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INTRODUCTION

Tobacco use remains a persistent human-made epidemic.1,2 While a remarkable diversity of tobacco products is emerging, combustible tobacco products, cigarettes in particular, are responsible for the vast majority of tobacco-related disease and death. Indeed, cigarette smoking remains the leading preventable cause of disease and premature mortality1,3 and the mortality risk from smoking has increased over time.1,4 At current consumption rates, about 400 million adults worldwide will be killed by smoking between 2010 and 2050. Half a million adults die from smoking-related causes every year in the United States alone.1,5,6 Smoking affects nearly every organ of the body and causes wide range of diseases and other adverse health effects. Smoking causes or contributes to nearly all the major causes of death in the U.S. including 16 different cancers, heart disease, chronic respiratory disease, cerebrovascular disease, diabetes, chronic liver disease, and kidney disease.1

Tobacco control efforts have dramatically decreased the prevalence of cigarette smoking in the United States, but the benefits of tobacco control efforts are not equitably distributed and remarkable tobacco-related cancer health disparities have emerged.1,7 Tobacco-related disparities include a higher prevalence of daily smoking, lower rates of quitting, poorer responses to standard evidence-based treatments, less access to treatment, variation in healthcare providers’ delivery of evidence-based tobacco use treatment, and an increased burden of tobacco-related cancers and other tobacco-related diseases.1,8–11 For instance, individuals of lower socioeconomic status (SFS) smoke at nearly three times the prevalence rate of higher SES individuals.12 Cigarette-smoking rates for adults who are uninsured or on Medicaid are more than twice those for adults with private health insurance.13 In 2015, 16.7% of non-Hispanic Black adults in the United States smoked cigarettes, compared with 15.1% of U.S. adults overall.14 Higher tobacco use prevalence rates exist among sexual minorities,15,16 persons with physical and intellectual disabilities,17 serious mental illnesses,1 and active military and veteran groups.18 The prevalence of cigarette smoking among individuals in recovery from substance use disorders (SUDs) is two to four times greater than the prevalence of smoking in the general population.19–21 All of these groups suffer disproportionately from tobacco-related disease. For instance, even after controlling for exposure levels, women are more likely to suffer from tobacco-related disease including lung cancer22 and chronic obstructive pulmonary disease.23 More than half of individuals who attain sustained remission from SUDs will die of tobacco-related diseases.24,25 These tobacco-related disparities have a significant, and preventable, impact on the health and well-being of these vulnerable groups.

EPIDEMIOLOGY OF TOBACCO USE

First cultivated in the pre-Columbian Americas, tobacco was used for centuries by Native Americans in ceremonial and social gatherings. After the arrival of Europeans in the New World, the crop became a major global industry. In the United States, a wide variety of tobacco products were consumed, with chewing tobacco, pipes, and cigars becoming common ...

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