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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kalousova L. Tobacco taxes as a community protective factor against cognitive decline in later life. Alzheimers Dement 2023; 19:3985-3997. [PMID: 37132125 DOI: 10.1002/alz.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Prior work has suggested that encouraging smoking cessation could be an important tool for curbing later-life cognitive decline and cognitive disparities. This study investigates whether higher cigarette taxes were associated with lower odds of subjective cognitive decline (SCD) and lesser cognitive disparities. METHODS Using the Behavioral Risk Factor Surveillance System data collected between 2019 and 2021, this study estimates logistic regression models predicting SCD by average state cigarette taxes in the last 5, 10, and 20 years, with gradual adjustment for sociodemographic and state characteristics. RESULTS The results show that higher cigarette taxes were associated with decreased odds of SCD only in models without adjustment. Among Hispanics only, higher taxes were associated with lower odds of SCD. DISCUSSION The lower rates of SCD in states with higher cigarette taxes could be explained by their different sociodemographic characteristics. Future research should explore the mechanisms that underlie the observed association among Hispanic Americans.
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Affiliation(s)
- Lucie Kalousova
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
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Woo J. How place matters for smoking cessation: Barriers to smoking cessation among low-income Black women. Health Place 2022; 78:102925. [DOI: 10.1016/j.healthplace.2022.102925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
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Le TTT, Jaffri MA. The association between smoking behaviors and prices and taxes per cigarette pack in the United States from 2000 through 2019. BMC Public Health 2022; 22:856. [PMID: 35484617 PMCID: PMC9052522 DOI: 10.1186/s12889-022-13242-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The conclusions on how tax and price increases affect smoking behaviors are mixed. This work is devoted to re-evaluating the relationship between cigarette prices and taxes and smoking behaviors. METHODS Using 2000-2019 Behavioral Risk Factor Surveillance System data, we employed linear mixed-effect models to re-examine the impact of cigarette prices and taxes on smoking prevalence and the proportion of current smokers having tried to quit smoking in the past 12 months. All the analyses were conducted for the general population, then by age group, gender, race/ethnicity, and income level. RESULTS The results indicate that higher cigarette prices and taxes were associated with a decrease in smoking prevalence and an increased likelihood of quitting smoking. Cigarette tax and price increases produced the most powerful impact on the smoking prevalence of 18- to 24-year-olds. The estimates also show that males tended to be more price-sensitive than females. Raising cigarette prices and taxes was estimated to be more effective in reducing the smoking prevalence among non-Hispanic Blacks and Hispanics when compared to non-Hispanic whites. Cigarette price and tax changes were likely to have a smaller effect on individuals with annual income under $25,000 relative to individuals with higher income levels. CONCLUSIONS Increases in cigarette prices and taxes are significantly associated with a reduction in smoking prevalence and an increased likelihood of quitting smoking among adults across different demographic and socioeconomic groups. However, as cigarette price and tax changes disproportionately affect low-income individuals, raising cigarette prices and taxes may deepen income disparities.
