National Conference on Tobacco and Health Disparities 

Eliminating Tobacco-Related 

Health Disparities 

Summary Report 

National Institutes of Health • National Cancer Institute 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Eliminating Tobacco-Related

Health Disparities

Summary Report

National Conference on Tobacco and Health Disparities

Forging a National Research Agenda to 

Reduce Tobacco-Related Health Disparities

December 11–13, 2002  Palm Harbor, Florida 
Table of Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv


Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi


Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1


Developing Research Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4


Cluster Concepts and Research Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21


References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22


Appendix A: National Conference on Tobacco and Health Disparities Agenda . . . . . . . . . . . . . . . . . . . . . . . . 26


Appendix B: Summary of Panel Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Acknowledgments

his report was prepared under the direction of the Tobacco Control Research Branch, Behavioral Research 

Program, Division of Cancer Control and Populations Sciences, National Cancer Institute. We are grateful Tto the conference planning committee; conference participants; MasiMax Resources, Inc.; Concept Systems, Inc.; and contributors to this report. We also would like to thank the supporters of this meeting: the 

National Cancer Institute, the Centers for Disease Control and Prevention, the American Legacy Foundation, 

The Robert Wood Johnson Foundation, the American Cancer Society, the Campaign for Tobacco-Free Kids, 

the National Latino Council on Alcohol and Tobacco Prevention, and the National African American Tobacco 

Prevention Network. 

Senior Editor 

Gary King, Ph.D. 

The Pennsylvania State University 

University Park, PA 

Assistant Editors 

Pebbles Fagan, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, MD 

Deirdre Lawrence, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, MD 

Conference Summary Report 

Contributors 

Mark Adams, C.M.P. 

MasiMax Resources, Inc. 

Rockville, MD 

Jennifer Anne Bishop, M.P.H. 

Harvard School of Public Health 

Boston, MA 

Jeanine Draut 

Concept Systems, Inc. 

Ithaca, NY 

Heather Freeborn 

Concept Systems, Inc. 

Ithaca, NY 

Tamika Gilreath, M.S. 

The Pennsylvania State University 

University Park, PA 

Rachel Grana, B.S.H.S. 

MasiMax Resources, Inc. 

Rockville, MD 

Sharon Marable, M.D., M.P.H. 

State of Rhode Island 

Department of Health 

Providence, RI 

Dan McLinden, Ed.D. 

Concept Systems, Inc. 

Dekalb, IL 

Paris Ponder, B.S. 

MasiMax Resources, Inc. 

Rockville, MD 

Ruth Stadius, B.A.A. 

MasiMax Resources, Inc. 

Rockville, MD 

Conference Honorary Chair 

Harold Freeman, M.D. 

National Cancer Institute 

Bethesda, MD 

Conference Planning 

Committee 

Mark Adams, C.M.P. 

MasiMax Resources, Inc. 

Rockville, MD 

Nancy Breen, Ph.D. 

National Cancer Institute 

Bethesda, MD 

Kevin Collins, M.P.A. 

Centers for Disease Control 

and Prevention 

Atlanta, GA 

Jane Daye, M.S. 

National Cancer Institute 

Bethesda, MD 

Mirjana Djordjevic, Ph.D. 

National Cancer Institute 

Bethesda, MD 

Pebbles Fagan, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, MD 

Harold Freeman, M.D. 

National Cancer Institute 

Bethesda, MD 

Phillip Gardiner, Dr.P.H. 

University of California 

Oakland, CA 

Rachel Grana, B.S.H.S. 

MasiMax Resources, Inc. 

Rockville, MD 

Benjamin Griffin, M.P.A. 

Environmental Protection Agency 

Washington, DC 

iv Eliminating Tobacco-Related Health Disparities 
Sandra Headen, Ph.D. 

National African American 

Tobacco Prevention Network 

Raleigh, NC 

Suzanne Heurtin-Roberts, 

Ph.D., M.S.W. 

National Cancer Institute 

Bethesda, MD 

Linda Jouridine, Ed.D. 

University of Kentucky 

Lexington, KY 

Gary King, Ph.D. 

The Pennsylvania State University 

University Park, PA 

Deirdre Lawrence, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, MD 

Scott Leischow, Ph.D. 

National Cancer Institute 

Bethesda, MD 

Helen Lettlow, M.P.H. 

American Legacy Foundation 

Washington, DC 

Rod Lew, M.P.H. 

Asian Pacific Partners for 

Empowerment and Leadership 

Oakland, CA 

Grace Ma, Ph.D., C.H.E.S. 

Temple University 

Philadelphia, PA 

Sharon Marable, M.D., M.P.H. 

State of Rhode Island 

Department of Health 

Providence, RI 

Stephen Marcus, Ph.D. 

National Cancer Institute 

Bethesda, MD 

Sherry Mills, M.P.H., M.D. 

Abt Associates, Inc. 

Bethesda, MD 

Deborah McLellan, M.H.S. 

Dana-Farber Cancer Institute 

Boston, MA 

Michael Moran 

MasiMax Resources, Inc. 

Rockville, MD 

Mildred Morse, J.D. 

National Tobacco 

Independence Campaign 

Silver Spring, MD 

Pamela Murray 

MasiMax Resources, Inc. 

Rockville, MD 

Dearell Niemeyer, M.P.H. 

Tobacco Technical Assistance 

Consortium 

Atlanta, GA 

Jeanette Noltenius, Ph.D., M.A. 

Rick Swartz and Associates 

Washington, DC 

Sallie Anne Petrucci, M.P.H., 

C.H.E.S. 

The Robert Wood Johnson 

Foundation 

Princeton, NJ 

Paris Ponder, B.S. 

MasiMax Resources, Inc. 

Rockville, MD 

Robert Robinson, Dr.P.H. 

Centers for Disease Control 

and Prevention 

Atlanta, GA 

Rebecca Ryan, B.S. 

MasiMax Resources, Inc. 

Rockville, MD 

Patricia Sosa, J.D. 

Campaign for Tobacco-Free Kids 

Washington, DC 

Ruth Stadius, B.A.A. 

MasiMax Resources, Inc. 

Rockville, MD 

Perry Stevens, M.P.A. 

Centers for Disease Control 

and Prevention 

Atlanta, GA 

Alexandria Stewart 

Centers for Disease Control 

and Prevention 

Atlanta, GA 

Ron Todd 

American Cancer Society 

Atlanta, GA 

Deborah Winn, Ph.D. 

