BACKGROUND: The 1998 U.S. Surgeon General’s Report (SGR) was the first to address disparities with a focus on “Tobacco Use Among U.S. Racial/Ethnic Minority Groups.” With greater attention on health equity in our field, the 2024 SGR provides an updated synthesis and recommendations for research, practice, and policy to reduce tobacco-related health inequities.
METHODS: Development of the 2024 SGR began in 2018, with data analyses and evidence synthesis continuing through 2023. Preparation of this report was guided by core principles emerging from the theory of social justice, including knowledge and understanding, equal respect, and sharing power. This report acknowledges that multiple, multilevel social and commercial dynamics predispose, enable, and reinforce health disparities.
RESULTS: More than 490000 deaths attributable to cigarette smoking and expo­sure to secondhand tobacco smoke are estimated to occur in the United States each year—about one in five of all deaths. Disparities in tobacco use persist by race and ethnicity, income, education, sexual orientation, gender identity, occupation, geography, and behavioral health status. Exposure to secondhand smoke remains disproportionately higher among Black people, youth, and people living in poverty. Tobacco-related disparities have multilayered influences, including the tobacco industry’s aggressive, targeted marketing.
CONCLUSIONS: Tobacco-related health disparities are a social injustice, in addition to an economic and health burden. Addressing disparities requires reflection on the complex history of the commercialization of tobacco and both past and present-day experiences of racism, discrimination, and targeted marketing by the tobacco industry. A comprehensive effort toward health equity must include a combination of complementary approaches to reduce the affordability, accessibility, appeal, and addictiveness of tobacco products. Interventions designed to reduce the use of tobacco products and the influences of the tobacco industry on society should accompany efforts to remove the underlying social, structural, commercial, and political drivers of health inequities.