While there has been a significant decline in tobacco use in the U.S., significant tobacco-related health disparities remain.
Surgeon General Vivek Murthy’s new report, "Eliminating Tobacco-Related Disease and Death: Addressing Disparities: A Report of the Surgeon General,” aims to address these longstanding disparities.
“Tobacco use imposes a heavy toll on families across generations. Now is the time to accelerate our efforts to create a world in which zero lives are harmed by or lost to tobacco,” said Dr. Murthy in a statement. “This report offers a vision for a tobacco-free future, focused on those who bear the greatest burden, and serves as a call to action for all people to play a role in realizing that vision.”
According to the report, smoking is the leading cause of preventable death in the U.S., causing about one in five of all deaths. There has been significant progress in reducing tobacco use among Americans, with cigarette smoking among adults declining by more than 70 percent since 1965. However, the report underscores that the progress has not resulted in the same outcomes across all U.S. population groups. Indeed, cigarette smoking remains higher among particular groups, including American Indian and Alaska Native individuals; people living in poverty; adults with lower levels of education; people who identify as gay, lesbian, or bisexual; adults who work in manual labor and service jobs; people who reside in rural areas; adults who reside in the Midwest or South; and people living with a mental health condition or substance use disorder.
Further, recent data from the Centers for Disease Control and Prevention (CDC) also shows tobacco use among U.S. middle and high school students has dropped to the lowest level in 25 years. From 2023 to 2024, an estimated 550,000 fewer middle school and high school students are using tobacco products. While the significant decline is encouraging, the data also showed persistent disparities are still at play, with the data showing American Indian or Alaska Native (AI/AN) students reported the highest prevalence of current use of any tobacco products, of e-cigarettes, and of multiple tobacco products. Additionally, while tobacco use declined for Hispanic students and remained stable for all other racial and ethnic groups from 2023 to 2024, it increased among AI/AN students.
The Surgeon General’s report outlines “endgame” approaches to address the appeal, addictiveness, and availability of tobacco products, as well as prevention and control strategies to reduce tobacco-related disparities.
The “endgame” approaches to reduce, and ultimately eliminate, tobacco use among all Americans includes:
- Reduce nicotine in cigarettes and other tobacco products to minimally addictive or nonaddictive levels
- Restrict the manufacture and/or sale of flavored tobacco products, including policies to prohibit all flavored tobacco products and product standards to prohibit menthol in cigarettes
- Restrict consumer marketing of tobacco products
- Restrict the sale of entire categories of tobacco products
- Prevent sales of tobacco products to future generations
To address tobacco-related health disparities in particular, Dr. Murthy made a call to action to governments, funders, public health practitioners, health care professionals and health care organizations, researchers and research institutions, businesses and employers, schools and academic institutions, communities, and individuals and families to advance tobacco-related health equity:
- Collaborate to advance a commercial tobacco endgame with a shared goal to enable all people to live a healthy life without tobacco use or exposure, as well as a life without tobacco-related disease, disability, and death
- Work together and be accountable with aligning resources, stated commitments, and actions to advance health equity
- Measure progress, reward successes, acknowledge and learn from mistakes, and utilize resources when shortcomings need to be addressed