National Cancer Institute 

Bethesda, MD 

ACKNOWLEDGMENTS v 
Executive Summary

he elimination of tobacco-related health disparities poses a major challenge to this nation. T 1 Certain groups remain at high risk for

tobacco use and suffer disproportionately 

from tobacco-related illness, disease, and death. Underlying the challenge to eliminate health disparities 

is the inadequate empirical understanding of the 

proximal and distal determinants of tobacco use, 

nicotine addiction, and related consequences among 

understudied and historically underserved populations in the United States. A research agenda that addresses the existing gaps in the scientific knowledge 

base and identifies optimal points for interrupting 

the continuum of tobacco-related health disparities, 

ranging from tobacco use to tobacco-related deaths, 

will help health professionals develop and implement effective intervention programs to reduce the 

burden of tobacco. 

opportunity to participate in this vital 

national public health agenda by documenting, monitoring, and elucidating 

disparities.”2 

“The health disparities movement offers 

the tobacco control community an 

reasons for these differences and by 

restructuring, reworking, and reinvigorating approaches for diverse communities 

to eliminate tobacco-related health 

Eliminating Tobacco-Related Health Disparities is the 

first report to identify critical steps to help reduce 

tobacco-related health disparities among understudied and historically underserved populations in the 

United States. This report describes the process employed to generate research recommendations in key 

scientific areas, summarizes the conference presentations, and presents nine research clusters/themes 

used to categorize more than 100 recommendations 

developed by the conference participants. These 

recommendations provide direction for research action, processes, and communication needed to 

build the evidence base for reducing tobacco use 

and the disproportionate burden of tobacco use and 

its consequences. 

This summary report represents efforts that began 

at the National Conference on Tobacco and Health 

Disparities (NCTHD) held in December 2002, in 

Palm Harbor, Florida. The conference planning committee, which included a diverse group of researchers and practitioners, worked to identify key 

funding organizations and individuals from academic institutions and community-based organizations to 

participate in this meeting. The NCTHD was the first 

scientific effort to review the current research, identify gaps, and develop a comprehensive research 

agenda to eliminate tobacco-related disparities. Supporters of this meeting included representatives from 

the National Cancer Institute, the Centers for Disease 

Control and Prevention, the American Legacy Foundation, The Robert Wood Johnson Foundation, the 

American Cancer Society, the Campaign for TobaccoFree Kids, the National Latino Council on Alcohol 

and Tobacco Prevention, and the National African 

American Tobacco Prevention Network. 

A critical step in developing a research agenda 

for addressing tobacco-related health disparities was 

to define the depth and breadth of health disparities. The conference planning committee defined 

tobacco-related disparities as follows: 

secondhand smoke). 

Differences in patterns, prevention, and 

treatment of tobacco use; the risk, incidence, morbidity, mortality, and burden 

of tobacco-related illness that exist 

among specific population groups in the 

United States; and related differences in 

capacity and infrastructure, access to 

resources, and environmental tobacco 

smoke (ETS) exposure (also known as 

Following the NCTHD, a work group from the 

conference planning committee convened to develop a framework for organizing and presenting the 

NCTHD research recommendations. The work 

group used concept mapping to help prioritize more 

than 100 recommendations. Concept mapping methods included sorting the recommendations into 

themes and rating them on scales of importance and 

vi Eliminating Tobacco-Related Health Disparities 
feasibility. Results revealed nine major clusters or 

closely related recommendations. All nine clusters 

are presented, and research recommendations that 

were ranked as both highly important and highly feasible are highlighted in this executive summary. 

Other research recommendations are outlined in 

the summary report, with each recommendation 

making a valuable contribution to the development 

of a research agenda. While this summary report includes many important research recommendations, 

it is not intended to be exhaustive of all the ideas 

and suggestions on this topic. Furthermore, while we 

acknowledge the importance of smokeless tobacco 

and other tobacco products, this report primarily focuses on cigarettes. 

Research Recommendations Highly Ranked on Importance and Feasibility 

Funding 

Mentoring and 

Systems 

Change 

Using 

Information to 

Inform Policy 

or Practice 

Research 

Training/ 

� Develop special grant peer-review groups that examine innovative, qualitative or 

quantitative research needs of small populations. 

� Design funding mechanisms to promote collaboration between investigators at minorityserving institutions and investigators at large research institutions. 

� Develop and explore funding mechanisms (e.g., community academic research awards) 

that incorporate methods to increase the likelihood that tobacco prevention efforts are 

culturally relevant and evidence-based. 

� Encourage ongoing funding for pilot projects and exploratory research (i.e., qualitative) 

that focus on innovative theories and methods from the perspective of the target 

populations. 

� Fund the training and mentoring of minority researchers. 

� Expand and fund mentorship programs, such as minority supplements, to increase 

opportunities for training in community intervention research. 

� Create broader multidisciplinary teams (e.g., community advocates and social, 

behavioral, and basic scientists) to develop a comprehensive perspective on tobacco 

use, addiction, and health consequences. 

� Prioritize funding for community-based policy research to build the case for innovative 

tobacco control policy activities related to disparate populations. 

� Increase understanding about how tobacco control programs, tax increases, and 

smoking restriction policies together affect changes in tobacco use or quit rates for 

disparate populations. 

� Improve the use of research, including basic biological research, in formulating policy. 

E X E C U T I V E S U M M A R Y vii 
Research Recommendations Highly Ranked on Importance and Feasibility 

continued 

Marketing 

Strategies to 

Use and Policy 

Examining and 

Understanding 

and Cessation 

Communitybased 

Dissemination 

and 

Communication 

Research 

Affect Tobacco 

Tobacco Use 

� Build a network of state and community health disparities researchers to facilitate 

effective communication and collaboration. 

� Create a repository of tobacco control resources developed for different groups. 

� Disseminate scientific data in a usable manner to academic researchers, community 

members who carry out their own research, and community members. 

� Document state-level best practices for tobacco policy and control for disparate 

communities. 

� Encourage use of marketing research to develop communication strategies that address 

prevention, interventions for cessation, and maintenance of quit behaviors. 

� Include additional questions on the use of menthol, light, and other types of cigarettes in 

national and state surveys. 

� Conduct secondary analysis of national surveys to generate information on disparate 

populations and ethnic communities. 

� Examine predictors of cessation in African Americans and other ethnic minority adult 

populations. 

� Conduct research on cessation among youth and assess differences in quitting among 

early and late initiators. 

� Increase the study of socioeconomic status in smoking initiation and cessation. 

� Study data on tobacco use and individual and community variables (e.g., number of 

stores that sell tobacco, provision and characteristics of cessation programs) that may 

influence use and quitting behaviors. 

� Continue and expand research on the prevalence and effects of ETS within special 

populations. 

