Confronting Tobacco Disparities in Louisiana: A Path to Enhanced Health and Equity

By Dr. Benjamin-Robinson, Louisiana Public Health Institute and Louisiana Cancer Research Center

As we seek to build a healthier and more equitable Louisiana, it is essential to confront the harsh realities of tobacco use and its associated health risks, particularly the dangers of secondhand smoke. In Louisiana alone, between 650 and 1,090 lives are lost each year due to the harmful effects of secondhand smoke. The pervasive threat of secondhand smoke affects millions across the United States, whether in their homes, workplaces, or recreational spaces, underscoring a critical need for change.

Secondhand smoke, a toxic mix from burning tobacco products—such as cigarettes, cigars, hookahs, and pipes—harms both smokers and non-smokers alike. It permeates indoor environments, negatively impacting everyone exposed to it. The only effective method to safeguard public health is to enforce 100% smoke-free indoor environments. While ventilation systems can remove visible smoke and odor, they do not eliminate the hazardous particulates present in tobacco smoke, as highlighted by a Jan. 2024 CNN Article , which cites a 2023 report from the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE).

Despite advancements in tobacco control, disparities persist, disproportionately affecting marginalized racial, ethnic, and socio-economic groups. These disparities stem from systemic inequities that perpetuate tobacco use and exposure to secondhand smoke, especially in environments like bars and casinos that fail to prioritize health and safety.

For instance, the Shreveport City Council's comprehensive smoke-free indoor ordinance, passed on August 1, 2021, was a commendable step toward protecting community health. However, the ordinance’s roll back exemption for casinos, in 2023, due to bureaucratic push back, undermines its effectiveness because it doesn’t hear the cries of the community voices, calling for a change. This compromise forces workers—often from lower-income backgrounds—to continue working in harmful conditions, illustrating the need for unwavering commitment to smoke-free environments.

Tobacco use rates reveal troubling disparities across different demographic groups in Louisiana. Individuals without a high school diploma have a smoking rate of 44%, compared to just 12% among college graduates. This disparity highlights the influence of educational attainment on health outcomes and underscores the need for targeted interventions.

Racial and ethnic disparities further illustrate the impact of systemic issues. The tobacco industry’s targeted marketing of menthol-flavored cigarettes to Black communities has significantly contributed to these disparities. Menthol cigarettes, which account for a substantial portion of the market, are disproportionately used by Black smokers—81% of whom prefer menthols, compared to 34% of white smokers. The stalled FDA proposal to ban menthol cigarettes exacerbates these health challenges.

Moreover, the LGBTQ+ community faces notable tobacco use disparities, with 33% of LGBTQ+ individuals in Louisiana reporting cigarette smoking. This disparity is linked to unique stressors and health determinants faced by LGBTQ+ individuals, including discrimination and inadequate healthcare access.

Economic factors also intersect with tobacco use disparities. In households earning below $50,000 annually, 32% of individuals smoke, compared to 24% in higher-income households. Alarmingly, 41% of those in households earning below $15,000 smoke. These figures highlight how poverty exacerbates tobacco-related health inequities.

Addressing these disparities requires a multi-pronged approach focused on equity and justice. Educating individuals about tobacco's harms is insufficient on its own. We must dismantle the systemic barriers perpetuating these disparities and create environments that promote health for everyone.

First, we must challenge the tobacco industry's exploitative practices, particularly its aggressive marketing to vulnerable populations. Advocating for robust tobacco control policies and regulations and enforcement of 100% comprehensive indoor smoke-free ordinances at the local government level is crucial to limit the industry's impact and protect our communities.

Investing in culturally sensitive prevention and cessation programs is also vital. Tailoring these programs to the unique needs of diverse populations will help empower individuals to make healthier choices and overcome tobacco addiction.

Additionally, addressing the social determinants of health—such as poverty, discrimination, and inadequate healthcare access—is essential. Collaborating across sectors to implement policies that promote economic opportunities, combat systemic racism, and ensure equitable healthcare access is key to reducing tobacco-related disparities.

As we work towards a tobacco-free Louisiana, let us uphold the principles of equity and justice. By focusing on the needs of vulnerable populations and advocating for comprehensive health equity policies, and 100% smoke-free indoor environments, we can build a future where every Louisianan has the opportunity to thrive free from the dangers of tobacco.

Together, let’s strive for a healthier, more equitable Louisiana for generations to come.

Dr. Benjamin-Robinson is a leading advocate for tobacco control and health equity at the Louisiana Public Health Institute, where he serves as the Senior Director for Tobacco Control & Prevention and the Louisiana Campaign for Tobacco-Free Living (TFL). He also directs the Louisiana Cancer Research Center’s Office of Community Outreach and Engagement.