Article Text

Download PDFPDF
Recommendations to advance equity in tobacco control
  1. Sarah D Mills1,2,
  2. Carrie Rosario3,
  3. Valerie B Yerger4,
  4. Marlene Donato Kalb1,
  5. Kurt M Ribisl1,2
  1. 1Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
  4. 4Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Sarah D Mills, Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599-7440, USA; sarahmills{at}


Reducing racial and socioeconomic inequities in smoking has been declared a priority for tobacco control in the USA for several decades. Yet despite the rhetoric, these inequities persist and some have actually worsened over time. Although tobacco companies have targeted racially and ethnically diverse and lower-income tobacco users, which substantially contributes to these disparities, less attention has been given to the role of individuals and organisations within the tobacco control movement who have allowed progress in eliminating disparities to stagnate. We examine the failure of tobacco control professionals to ensure the widespread adoption of equity-focused tobacco control strategies. Review of major US tobacco control reports found that the focus on equity often stops after describing inequities in tobacco use. We suggest ways to advance equity in tobacco control in the USA. These recommendations fall across five categories: surveillance, interventions, funding, accountability and addressing root causes. Policy interventions that will have a pro-equity impact on smoking and related disease should be prioritised. Funding should be designated to tobacco control activities focused on eliminating racial and socioeconomic inequities in smoking, and tobacco control programmes should be held accountable for meeting equity-related goals.

  • Disparities
  • Priority/special populations
  • Public policy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors SDM and KMR developed the initial plan for the manuscript. SDM, CR, VBY, KMR and MDK contributed to the writing, drafting and revision of the manuscript. SDM and KMR and MDK developed the figures and tables. SDM is the guarantor.

  • Funding This work was supported by the National Cancer Institute and Food and Drug Administration Center for Tobacco Products (1K01CA242530 and 1P01CA225597).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

  • Competing interests KMR has been a paid expert in litigation against tobacco companies. All other authors have no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.