� Examine barriers among disparate groups regarding the use of behavioral and 

pharmacological treatments at the individual, organizational, and community levels, 

and assess ways of improving access to treatments. 

viii Eliminating Tobacco-Related Health Disparities 
EXECUTIVE SUMMARY ix

Cessation,

Environmental

Risks, and

Harm

Reduction

� Explore the combination of constituents in tobacco (e.g., menthol) and the effect of

differing levels (e.g., within different products or brands) on addiction and subsequent

health effects.

� Conduct research on how to obtain support for ETS policies within disparate

communities.

� Conduct community assessment or capacity studies to determine optimal strategies for

building, strengthening, and developing tobacco control initiatives.

� Encourage research on the sustainability and effectiveness of community and state

antitobacco coalitions in addressing tobacco issues in communities of color.

� Develop and evaluate interventions to promote delivery and use of treatments for

nicotine addiction in various populations, including substance abusers and mental

health populations.

� Conduct research to assess how evidence-based treatment programs are adopted,

implemented, and maintained in health care systems, schools, and other settings.

Research Recommendations Highly Ranked on Importance and Feasibility

continued

Exploratory

and

Developmental

Research

� Expand national and state surveys to include questions relevant to tobacco use

behaviors, including questions on smokeless tobacco and other methods of using

tobacco by understudied populations (e.g., Lesbian, Gay, Bisexual, and Transgender

[LGBT], Native American, and Alaska Native).

� Develop culturally and ethnically appropriate sampling methods, survey designs, and

measures to obtain larger samples and to assess the smoking behaviors of small

populations at national, regional, and local levels.

� Develop surveys and intervention materials in the native language (non-English) of the

survey respondents, intervention participants, and community.

� Develop and assess reliable measures, protocols, methods, and models to assess

cultural dimensions of health (e.g., country of origin, acculturation, and linguistic and

geographic factors).

� Fund research studies to examine the effects of acculturation, stress, coping, racism,

and discrimination on the etiology of smoking, trajectories in smoking, quitting, and

disease onset and progression.

� Support research that examines the role of culturally specific beliefs, perceptions, and

behaviors on tobacco use and exposure within multiple populations.

� Develop, implement, and utilize longitudinal studies (e.g., Black Women’s Health Study)

for small, understudied, and underserved populations.
Research Recommendations Highly Ranked on Importance and Feasibility 

continued 

the Impact of 

Industry 

Policies and 

Research on 

Tobacco 

Products 

� Conduct research on different tobacco industry pricing practices in communities, 

especially in low socioeconomic status neighborhoods. 

� Study the impact of tax increases on consumption patterns, quitting, and reduction in 

the number of cigarettes smoked in specific minority or disparate community 

populations. 

� Conduct research on differential consequences of tobacco use policies in disparate 

neighborhoods. 

� Conduct counter-marketing research utilizing social marketing techniques and principles 

with specific application to disparate populations. 

x Eliminating Tobacco-Related Health Disparities 
Introduction

he elimination of tobacco-related health disparities poses a major challenge to this nation.1 T Tobacco, the single most preventable 

cause of death in the United States, kills 

more than 440,000 smokers3 and approximately 

40,000 nonsmokers annually. Unfortunately, certain 

groups including racial and ethnic minorities,4,5,6,7,8 

women,8,9 youth,8,10 workers exposed to occupational 

hazards,8,11 blue-collar and service workers,11 and others with low levels of education7,9,12 remain at high 

risk for tobacco use and exposure and bear a disproportionate burden of tobacco-related illnesses and 

deaths.9,11,13 

While progress has been made to document these 

differences, additional data are needed to help explain the causes. Currently, we have an inadequate 

understanding of the proximal and distal determinants of tobacco use, nicotine addiction, and related 

consequences among understudied and historically 

underserved populations in the United States. 

Tobacco-related health disparities represent a variety 

of differences that may not span the entire disease 

continuum for certain segments of the population, 

while severely impacting others along the entire 

causal pathway. For example, some populations may 

experience a single disparity in exposure, initiation, 

current use, dependence, cessation and treatment, 

the economic and political consequences of tobacco 

production and sale, and in morbidity and mortality; 

others may experience multiple disparities. Below 

are some research findings that offer insight into the 

different aspects of tobacco use and exposure for 

some of the disparate populations in the United 

States. 

Tobacco Use Initiation 

�	 The majority of Asians and Pacific Islanders and 

African Americans initiate regular smoking as 

young adults, much later than other racial and 

ethnic groups.14 

�	 Low socioeconomic status predicts smoking initiation among youth.15,16,17 

�	 Children of parents with low educational attainment are more likely to try smoking.18,19 

�	 English language use is associated with a risk 

of lifetime smoking among Hispanic20,21,22,23 and 

Asian youth.20,21,24 

Current Tobacco Use 

�	 Forty-two percent of those with a General Education Development (GED) diploma smoke 

cigarettes.25 

�	 Twenty-nine percent of American Indian and 

Alaska Native boys report smoking compared to 

15 percent of White male boys.26 

�	 Lesbian and bisexual girls are more than 6 times 

as likely to have smoked in the past month compared to heterosexual girls.27 

�	 Disabled adults are 1.5 times as likely to smoke 

than those not disabled.28 

�	 Native-born African Americans are more likely to 

be smokers than foreign-born Blacks.29 

�	 More than 80 percent of schizophrenia, bipolar 

disorder, and alcohol or drug-dependent patients 

smoke.30 

Number of Cigarettes Smoked Per Day 

�	 Those who are unemployed early in life are more 

than twice as likely to report daily smoking than 

those with no early unemployment.31 

�	 African Americans, Hispanics, and Asians have a 

greater proportion of light smokers than heavy 

smokers; yet few interventions target light smokers.6 

�	 African Americans smoke fewer cigarettes per 

day than Whites, but have higher levels of serum 

cotinine than White,32,33 Mexican,6,32,33 and Asian 

American smokers.34 

�	 Twenty-seven percent of smokers who are bluecollar workers and farmers report smoking ≥ 25 

cigarettes/day compared to 18 percent of whitecollar smokers.35 

Quitting Tobacco Use 

�	 Of ever smokers, 34 percent who were below 

poverty level quit smoking compared to 50 percent of those at or above poverty level.36 

INTRODUCTION 1 
�	 Thirty-three percent of service workers compared 

to 51 percent of white-collar workers report being 

former smokers.35 

�	 Only one-third of women who stop smoking during pregnancy are still abstinent 1 year after their 

delivery.9 

�	 Women living in high unemployment areas are 

1.7 times more likely to be current smokers than

former smokers.37 

Treatment/Cessation of Tobacco Use 

�	 Only 34 percent of youth, ages 9–21 years, who 

visited a doctor’s office report receiving advice 

from a health care provider on the dangers of tobacco use.38 

�	 Nonwhite racial and ethnic groups,39 younger patients, the uninsured, the healthy, lower health 

care service users, light smokers,40 and the less educated41 are less likely to receive advice to quit. 

