Tobacco-related health outcomes and inequities
Smoking remains the leading cause of preventable death and disease in the US and Massachusetts. Smoking affects nearly every organ in the body and is associated with multiple preventable chronic diseases including coronary heart disease, stroke, type 2 diabetes, chronic obstructive pulmonary disease, asthma, and numerous types of cancer. Nicotine is addictive and has the potential to severely compromise the long-term health of the brain, particularly for individuals under the age of mid-20s for whom the brain is still developing.
Social, environmental, and economic conditions of health such as education, employment, access to health care and quality of care, support from families and peers, and the built environment and housing impact health risk behaviors and long-term health outcomes. Differences in these conditions can make it more difficult for people to achieve healthy behaviors and good health. Historical policies that have perpetuated segregation and wealth inequities have led to inequities in many social, environmental, and economic conditions, such as greater tobacco retail density in neighborhoods of color, and decreased access to health insurance and quality health care among people of color.
As a result, significant gaps in the prevalence of smoking and quitting exist among different populations. Higher smoking rates, lower quit rates, and/or higher rates of tobacco-related health outcomes are reported more for the following groups of people than the Massachusetts overall population:
- Black non-Hispanics and Hispanics
- Individuals that have MassHealth insurance
- Individuals with lower income
- Individuals with less than a high school education
- Persons with disabilities
- Individuals experiencing poor mental health
- Individuals who identify as LGBT
Over the past 20 years, Massachusetts has increased the passage of statewide and local tobacco control policies and protections that have reduced the availability of tobacco products and tobacco advertising and decreased smoke in the air. However, these protections are less likely to cover areas where people of color and other groups experiencing systemic discrimination live, work, and play, contributing to the inequities we continue to see in smoking rates, quitting rates, exposure to secondhand smoke, and smoking-attributable disease.
Data dashboard
The following dashboard provides data and information on the impact tobacco use has on Massachusetts cities and towns, and the strategies being used in by the cities and towns to combat tobacco use and exposure. While the dashboard is neither inclusive of all types of institutions and conditions that may lead to tobacco-related inequities, nor include data for all populations disproportionately affected by tobacco, use this dashboard as a starting point to learn about and act against tobacco related inequities.
For more data on social determinants of health in your community, see Population Health Tool Community Reports.
Statewide Tobacco Policies
- The sale of flavored tobacco products, including menthol, are restricted to licensed smoking bars for onsite consumption (06/01/2020)
- The sale of non-flavored nicotine vaping products (with a nicotine content > 35 mg/mL) is restricted to licensed, adult-only retail tobacco stores and smoking bars (06/01/2020)
- The sale of tobacco and vaping products is prohibited in health care institutions, including pharmacies (12/31/2018)
- 21 is established as the minimum legal sales age for tobacco (Must be 21 to buy any tobacco product, including e-cigarettes (12/31/2018))
Glossary
- Smoking Rate: Percentage of the population who smoke cigarettes (small area estimate of 2015-2019 Behavioral Risk Factors Surveillance System, or BRFSS data). The municipality-level smoking numbers are obtained using a statistical technique called a "Small Area Estimate" using BRFSS, Census and American Community Survey data. Estimates cannot be produced for municipalities with small sample sizes. Only valid estimates are reported at the municipality-level.
- Asthma Emergency Room Visits: Number of asthma-related emergency room visits divided by the population (*1000) (2016 -2018 Casemix data)
- Quitline Intakes: Total number of people who completed an intake questionnaire for the Massachusetts Smoker’s Quitline (Fiscal Year 2021-2023)
- Lung Cancer Standard Incidence Ratio: The observed number of lung cancer cases divided by the population (*100) (MA Cancer Registry 2011-2015)
- Number of Retailers: Total number of tobacco retail stores in a given geography
- Retail Density: Total number of tobacco retail stores in a given geography divided by total population of that same geography (*1000)
- Youth Retail Density: Total number of tobacco retail stores in a given geography divided by population of that same geography who are under the age of 21 (*1000)
- Cheapest Single Cigar Price: Average price of the cheapest single cigar sold from each tobacco retailer surveyed (from MTCP’s FY22 Pricing Survey)
- Single Cigar Availability: Percentage of tobacco retailers who sell single cigars (from MTCP’s FY22 Pricing Survey)
- Stores Selling Vape Products: Percentage of tobacco retailers who sell any vape products (from MTCP’s FY22 Pricing Survey)
- Capping Policy: Sets a maximum number of tobacco retailer permits that may exist in a given municipality
- Cigar Regulation: Requires single cigars to be sold for at least $2.50, and for multi-packs of two or more to be sold for at least $5.00