RT Journal Article SR Electronic T1 Using systems science to advance health equity in tobacco control: a causal loop diagram of smoking JF Tobacco Control JO Tob Control FD BMJ Publishing Group Ltd SP 287 OP 295 DO 10.1136/tobaccocontrol-2021-056695 VO 32 IS 3 A1 Mills, Sarah D A1 Golden, Shelley D A1 O’Leary, Meghan C A1 Logan, Paige A1 Hassmiller Lich, Kristen YR 2023 UL http://tobaccocontrol.bmj.com/content/32/3/287.abstract AB Objectives Develop and use a causal loop diagram (CLD) of smoking among racial/ethnic minority and lower-income groups to anticipate the intended and unintended effects of tobacco control policies.Methods We developed a CLD to elucidate connections between individual, environmental and structural causes of racial/ethnic and socioeconomic disparities in smoking. The CLD was informed by a review of conceptual and empirical models of smoking, fundamental cause and social stress theories and 19 qualitative interviews with tobacco control stakeholders. The CLD was then used to examine the potential impacts of three tobacco control policies.Results The CLD includes 24 constructs encompassing individual (eg, risk perceptions), environmental (eg, marketing) and structural (eg, systemic racism) factors associated with smoking. Evaluations of tobacco control policies using the CLD identified potential unintended consequences that may maintain smoking disparities. For example, the intent of a smoke-free policy for public housing is to reduce smoking among residents. Our CLD suggests that the policy may reduce smoking among residents by reducing smoking among family/friends, which subsequently reduces pro-smoking norms and perceptions of tobacco use as low risk. On the other hand, some residents who smoke may violate the policy. Policy violations may result in financial strain and/or housing instability, which increases stress and reduces feelings of control, thus having the unintended consequence of increasing smoking.Conclusions The CLD may be used to support stakeholder engagement in action planning and to identify non-traditional partners and approaches for tobacco control.Data sharing not applicable as no data sets generated and/or analysed for this study. Data sharing is not applicable because no datasets were generated for this study.