�	 Rates of smoking cessation counseling for hospitalized patients are 40 percent, but only 29 percent for Black patients.42 

Environmental and Transdermal Exposure 

to Tobacco 

�	 Blue-collar and service workers are significantly 

less likely than white-collar workers to be protected by smoke-free policies.43 

�	 Bartenders and waiters/waitresses are less likely 

to be covered by a smoke-free policy and are 

more likely to be exposed to ETS even when covered by such a policy.43 

�	 Migrant, seasonal, and other farm workers who 

are exposed to tobacco leaves may suffer from 

green tobacco sickness, an occupation illness resulting from transdermal nicotine exposure.44 

Marketing 

�	 In-store and over-the-counter promotions for tobacco products seem to target racial and ethnic 

communities disproportionately.6 

�	 The tobacco industry has targeted LGBT communities9,45 and has advertised in the gay media,46 

at sponsored events,47 and contributed to gay and 

AIDS organizations.48,49 

�	 The tobacco industry has targeted women since 

the early 1900s and has produced brands that target women in the United States and overseas.9 

These examples provide merely a snapshot of the 

wide range of disparities that affect the young, the 

poor, the less educated, women, LGBT communities, 

the disabled, the mentally ill, workers, the unemployed, and racial and ethnic communities across 

the United States. For some population groups, little 

information is known about tobacco use and exposure. Gaps exist in comparative data as well as data to 

explain the heterogeneity observed in racial and ethnic groups. 

Even less is known about the consequences and 

disease causal pathways among disparate groups. 

Since 1964, the Surgeons General have published 

several reports on the health consequences of smoking. Forty years later, the former Secretary of the U.S. 

Department of Health and Human Services, Tommy 

G. Thompson, said,

“It [smoking] continues to cost our 

society too many lives, too many 

dollars, and too many tears.”50 

Unfortunately, the cost of smoking and exposure to 

tobacco have cost some American communities 

more than others. 

The 1964 Surgeon General’s Report concluded 

that cigarette smoking causes cancers of the lung 

and larynx.51 In 2003, African American men were diagnosed for invasive lung and bronchus cancer at a 

rate of 110.2 compared to 77.3 per 100,000 for 

Whites.52 Overall, lung cancer rates in men have declined, while rates in women are still rising.50 Men living in counties with 20 percent or more of the population below poverty level in 1990 had a lung cancer 

mortality rate of 93.5 compared to 73.1 of those men 

living in counties with less than 10 percent below 

poverty.53 Occupational exposures, as reported in the 

1985 Surgeon General’s Report, place a number of 

workers at high risk for lung cancer. Some of these 

occupational agents are synergistic with smoking in 

2 Eliminating Tobacco-Related Health Disparities 
increasing lung cancer risk54,55,56 and diseases such as 

restrictive and chronic obstructive lung disease.50 

Tobacco-related disease disparities also exist across 

the lifecycle. In utero exposure to maternal smoking is 

associated with reduced lung function among infants.9 

Studies demonstrate an association between exposure to secondhand smoke and childhood asthma,50,57,58 and increased number and severity of respiratory illnesses and decreased physical fitness.50 

Furthermore, smoking adversely affects bone density 

and increases the risk for hip fractures in postmenopausal women.9,50 

Although this is not an exhaustive list of tobaccorelated diseases, this snapshot provides some insight 

into the consequences of tobacco use and exposure in 

disparate communities. There is still more to learn about 

disparities in tobacco-related health outcomes and the 

consequences of tobacco use and exposure in understudied and underserved communities in the United 

States. 

Eliminating Tobacco-Related Health Disparities is the 

first report to identify critical steps to help reduce tobacco use and its consequences among understudied and historically underserved populations in the 

United States. This summary report includes 

�	 a description of the process employed to 

generate research recommendations in 

key scientific areas, 

�	 final research recommendations for reducing 

tobacco-related health disparities, and 

�	 a summary of the conference panel


presentations.


This summary report presents more than 100 research recommendations developed by conference 

participants. The implementation of these research 

recommendations by policymakers, researchers, and 

practitioners will ultimately help to reduce the disproportionate burden of tobacco use on specific 

populations in the United States. 

INTRODUCTION 3 
Developing Research

Recommendations 

eveloping research recommendations for 

tobacco-related health disparities includ­ Ded two major steps. First, presenters at a

national conference identified gaps and directions for future research. Work group exercises 

followed and were conducted to generate new recommendations and to gain consensus on recommendations presented by speakers. Second, the postconference work group used concept mapping to 

help prioritize the research recommendations developed by the conference work groups. 

Presentations by Conference Participants

and Work Groups

This summary report represents efforts that began at 

the National Conference on Tobacco and Health Disparities (NCTHD), which was held December 11–13, 

2002, in Palm Harbor, Florida. The NCTHD was the 

first scientific gathering to convene researchers and 

practitioners for the purposes of reviewing the current 

research, identifying gaps, and developing a set of research recommendations for eliminating tobaccorelated health disparities. Key funding organizations 

and individuals from academic institutions and 

community-based organizations convened to develop a comprehensive research agenda aimed to reduce tobacco-related health disparities for multiple 

populations. Supporters of this meeting included 

representatives from the National Cancer Institute, 

the Centers for Disease Control and Prevention, the 

American Legacy Foundation, The Robert Wood 

Johnson Foundation, the American Cancer Society, 

the Campaign for Tobacco-Free Kids, the National 

Latino Council on Alcohol and Tobacco Prevention, 

and the National African American Tobacco Prevention Network. 

A critical step in developing a research agenda for 

addressing tobacco-related health disparities was to 

define the depth and breadth of health disparities. 