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Affiliation(s)
- Thuy T T Le
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Mohammed A Jaffri
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Gao M, Lee C, Park S. Gender, Tobacco Control Policies, and Persistent Smoking Among Older Adults: A Longitudinal Analysis of 11 European Countries. Nicotine Tob Res 2022; 24:1247-1256. [PMID: 35092442 PMCID: PMC9278835 DOI: 10.1093/ntr/ntac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/15/2021] [Accepted: 01/25/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Little is known about sociodemographic and macro-level predictors of persistent smoking when one has developed a health condition that is likely caused by smoking. AIMS AND METHODS We investigate the impact of gender, education, and tobacco control policies (TCPs) on persistent smoking among older Europeans. Respondents (aged 50 +) with a smoking history and at least one smoking-related health condition were pooled from the Survey of Health, Aging and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) from four waves from 2004 to 2013. We fitted gender-specific logistic regression models with two-way fixed effects (country and year) and tested interaction terms between gender, education, and TCPs. RESULTS Although women are less likely to smoke than men, they were more likely to smoke persistently. The effects of education and general TCPs on persistent smoking were significant for women only. Compared to women with low levels of education, those with moderate education (odds ratio [OR] = .63; .49-.82) and high education (OR = .57; .34-.98) are less likely to be persistent smokers. TCPs are associated with a reduced risk of women's persistent smoking (OR = .70; .51-.95) and the association is stronger for those having less education. CONCLUSIONS Older women, particularly those with low levels of education, are vulnerable to persistent smoking. TCPs might be effective in reducing persistent smoking for older women, with greater effects for less-educated women. Future studies are needed to understand mechanisms that explain gender differences in responsiveness to TCPs. IMPLICATIONS Persistent smoking is a particularly harmful smoking behavior as it is associated with greater risks of comorbidity and mortality. By employing the framework of the multilevel social determinants of health, this study examined the behavior of persistent smoking among older adults in European countries. Women, especially women with low levels of education are vulnerable to persistent smoking. Moreover, TCPs, in general, are significantly related to a reduction in persistent smoking among older women only and the negative association is stronger for those having less education, indicating gender and socioeconomic differences in responsiveness to TCPs.
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Affiliation(s)
- Manjing Gao
- Department of Sociology, University of California-Riverside, Riverside, CA, USA
| | - Chioun Lee
- Corresponding Author: Chioun Lee, PhD, 1207 Watkins, 900 University Ave., Riverside, CA 92521, USA. Telephone: +1 952-827-4411; E-mail:
| | - Soojin Park
- Graduate School of Education, University of California-Riverside, Riverside, CA, USA
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Shuval K, Stoklosa M, Nargis N, Drope J, Tzafrir S, Keinan-Boker L, DeFina LF, Qadan M. Cigarette Prices and Smoking Behavior in Israel: Findings from a National Study of Adults (2002-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168367. [PMID: 34444117 PMCID: PMC8394522 DOI: 10.3390/ijerph18168367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous countries, scant evidence exists on this topic for Israel. Accordingly, we assessed the association between cigarette prices and smoking prevalence and intensity from a national sample of adults in Israel (2002-2017). Data on smoking behavior were derived from the Israeli Knowledge Attitudes and Practices (KAP) survey, a repeated cross-sectional survey. Price information is from the Economist Intelligence Unit (EIU) since it was not collected in the KAP survey. We used the price of a pack of 20 cigarettes for Marlboro and the local brand. These two price variables were the primary independent variables, and we adjusted for inflation. The dependent variables were current smoking (yes/no) and smoking intensity, defined as the number of cigarettes smoked per week. Multivariable analysis was employed using a two-part model while adjusting for covariates. The first step of the model utilized logistic regression with current smoking as the dependent variable. The second step examining smoking intensity as the dependent variable, used OLS regression. Price elasticity was estimated as well. Analysis revealed that a one-unit increase (Israeli currency) in the price of local brand of cigarettes was related to 2.0% (OR = 0.98; 95%CI 0.98, 0.99) lower odds of being a current smoker, adjusting for covariates including household income. Moreover, a one unit increase in the price of the local brand of cigarettes was related to consuming 1.49 (95% CI -1.97, -1.00) fewer weekly cigarettes, controlling for household income and covariates. Similar results were found with the Marlboro cigarette prices. The total price elasticity of cigarette demand, given by the sum of price elasticities of smoking prevalence and intensity, showed that a 10.0% increase in the price is associated with a 4.6-9.2% lower cigarette consumption among Israeli adults. Thus, increasing cigarette prices will likely lead to a reduction in cigarette smoking thereby improving public health in Israel.
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Affiliation(s)
- Kerem Shuval
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel;
- The Cooper Institute, Dallas, TX 75230, USA;
- Correspondence:
| | - Michal Stoklosa
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Nigar Nargis
- Economic and Health Policy Research, American Cancer Society, Atlanta, GA 30303, USA;
| | - Jeffrey Drope
- Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Shay Tzafrir
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel;
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Ramat Gan 5262160, Israel
| | | | - Mahmoud Qadan
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
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