The Truth Initiative recently released a report titled, “Tobacco Nation: A Call to Eliminate Geographic Smoking Disparities in the U.S.” This report analyzed smoking prevalence in the United States and found that weaker tobacco policies have led to disparities in commercial tobacco use, specifically among Southern and Midwestern states. The report also made recommendations for policy, system and environmental change strategies to advance health equity.  

Certain policies and practices have led to this significant geographical difference in the prevalence of commercial tobacco use, as well as poor health outcomes associated with tobacco. For example, people living in these areas are more likely to be involuntarily exposed to secondhand smoke because they are not protected by comprehensive smoke free laws at their worksites, such as restaurants, bars and casinos. This unjust gap in policy leads workers who do not smoke to make a choice between their paycheck and their health.  

Additionally, the tobacco industry has a long history of targeting rural areas by offering discounts and special sales, tailored advertising, cultural events such as rodeos, and placing commercial tobacco products in discount stores. These high-pressure marketing tactics, combined with the lack of state and local comprehensive smoke-free and retail policies, have led to longstanding disparities related to tobacco product initiation, use and cessation, as well as secondhand smoke exposure and tobacco-related health disparities in these areas. 

The Truth Initiative found that these unjust practices have led to a 50% higher smoking prevalence among adults and youth when compared to the rest of the country. This region, nicknamed “Tobacco Nation”, consists of the following 12 states: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee and West Virginia. 

Strong commercial tobacco policies have been proven to decrease commercial tobacco usage and the poor health outcomes associated with commercial tobacco and secondhand smoke exposure. The Truth Initiative highlighted the following policies to help these communities increase their health outcomes through prevention efforts: 

  1. Comprehensive smoke free policies 
  2. Higher commercial tobacco excise taxes 
  3. Point of sale policies 
  4. Strong flavor policies