The conference planning committee defined tobaccorelated health disparities as follows: 

Tobacco-related disparities are differences 

in patterns, prevention, and treatment 

of tobacco use; the risk, incidence, 

morbidity, mortality, and burden of 

as secondhand smoke). Disparate populations may be defined by race and ethtion, mental illness, income, social class, 

education, and institutionalization. 

tobacco-related illness that exist among 

specific population groups in the United 

States; and related differences in capacity and infrastructure, access to resources, and ETS exposure (also known 

nicity, gender, age, geography, sexual 

orientation, disability, religion, occupaDuring the conference, researchers and practitioners from multiple disciplines used this definition 

as a basis for discourse on advancing the science of 

eliminating tobacco-related health disparities in several areas: epidemiology, psychosocial risk factors, 

harm reduction, capacity and infrastructure, policy, 

community and state, basic biology, marketing, surveillance, treatment of nicotine addiction, and the 

prevention of tobacco use. About 178 conference 

participants participated in this 3-day meeting. (See 

Appendix A for the agenda and Appendix B for the 

summaries of the presentations.) 

Dr. Pebbles Fagan of the National Cancer Institute opened the meeting and introduced the 

keynote speakers, Dr. Jeff Krischer of the H. Lee 

Moffitt Cancer Center and Research Institute and 

Dr. Harold Freeman of the National Cancer Institute. The opening plenary focused on Race, Social 

Disparities, and Scientific Research. This session was followed by breakout sessions on Building Tobacco Capacity and Research Infrastructure and Epidemiology of 

Longitudinal Studies. The breakout sessions were followed by the luncheon panel on Tobacco Control Policy and Disparate Populations. The afternoon breakout 

sessions focused on Behavioral and Psychosocial Research, Prevention of Tobacco Use and Nicotine Addiction, 

and Community and State Interventions and Research. 

The evening session included poster presentations 

and provided participants with an opportunity to 

meet other researchers and practitioners. 

On the second day, the NCTHD opened with the 

plenary session on Biological Factors Influencing Tobacco 

Use and Risk. A second plenary on Epidemiology: Small 

Populations and Tobacco Research also was held during 

4 Eliminating Tobacco-Related Health Disparities 
the morning. Following the plenary presentations, 

breakout sessions on Treatment of Nicotine Addiction 

and Basic Biology were held. The luncheon panel focused on Marketing by the tobacco industry to disparate populations and tobacco control research 

being conducted on this topic. The afternoon breakout sessions also focused on Marketing and Harm Reduction. Mr. Kevin Collins from the Centers for Disease Control and Prevention, Office on Smoking 

and Health, closed the conference presentation 

phase of the meeting and provided directions to prepare conference participants for the next phase in 

the planning and priority-setting process—formulating recommendations. 

On the third day, participants worked in small 

groups to further define and prioritize the research 

recommendations that were developed in 11 scientific areas: 

1. Epidemiology 

2. Psychosocial risk factors 

3. Tobacco harm reduction 

4. Capacity and infrastructure 

5. Policy 

6. Community and state 

7. Basic biology 

8. Marketing 

9. Surveillance 

10. Treatment of nicotine addiction 

11. Prevention of tobacco use 

Facilitators and note takers were assigned to each 

group. The work groups were charged with developing both short-term and long-term recommendations for eliminating tobacco-related health disparities. To promote a full exchange of ideas and 

suggestions, attendees had the opportunity to participate in at least three different work groups, thereby 

contributing to the discussions of three different scientific areas. Some research recommendations 

stemmed from the presentations given in the previous 2 days, and others were developed during work 

group sessions. Designated facilitators compiled 

the results and reported recommendations to the 

full group. During the working lunch session, each 

facilitator presented work group results, and conference participants had the opportunity to provide additional input on the recommendations. This 

process resulted in 166 recommendations. 

Concept Mapping to Prioritize 

Recommendations 

Following the conference, a small working group 

from within the conference planning committee 

convened to edit and eliminate the redundancy of 

recommendations. This postconference working 

group decided to implement a process called concept 

mapping to further prioritize the research recommendations. This process occurred from January to 

July 2003 in coordination with Concept Systems, Inc. 

Concept mapping is a mixed methods planning 

and evaluation approach that integrates familiar 

qualitative group processes (e.g., brainstorming, categorizing ideas, and assigning value ratings) with 

multivariate statistical analyses to help a group describe its ideas on any topic of interest and represent 

these ideas visually through a map. Participants were 

involved in the following steps: 1) individually sorting statements into related categories by relevance, 

2) rating each statement on one or more dimensions, and 3) interpreting the resulting maps. The 

steps for implementing the concept mapping are listed in Table 1. 

The analyses of the data included multidimensional scaling (MDS) of the sorted data, and a hierarchical cluster analysis of the MDS coordinates to 

create a map of data points that shows the distance 

between the data points. The final stage resulted in 

102 recommendations or data points that were then 

sorted and rated on importance and feasibility. The 

ratings provided the data used to compute an average for each individual item and for each cluster of 

items. Clusters that were closely related based on 

similar ratings were presented visually as maps. The 

maps were subsequently interpreted by the postconference work group in a facilitated group session 

(see Figure 1). Results from the concept mapping 

exercise revealed nine major clusters or closely related recommendations (see Figure 2). In addition, the 

importance and feasibility tables also were reported. 

DEVELOPING RESEARCH RECOMMENDATIONS 5 
Table 1. Steps for Implementing the Concept Mapping* 

Participant 

Extended 

Participant Concept 

Mapping, Inc. 

Review list of recommendations to determine 

relevance to disparities, reduce redundancy or 

duplication, clarify meaning, and determine the 

appropriateness for sorting and rating 

recommendations. 

✓ ✓ 

Sort recommendations into related categories 

or groups based on similarity of ideas. 

✓ ✓ 

Rate each recommendation alone on a fivepoint scale for importance and feasibility. 

✓ ✓ ✓ 

Calculate the results. ✓ 

Interpret the resulting maps and name the 

clusters. 

✓ ✓ 

Task Postconference 

Work Group 

Core 

Group Group 

*For references and articles on the Concept System, contact 607.272.1206, or infodesk@conceptsystems.com. 

6 Eliminating Tobacco-Related Health Disparities 
DEVELOPING RESEARCH RECOMMENDATIONS DEVELOPING RESEARCH RECOMMENDATIONS

Figure 1. Point Cluster MapThe 102 recommendations were numbered and produced the following map based on how similaror closely related the recommendations were.

1 

2 

3 

4 

5 6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16

17 

18 

1

20 

21 

22 

23 

24 

25 

26 

27 

28 

30 29

31 

32 

33 

34 

36 

37 

38 

39 

42 

43 

44

46 

48 

49 

50 

51 

52 

53 

54 

55 

56 

57 

58 

59 

60 

61 

63 

65 

66 

67 

68 

70 

71 72 

73 

75 

76 

77 

78 

79 

80

81 

82 

83 

84 

86 

87 

88 

89 

90 

92 94 

95 

96 

97 

98 

100 101

102 

74

99

47

62 

45

85 

91 

93 

7 
Eliminating Tobacco-Related Health Disparities 

Figure 2. Combined Point Cluster and Concept MapA nine-cluster concept map, which indicates the main topics/concepts that contain the 102 recommendations, was creatSmall clusters, such as Marketing Research Strategies to Affect Tobacco Use and Policy and Examining and Understan

Tobacco Use and Cessation, suggest groups of closely related ideas. Larger clusters, such as Community-based Disse

and Communication and Research Funding, are representative of broader-encompassing concepts.

