People With Social Or Economic Disadvantages
In 2005, nearly 280,000 Colorado smokers (36.5% of adult smokers) reported one or more disadvantages – they didn't graduate from high school, they lived in poverty or near-poverty, they had no health insurance, or they were unable to work (disabled). Having any of these disadvantages is linked with higher odds of smoking, lower odds of quitting, and greater likelihood of exposure to secondhand smoke. Each additional disadvantage is linked with additional tobacco burdens.
Slightly more than one-third of Colorado adults were socioeconomically disadvantaged in 2005, a significantly increase from 2001, and this group included more than half the state's adult smokers. In both years, the strongest tie to smoking was not having completed high school.
Smokers with social or economic disadvantages are only about two-thirds likely as others to quit smoking. Social and economic disadvantage is also linked to smoke exposure. Disadvantaged people are more than twice as likely than others to report that smoking occurs in their homes. Children in households with socially or economically disadvantaged adults are more than three times more likely to be exposed to cigarette smoke at home.
Before Colorado adopted the Smoke-Free Workplace Law in 2006, smoke-free workplace rules were one-fourth as common among people in poverty, one-third as common among people without health insurance, and half as common among high school non-completers.
Ethnicity.
Among men, every non-Anglo ethnic group is less likely to quit smoking than Anglo smokers. Among women, Latinas and American Indians are less likely to quit than Anglo smokers.
Latino smokers whose main language is Spanish are less likely than Anglo smokers to be advised by a doctor to quit smoking, because they are less likely to see a doctor.
When trying to quit smoking, Latino and American Indian men are less likely than Anglo men to use proven medicines to assist in quitting, as are Latina, African American and Asian American women compared to Anglo women.
Smokeless Tobacco
Men in parts of rural Colorado – the West Slope and southeastern corner of the state – are much more likely to use snuff or chewing tobacco, as the map illustrates.
Addressing Disparities
The burdens described thus far were used to prioritize the following populations for appropriate interventions to reduce tobacco disparities:
- African Americans
- American Indians
- Asian AmericansLatinos and Hispanics
- People with low socio-economic status
- People with disabilities and
- Spit tobacco users.
Three additional populations were prioritized based on national evidence of elevated tobacco burdens:
- Lesbian-gay-bisexual-transgender communities
- People with mental illnesses and
- People with substance abuse disorders.
In 2003, at the behest of the The Robert Wood Johnson Foundation, the Program In Health Services Management and Policy, Robert J. Milano Graduate School of Management and Urban Policy, revised and updated a previous study of community-based disparity initiatives through internet and literature searches, expert interviews, surveys and site visits in order to describe and analyze existing programs, delineate some of their “best practices,? and recommend future actions that might help strengthen community-based systems to address disparities. In 2005, the Colorado Department of Public Health and Environment Office of Health Disparities released a report entitled “Racial ad Ethnic Health Disparities in Colorado created under similar circumstances and reaching similar conclusions and recommendations.
The recommendations to address health disparities (and applicable to tobacco-related disparities) fell within the following categories:
Research and Evaluation: Improve the Practice of Epidemiology, Identify Best Practices
Develop a Business Case Model of Disparities: Improve Workforce Diversity
Improve the Social Determinants of Health, e.g., socio-economic status, etc.
Focus on involving existing organizations while encouraging new organization and innovation with copious training, technical assistance, and general capacity building
Develop leadership and core competencies
Improve Cultural and Linguistic Competency