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​Not everyone has an equal opportunity for a he​althy and smoke-free​ life. By identifying disproportionately affected groups, ​targeted tobacco control strategies can be implemented to help everyone attain their highest ​​health potential​.

Social Dete​rminants of ​Health

Health disparities are refle​cted through differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment​​​. If a health outcome is seen to a greater or lesser extent between populations, there is disparity.​

Social determinants of health are the conditions in the environments in which people are born, live, learn, work, play, worship, and age. These factors affect a ​wide range of health, functioning, and quality-of-life outcomes and risks. ​​​​Some of those factors include economic stability, social and community context, neighborhood and environment, health care, and education. They are affected by structural racism, oppression​, and power imbalances. 

Social Determinants of Health  

Facing Tobacco-Related Health Dispar​ities

The California Department of Education has identified the following student groups as having disparately high rates of tobacco use, and potentially higher rates of adverse health outcomes:

  • ​​African American/Black
  • American Indian/Alaska Native
  • Latino/Hispanic
  • Native Hawaiian/Pacific Islander
  • Students identifying as Lesbian, Gay, Bisexual, Transgender, or Queer/Questioning (LGBTQ)
  • Foster youth
  • Students experiencing homelessness
  • Students enrolled in non-traditional schools
  • Rural communities
  • Low-income communities​

These groups were identified using statewide data. Not all communities are the same, so it is important to assess your own community and accurately address your local tobacco-use disparities.​​​

When working to reduce these disparities, it is important to consider and address the social determinants of health that may be contributing to their high rates of tobacco use.​​​​​​​

​Health Equity and
Social Determinants of Health


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Although tobacco use has declined since 1964, disparities remain across groups defined by race, ethnicity, educational level, socioeconomic status, and geography. Tobacco companies have strategically marketed tobacco products to target racial and ethnic communities for decades.​​​

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​Truth Initiative​

Visit the Truth Initiative's website to learn more about tobacco as a social justice issue.

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​Center for Disease Control (CDC)​​

Visit the CDC website to learn more about the different ethnic and racial groups with higher tobacco use rates. ​​

​​Tribal Communities

The Tobacco Industry has targeted tribal communities by heavily marketing brands like Natural American Spirit, sponsoring events, and feigning support of the culture to encourage commercial tobacco use (nontraditional ​use). They have appropriated the culture to appeal to this community, leading to some of California's highest tobacco use rates.

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​Tribal Community Coordinating Center (TCCC)​

Visit the TCCC's website to learn more about Tribal communities, tools, resources, and initiatives to p​romote a smoke-free lifestyle. 

​Tobacco-Free CA Project

Download a PDF titled: "Story of Inequity: American Indian" to learn about tobacco-use rates among this community and the history of targeted messaging.


​LGBTQ+ Community

Young people within the LGBTQ+ community tend to have higher rates of tobacco use. This is due to a number of contributing factors, including targeted messaging and outreach by the tobacco industry and increased stress due to stigma and discrimination. 

American Lung Association

Download a PDF factsheet titled: "The LGBT Community: A Priority Population for Tobacco Control" to learn more about the increased risk faced and messaging strategies for moving forward.

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American Cancer Society

Download a PDF factsheet titled "Tobacco and LGBT Communities: Protect Yourself and People You Care About" to learn about the LGBT community's inequities. ​​

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Pregnant Minors and Minor Parents

Pregnant minors and minor parents are an important focus of TUPE resources,​ as any tobacco use can directly impact their child's development (especially during pregnancy). Prevention, intervention, and cessation services are specifically tailored for this population to help them understand the consequences of exposing their children to tobacco products and to assist them with quitting tobacco.

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Campaign for Tobacco-Free Kids

Download a PDF factsheet titled "Tobacco Harms​ to Kids" to learn more about tobacco impacts on children in the home and during pregnancy.

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Campaign for Tobacco-Free Kids

Download a PDF factsheet titled: "Health Harms Caused by Pregnant Women Smoking of Being Exposed to Secondhand Smoke" to learn about the impacts of tobacco use during pregnancy.​​​​​​​

​Learn More

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A Story of Inequity

Visit the T​​obaccoFreeCA website page: "A Story of Inequity" to learn more about identified groups facing tobacco-related health disparities. The website shares the stories of how these groups have been targeted. 

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Tobacco-Related Disease Research Program (TRDRP)

Visit the TRDRP website page: "Tobacco-Related Health Disparities" to learn more abou​t health disparity groups and ways to optimize tobacco-prevention interventions among these populations​. ​​​​​​​