Training/Mentoring

Policy 

Industry Policies

and Products Environmental Risks,

and Harm Reduction 

1 

2 

3 

4 

5 6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

30 29

31 

32 

33 

34 

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39 

40

41 

42 

43 

44

46 

48 

49 

50 

51 

52 

53 

54 

55 

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57 

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61 

63 

64 

65 

66 

67 

68 

69 

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71 72 

73 

75 

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78 

79 

80

81 

82 

83 

84 

86 

87 

88 

89 

90 

94 

95 

96 

97 

98 

100 101

102 

74

99

47

62 

45

85 

91 

93 Using Information

to Inform Policyor Practice

Community-basedDissemination andCommunication 

Marketing Research

and Systems Change 

ResearchFunding 

ExploDeveRese

Examining andUnderstandingand Cessation

Cessation,

Research on the

92 

Strategies to Affect Tobacco Use and

Tobacco Use

Impact of Tobacco

8 
Cluster Concepts and

Research Recommendations 

ach cluster concept is composed of items 

which, while specifically different, con­ Etribute to a common theme. The nine clusters (see Figure 2) include the following conceptual categories named by the postconference 

work group: 

�	 Research Funding 

�	 Training/Mentoring and Systems Change 

�	 Using Information to Inform Policy or 

Practice 

�	 Community-based Dissemination and 

Communication 

�	 Marketing Research Strategies to Affect 

Tobacco Use and Policy 

�	 Examining and Understanding Tobacco Use 

and Cessation 

�	 Exploratory and Developmental Research 

�	 Cessation, Environmental Risks, and Harm 

Reduction 

�	 Research on the Impact of Tobacco Industry 

Policies and Products. 

The concept maps in Figure 2 only apply to the 

data from the sorting exercise. The shape and size of 

the categories reflect the distribution of the points 

within that cluster, with large clusters typically covering more conceptual areas than small clusters. The 

value is represented in the importance and feasibility 

rating of the clusters and the recommendations represented within each cluster. 

The concept mapping participants ranked all the 

clusters, and the results indicate the following priority clusters: Research Funding, Training/Mentoring 

and Systems Change, Exploratory and Developmental Research, and Community-based Dissemination 

and Communication. The graphs on the following 

pages present the results of the importance and feasibility rankings of individual recommendations within 

each cluster. The resulting four quadrants represent 

high importance–high feasibility, high importance– 

low feasibility, low importance–high feasibility, and 

low importance–low feasibility. These rankings do not 

suggest that research recommendations ranked low 

importance–low feasibility should not be addressed, 

but rather provide guidance on what might be addressed first among many recommendations. Each 

organization must also determine which recommendations best fit its mission and goals. 

CLUSTER CONCEPTS AND RESEARCH RECOMMENDATIONS 9 
Research Funding

R E C O M M E N D A T I O N S 

12  Develop special grant peer-review groups that 

examine innovative, qualitative or quantitative 

research needs of small populations. 

25  Design funding mechanisms to promote collaboration between investigators at minorityserving institutions and investigators at large 

research institutions. 

46  Develop and explore funding mechanisms 

(e.g., community academic research awards) 

that incorporate methods to increase the likeliturally relevant and evidence-based. 

100  Encourage ongoing funding for pilot projects 

and exploratory research (i.e., qualitative) that 

focus on innovative theories and methods 

from the perspective of the target populations. 

17  Fund more studies to develop interventions to 

54  Create a small grants program to fund secondary analyses and dissemination of existing 

data on the relationships between smoking 

and other risk behaviors and protective factors that are specifically related to disparate 

populations. 

34  Ensure that evidence-based programs are 

populations. 

39  Develop funding mechanisms that allow for 

a co-principal investigator structure between 

researchers and community organizations, 

and develop mechanisms to ensure equity 

in resources. 

102  Incorporate principles of community-based 

participatory research and outcomes into the 

studies and develop databases of these 

strategies for specific priority populations. 

83  Promote an understanding that psychosocial 

issues are broader than the individual, and 

experiences. 

29  Fund randomized trials of comprehensive, 

community-based adolescent prevention 

programs. 

30  

ing tobacco industry documents, and integrate 

this research into tobacco control practices. 

75  

care costs related to ETS and help disparate 

communities develop messages to use in their 

HIGH FEASIBILITY 

LOW FEASIBILITY LOW FEASIBILITY

hood that tobacco prevention efforts are culreduce children’s exposure to ETS in homes. 

culturally appropriate and effective for diverse 

encompass an individual’s social context and 

Fund research on the tobacco industry, includFund efforts to identify and estimate health 

prevention efforts. 

HIGH IMPORTANCE — LOW IMPORTANCE — HIGH FEASIBILITY 

HIGH IMPORTANCE — LOW IMPORTANCE — 

10 Eliminating Tobacco-Related Health Disparities 
Training/Mentoring

and Systems Change

R E C O M M E N D A T I O N S 

85  Fund the training and mentoring of minority 

researchers. 

58  Expand and fund mentorship programs, such 

as minority supplements, to increase opportunities for training in community intervention 

research. 

31  Create broader multidisciplinary teams (e.g., 

community advocates and social, behavioral, 

and basic scientists) to develop a comprehensive perspective on tobacco use, addiction, 

and health consequences. 

101  Prioritize funding for community-based policy 

research to build the case for innovative 

tobacco control policy activities related to 

disparate populations. 

None. 

48  Provide sustained funding for long-term 

community research. 

56  

research, especially skills related to building 

and maintaining relationships, negotiation, 

and group facilitation. 

20  Create a network of researchers to facilitate 

communication and collaboration about harm 

reduction studies and recommendations. 

70  Develop systems of accountability to ensure 

that funds are spent and priorities are set in 

accordance with health disparities data. 

77  Convene review committees that recognize 

views on research and health. 

80  Develop strategies to facilitate change in the 

culture of research in academic and federal 

settings (e.g., attitudes, beliefs, criteria for 

encourage diverse research perspectives. 

