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 youth and young adults for whom the brain is still developing.
Social determinants 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 with a greater percentage of Black, Indigenous, and People of Color (BIPOC) residents, and decreased access to health insurance and quality health care among BIPOC residents.
As a result, inequities in the prevalence of smoking and quitting exist among different populations. Higher tobacco/nicotine use 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:
- Individuals who are Black non-Hispanic and/or Hispanic
- Individuals that have MassHealth insurance
- Individuals with lower income
- Individuals with less than a high school education
- Individuals with disabilities
- Individuals experiencing 15 or more days per month where their mental health is “not good”
- 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 BIPOC residents 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.
Community Data Dashboard
The following dashboard provides data on the impact tobacco and nicotine availability has on Massachusetts communities, and the strategies being used in by communities 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 Home Page - Massachusetts Health Data Tool
Statewide 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))
Data Dictionary
Policy
- Capping Policy: Policy that sets a maximum number of tobacco retailer permits that may exist in a given municipality. Number of permits varies by community. Policy data pulled Fall 2025.
- Cigar Packing Restriction: Policy thatrequires single cigars and multi-pack cigars to be sold at a minimum price. Price varies by community. Policy data pulled Fall 2025.
- NFG Policy: Nicotine Free Generation Policy, a policy that bans the sale of tobacco and nicotine products to anyone born after a specific date. Dates vary by community. Policy data pulled Fall 2025.
- Ban Retailers Near Schools: Policy that prohibits tobacco retailers from being within a certain distance from a school. Distance varies by community. Policy data pulled Fall 2025.
- Pouches to Adult Only Stores: Policy that restricts the sale of nicotine pouches to adult-only (21+) retail tobacco stores and smoking bars. Policy data pulled Fall 2025.
- Adult Only Stores Ban: Policy that prohibits the licensing of adult-only (21+) retail tobacco stores. Policy data pulled Fall 2025.
Demographics
- Total population: Data from 2023 American Community Survey 5-year estimates
- Population under age 21: Data from 2023 American Community Survey 5-year estimates.
- Median age: Data from 2023 American Community Survey 5-year estimates.
- Percent American Indian or Alaskan Native: Data from 2023 American Community Survey 5-year estimates.
- Percent Asian: Data from 2023 American Community Survey 5-year estimates.
- Percent Below Federal Poverty Level: Data from 2023 American Community Survey 5-year estimates.
- Percent Black or African American: Data from 2023 American Community Survey 5-year estimates
- Percent BIPOC: Percent Black, Indigenous or People of Color. Data from 2023 American Community Survey 5-year estimates.
- Percent High School Education or Less: Data from 2023 American Community Survey 5-year estimates.
- Percent MassHealth: Data from 2023 American Community Survey 5-year estimates.
- Percent Native Hawaiian or Other Pacific Islander: Data from 2023 American Community Survey 5-year estimates
- Percent two or more races: Data from 2023 American Community Survey 5-year estimates.
- Percent White non-Hispanic: Data from 2023 American Community Survey 5-year estimates.
Other MTCP Metrics
- MTCP Priority: MTCP designated priority community based on smoking rate, tobacco retail density, percent BIPOC population, percent below federal poverty level, and Social Vulnerability Index (SVI).
- BOH Region: MTCP Funded Board of Health Region
- CP Region: MTCP Funded Community Partnership Program
- Tobacco Retailers: Number of Tobacco Retailers, pulled August 2025
- Youth Retail Density: (Number of Tobacco Retailers /total population under age 21)*1000)
- Retail Density: (Number of Tobacco Retailers /total population)*1000)
- Smoking Rate: Percent of residents who smoke cigarettes. Data are from 2023 age-adjusted small area estimates from electronic health records (EHR) from MDPHnet. MDPHnet contains EHR data from 20% of the Massachusetts State Population.
- Asthma ER Visits: Asthma related Emergency Department Visits, 2021. Data from MEPHT | Health Data.
- Lung Cancer SIR: Lung Cancer Standard Incidence Ratio, 2016-2020. Standard Incidence Ratios represent the observed cancer diagnoses in an area to the number of expected diagnoses multiplied by 100. Data from MEPHT | Health Data.
- Quitline Intakes: Number of intakes to the Massachusetts Quitline (1800-QUIT NOW) based on community of residence. Data from FY24 and FY25 combined. Data are suppressed for any community with less than 5 intakes.
Pricing and Availability Data
- Cheapest Single Cigar Price: Average price of the cheapest single cigars available in surveyed retailers. Data from FY25 MTCP Pricing and Availability Survey.
- Retailers with Cigarettes Available: Percent of surveyed retailers with cigarettes available. Data from FY25 MTCP Pricing and Availability Survey.
- Retailers with multi-pack cigars available: Percent of surveyed retailers with multi-pack cigars available. Data from FY25 MTCP Pricing and Availability Survey.
- Retailers with Nicotine Pouches Available: Percent of surveyed retailers with nicotine pouches available. Data from FY25 MTCP Pricing and Availability Survey.
- Retailers with Single Cigars Available: Percent of surveyed retailers with single cigars available. Data from FY25 MTCP Pricing and Availability Survey.
- Retailers with Vape Products Available: Percent of surveyed retailers with vape/e-cigarette products available. Data from FY25 MTCP Pricing and Availability Survey.