adults aged 18-49 since 2019. Black Americans have the second-highest prevalence of past-month smoking (20.6%) among racial groups, second to American Indian and Alaska Natives at 30%.

The Crossover Effect: A Unique Smoking Trajectory

Black Americans are less likely to smoke during adolescence compared to White peers. However, this trend reverses in adulthood, typically around age 30, marking a ‘crossover effect.’ This term refers to the phenomenon where Black Americans, who were less likely to smoke in their youth, start smoking at a higher rate than their White counterparts in adulthood.

The crossover effect has been attributed to the insidious and pervasive targeted marketing strategies by the tobacco industry, particularly the promotion of menthol cigarettes in Black communities. Menthol cigarettes, which are easier to smoke and harder to quit, have been heavily advertised in predominantly Black neighborhoods and publications popular with Black audiences. Today, a significant majority of Black Americans who smoke use menthol cigarettes, a preference shaped by decades of targeted marketing by the tobacco industry.

Left: A Kool cigarettes advertisement targeting Black communities for a sponsored event, the Kool Jazz Festival; Right: A Newport cigarettes ad targeting young Black customers.
Stanford Research into the Impact of Tobacco Advertising

Black Americans are also less likely to successfully quit smoking than other racial groups due in part to the addictiveness of menthol cigarettes and a lack of support from healthcare providers. This lower cessation success perpetuates higher smoking rates among Black adults while their White counterparts quit smoking.

The crossover effect underscores the impact of this predatory marketing and the crucial need for robust and comprehensive public health interventions to address these disparities.

Tobacco Use Trends in Black Communities

Black Americans exhibit unique patterns of tobacco use compared to other racial groups.

Menthol Cigarette Use

Nearly 90% of Black people who smoke use menthol cigarettes, a preference largely driven by decades of targeted advertising in Black communities. Menthol use continues to be highest among Black and African Americans compared to other racial and ethnic groups.

The use of menthol cigarettes is especially problematic because they are easier to get addicted to and harder to quit. Menthol has a cooling effect, which lessens the burn that one gets from inhaling a cigarette and makes them easier to smoke. Research has found that young people who experiment with menthol cigarettes are more likely to develop a smoking addiction than those who experiment with non-menthol cigarettes.

Non-Daily Smoking

Black Americans are more likely to smoke non-daily, a behavior that carries similar health risks to daily smoking but is often perceived as less harmful. Non-daily smoking may lead to an underestimation of its risks, reducing the urgency for cessation. Additionally, this pattern complicates cessation efforts, as it may delay recognition of addiction and the need for intervention.

Polytobacco Use

Black Americans report higher rates of using multiple tobacco products, including co-use with cannabis, increasing cumulative health risks. The combined use of tobacco and cannabis can amplify harmful effects on respiratory and cardiovascular health. Polytobacco use also reflects broader challenges, such as the normalization of multiple substance use in communities facing targeted marketing and systemic inequities.

Tobacco- Related Health Harms Among Black Americans

Tobacco use harms every part of the body. Cigarettes are the only consumer product that kills half of its customers when used as intended. Despite cigarettes’ universal deadliness to their consumers, Black Americans face disproportionately higher levels of some tobacco-related health consequences.

Mortality: Smoking causes over 50,000 deaths annually among Black adults, accounting for one in five deaths in this population.
Lung Cancer: Black men have the highest rates of lung cancer incidence (predominantly caused by smoking) and mortality of all racial groups.
Heart Disease: Smoking-related heart disease disproportionately affects Black men and women.

Image via Freepik

Secondhand smoke

Black and African Americans have higher secondhand smoke exposure than other racial groups. Secondhand smoke exposure is more than twice as high among Black adults compared to Black adults compared to White and Hispanic adults.

While secondhand smoke exposure has decreased in recent years among all racial and ethnic groups, progress has been significantly slower for Black Americans and other racial minorities compared to White Americans. This disparity is exacerbated by structural inequities, such as higher rates of multi-unit housing and occupational exposure, which make it harder for Black Americans to avoid secondhand smoke and quit smoking.

Tobacco cessation

Black and African Americans make more attempts to quit smoking yet have lower rates of smoking cessation than their White counterparts. Black adults face systemic challenges in quitting smoking, including:

Lack of Support from Healthcare Providers

Black adults make more attempts to quit smoking than White adults but are less successful in quitting. Some research has found that Black people are less likely to be asked about tobacco use during healthcare visits. Moreover, healthcare providers less often advise Black patients to quit smoking or offer cessation support than they do for White patients. This lack of support is a significant barrier to quitting, as it means Black people make less use of quit aids like nicotine replacement therapy and prescription quit medications. Addressing this issue is crucial to improving cessation success among Black Americans.

Menthol Use

Using menthol cigarettes also decreases the likelihood of cessation, especially among Black women. Menthol cigarettes are particularly hard to quit because they enhance nicotine’s addictive effects. The cooling and numbing properties of menthol mask the harshness of smoke, allowing for deeper inhalation and greater nicotine absorption. This leads to stronger nicotine dependency over time. Additionally, menthol’s sensory effects can create a comforting ritual, making the habit harder to break. Studies have shown that people who smoke menthol cigarettes are less likely to successfully quit compared to those who use non-menthol tobacco products.

Racial Discrimination

Stigma and discrimination contribute to higher tobacco use and lower odds of quitting among Black and African Americans. A newly published article from the American Psychological Association found evidence suggesting that experiencing racial discrimination and trauma can lead to continued smoking and make quitting more difficult. Racial trauma increases stress, which can make smoking feel like a coping mechanism. It also makes quitting seem less important and creates mental barriers, like believing it’s too hard to stop. These experiences highlight how systemic racism and bias contribute to tobacco addiction.

Image via wirestock on Freepik

What are the key takeaways from this report?

Black and African American communities bear a disproportionate share of the burden caused by tobacco use, shaped by decades of racially targeted marketing, systemic inequities, and healthcare access barriers. The most recent US Surgeon General’s report details the unique and severe tobacco-related health challenges faced by Black Americans. Menthol cigarettes, non-daily smoking patterns, and polytobacco use contribute significantly to these disparities. The crossover effect highlights how targeted marketing and systemic barriers impact smoking trends across a lifetime. Additionally, systemic racism and discrimination exacerbate addiction and reduce cessation success.

Addressing these issues through policy changes, culturally sensitive programs, and equitable healthcare access is crucial for eliminating tobacco-related disparities and improving health outcomes for Black communities.

References

American Psychological Association. (2025). Racial trauma and smoking behavior: The role of discrimination in cessation barriers among Black Americans. Journal of Health Psychology, 40(3), 456–470. https://psycnet.apa.org/record/2025-56026-001

Centers for Disease Control and Prevention. (2024). Health effects of cigarette smoking. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm

Office of the Surgeon General. (2024). Eliminating tobacco-related disease and death: A report of the Surgeon General. Washington, D.C.: U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/2024-sgr-tobacco-related-health-disparities-full-report.pdf

U.S. Food and Drug Administration. (2022). The dangers of menthol cigarettes. https://www.fda.gov/tobacco-products/products-ingredients-components/menthol-and-other-flavors-tobacco-products

World Health Organization. (2021). Tobacco: Key facts. https://www.who.int/news-room/fact-sheets/detail/tobacco