HIGH FEASIBILITY HIGH FEASIBILITY

LOW FEASIBILITY LOW FEASIBILITY

Train researchers in effective community 

and value different perspectives and worldreview, types of research rewarded) and 

HIGH IMPORTANCE — LOW IMPORTANCE — 

HIGH IMPORTANCE — LOW IMPORTANCE — 

CLUSTER CONCEPTS AND RESEARCH RECOMMENDATIONS 11 
Using Information to

Inform Policy or Practice 

R E C O M M E N D A T I O N S 

92  Increase understanding about how tobacco 

control programs, tax increases, and smokchanges in tobacco use or quit rates for 

disparate populations. 

26  Improve the use of research, including basic 

18  Create a marketing expert panel to provide 

independent analyses and recommendations 

for counter-marketing and marketing 

strategies. 

67  Obtain tobacco industry documents available 

other sources, because tobacco companies 

are only obligated to make them available for 

a limited time. 

71  Evaluate how state tobacco control dollars 

(e.g., CDC, state, and tobacco settlement 

money) are being used in disparate 

communities. 

94  Identify the associations that the tobacco 

industry establishes among population 

groups and use these data to help develop 

cross-cutting counter-marketing campaigns 

that reach across public health demographic 

variables. 

1  

claims. 

7  Develop valid measures for testing tobacco 

products that claim . 

LOW FEASIBILITY LOW FEASIBILITY

HIGH FEASIBILITY HIGH FEASIBILITY

ing restriction policies together affect 

biological research, in formulating policy. 

from tobacco industry Web sites and from 

Expand Food and Drug Administration regulations about tobacco products’ content and reduced harm

HIGH IMPORTANCE — LOW IMPORTANCE — 

HIGH IMPORTANCE — LOW IMPORTANCE — 

12 Eliminating Tobacco-Related Health Disparities 
Community-based Dissemination

and Communication 

R E C O M M E N D A T I O N S 

4  Build a network of state and community 

health disparities researchers to facilitate 

33  Create a repository of tobacco control 

24  Disseminate scientific data in a usable manner to academic researchers, community 

members who carry out their own research, 

and community members. 

3  

and use media outlets to promote their 

programs. 

53  

practices information for tobacco control 

researchers and advocates. 

59  Disseminate information about research 6  Develop and evaluate prevention resources 

that are culturally appropriate for elementary 

school children. 

37  Develop the appropriate messages about 

harm reduction products for underserved 

populations, community providers, and others to increase their awareness about the 

consequences of their use. 

65  Educate populations across cultures about 

the value of research to their communities 

and its significance in reducing tobacco 

consumption and related diseases. 

82  Examine the current literature to disseminate 

existing research on programs that focus on 

polysubstance use and multirisk behaviors 

among teens. 

HIGH FEASIBILITY 

LOW FEASIBILITY 

effective communication and collaboration. 

resources developed for different groups. 

Train people on how to approach the media 

Fund a national Web site to post best 

findings to the community. 

HIGH IMPORTANCE — HIGH FEASIBILITY LOW IMPORTANCE — 

HIGH IMPORTANCE — LOW FEASIBILITY LOW IMPORTANCE — 

CLUSTER CONCEPTS AND RESEARCH RECOMMENDATIONS 13 
Marketing Research Strategies to

Affect Tobacco Use and Policy 

R E C O M M E N D A T I O N S 

5  Document state-level best practices for 

tobacco policy and control for disparate 

communities. 

97  Encourage use of marketing research to 

develop communication strategies that 

address prevention, interventions for cessation, and maintenance of quit behaviors. 

78  Meet with tobacco control and marketing 

experts to develop directions for marketing 

strategies. 

None. 49  Develop partnerships with schools of business 

to gain a better understanding of marketing 

environments and their relationships to disparate communities. 

57  Assist in reducing exposure to ETS among 

children by producing and disseminating state 

estimates and demographic characteristics of 

household exposure to ETS. 

95  

of marketing and product placement on tobacco use, particularly among minors. 

HIGH FEASIBILITY 

LOW FEASIBILITY LOW FEASIBILITY

Disseminate at the community level the effects 

HIGH IMPORTANCE — HIGH FEASIBILITY LOW IMPORTANCE — 

HIGH IMPORTANCE — LOW IMPORTANCE — 

14 Eliminating Tobacco-Related Health Disparities 
Examining and Understanding

Tobacco Use and Cessation 

R E C O M M E N D A T I O N S 

99  Include additional questions on the use of 

menthol, light, and other types of cigarettes 

in national and state surveys. 

87  Conduct secondary analysis of national surveys to generate information on disparate 

populations and ethnic communities. 

15  

Americans and other ethnic minority adult 

populations. 

44  Conduct research on cessation among youth 

and late initiators. 

88  Increase the study of socioeconomic status in 

smoking initiation and cessation. 

27  Study data on tobacco use and individual and 

community variables (e.g., number of stores 

that sell tobacco, provision and characteristics 

of cessation programs) that may influence use 

and quitting behaviors. 

2  Continue and expand research on the 

special populations. 

68  Examine barriers among disparate groups 

regarding the use of behavioral and pharmacological treatments at the individual, organizational, and community levels, and assess 

ways of improving access to treatments. 

66  Investigate how social support networks 

to reduce tobacco use. 

HIGH FEASIBILITY 

Examine predictors of cessation in African 

and assess differences in quitting among early 

prevalence and effects of ETS within 

(e.g., family, peer, faith-based) can be used 

HIGH IMPORTANCE — HIGH FEASIBILITY LOW IMPORTANCE — 

CLUSTER CONCEPTS AND RESEARCH RECOMMENDATIONS 15 
Examining and Understanding

Tobacco Use and Cessation 

R E C O M M E N D A T I O N S CONTINUED

72  Investigate the mechanisms mediating the 

use behaviors. 

79  Systemically analyze the interactions among 

tobacco constituents, genetic factors, and 

other environmental risks (e.g., dietary factors, 

occupational or chemical exposures, psychosocial risks, and protective factors) on 

health. 

47  

ences in cessation success and disease risk 

(e.g., menthol smokers versus nonmenthol 

smokers). 

74  Conduct larger studies to assess whether 

tobacco-related diseases are correlated with 

genetic variations in racially or ethnically classified social groups. 

96  Conduct more qualitative research on aspects 

of socioeconomic status, stress, locus of condetermine specific components associated 

with smoking, thus generating hypotheses 

and clarifying concepts. 

21  Assess patterns of use with Ecological 

populations. 

LOW FEASIBILITY LOW FEASIBILITY

effects of socioeconomic status on tobacco 

Evaluate the determinants of potential differin users of different types of tobacco products 

observed differences in tobacco addiction and 

trol, cultural affinity, and sexual orientation to 

Momentary Assessment (EMA) in special 

HIGH IMPORTANCE — LOW IMPORTANCE — 

16 Eliminating Tobacco-Related Health Disparities 
Exploratory and

Developmental Research 

R E C O M M E N D A T I O N S 

40  Expand national and state surveys to include 

questions relevant to tobacco use behaviors, 

including questions on smokeless tobacco and 

other methods of using tobacco by understud9  Develop culturally and ethnically appropriate 

sampling methods, survey designs, and measures to obtain larger samples and to assess 

the smoking behaviors of small populations at 

national, regional, and local levels. 

35  Develop surveys and intervention materials 

in the native language (non-English) of the 

survey respondents, intervention participants, 

41  Develop and assess reliable measures, protocols, methods, and models to assess cultural 

dimensions of health (e.g., country of origin, 

acculturation, and linguistic and geographic 

factors). 

19  

of acculturation, stress, coping, racism, and 

discrimination on the etiology of smoking, trajectories in smoking, quitting, and disease 

onset and progression. 

64  Support research that examines the role of 

culturally specific beliefs, perceptions, and 

behaviors on tobacco use and exposure 

within multiple populations. 

10  Develop, implement, and utilize longitudinal 

for small, understudied, and underserved 

populations. 

14  Examine current models of acculturation that 

can be applied to tobacco-related behavior 

and determine how these models should be 

altered for specific populations. 

86  Explore other comorbid/co-occurring behaviors 

with smoking and tobacco use (e.g., alcohol 

16  Conduct qualitative studies to identify patterns, 

ceptions of culture. 

HIGH FEASIBILITY 

ied populations (e.g., LGBT, Native American, 

and Alaska Native). 

and community. 

Fund research studies to examine the effects 

studies (e.g., Black Women’s Health Study) 

and coffee-drinking contexts). 

similarities, and differences in community perHIGH IMPORTANCE — HIGH FEASIBILITY LOW IMPORTANCE — 

CLUSTER CONCEPTS AND RESEARCH RECOMMENDATIONS 17 
Exploratory and

Developmental Research 

R E C O M M E N D A T I O N S CONTINUED

42  Develop community-based research processes that are based on establishing and maintaining long-term relationships within the 38  Expand large sample-size research in question breadth and methodology to incorporate 

small populations, especially with regard to 

guage use, the disabled, and within various 

ethnic groups. 

51  Support longitudinal studies that identify intergenerational risks and protective factors 

among disparate groups. 

55  Address multiple issues (e.g., ethical, legal, 

insurance, conceptual) related to genetic differences in susceptibilities and population disinfluence tobacco addiction and tobaccorelated disease. 

60  Develop methods to assess and reduce the 

burden of green tobacco sickness in tobacco 

production and distribution. 

62  Promote greater use of process evaluation 

research in interventions to determine its 

impact on tobacco research outcomes, such 

as prevalence, health, and cessation. 

69  Develop and test instruments for measuring 

psychosocial contextual factors. 

89  Examine the definition of community, so data 

are collected with regard to special populaAmerican populations). 

LOW FEASIBILITY LOW FEASIBILITY

community. collection of data on LGBT populations, lantribution differences in genetic variants that 

tions (e.g., subgroups of LGBT and Native 

HIGH IMPORTANCE — LOW IMPORTANCE — 

18 Eliminating Tobacco-Related Health Disparities 
Cessation, Environmental Risks, 

and Harm Reduction 

R E C O M M E N D A T I O N S 

23  Explore the combination of constituents in 

brands) on addiction and subsequent health 

36  Conduct research on how to obtain support for 

ETS policies within disparate communities. 

28  Conduct community assessment or capacity 

studies to determine optimal strategies for 

building, strengthening, and developing tobacco control initiatives. 

81  Encourage research on the sustainability and 

bacco coalitions in addressing tobacco issues 

43  Develop and evaluate interventions to promote 

delivery and use of treatments for nicotine 

addiction in various populations, including substance abusers and mental health populations. 

45  Conduct research to assess how evidencebased treatment programs are adopted, implemented, and maintained in health care 

systems, schools, and other settings. 

8  Survey the therapeutic community about 

knowledge, attitudes, and behaviors and 

beliefs about the harm-reducing claims of 

tobacco products. 

76  Examine treatments in other fields for relevance to the treatment of nicotine addiction. 

61  Develop novel therapies and innovative ways 

of treating nicotine dependence. 

50  Collect data on the economic impact of ETS 

etc., in minority communities. 

11  Increase the use of current technologies to 

determine molecular changes resulting from 

tobacco exposure in order to gain better 

understanding of the biological mechanistic 

pathways. 

84  Investigate the impact of products with harmreducing claims on cessation practices of 

underserved populations. 

HIGH FEASIBILITY 

LOW FEASIBILITY LOW FEASIBILITY

tobacco (e.g., menthol) and the effect of differing levels (e.g., within different products or 

effects. 

effectiveness of community and state antitoin communities of color. 

policies on restaurants, bars, gaming industry, 

HIGH IMPORTANCE — LOW IMPORTANCE — HIGH FEASIBILITY 

HIGH IMPORTANCE — LOW IMPORTANCE — 

CLUSTER CONCEPTS AND RESEARCH RECOMMENDATIONS 19 
Research on the Impact of

Tobacco Industry Policies and Products 

R E C O M M E N D A T I O N S 

13  

try pricing practices in communities, especially in low socioeconomic status 

neighborhoods. 

63  Study the impact of tax increases on consumption patterns, quitting, and reduction in 

the number of cigarettes smoked in specific 

minority or disparate community populations. 

90  

ces of tobacco use policies in disparate 

neighborhoods. 

32  Conduct counter-marketing research utilizing social marketing techniques and principles with specific application to disparate 

populations. 

22  

action to future or enacted policies. 

98  Conduct research in disparate communities 

on the enforcement of existing tobacco policies, voluntary policies, and the synergy 

between them. 

52  

advertisements and promotions on smoking 

status and sustained cessation. 

73  

marketing behaviors for each product with 

harm-reducing claims. 

91  Study the impact of tobacco product 

redesign on public and individual health. 

93  

industry documents pertaining to biochemical 

HIGH FEASIBILITY 

LOW FEASIBILITY LOW FEASIBILITY

Conduct research on different tobacco indusConduct research on differential consequenMonitor the tobacco industry’s response or 

Research the effects of point-of-purchase 

Conduct research on the tobacco industry’s 

Identify, examine, and analyze tobacco 

effects of cigarettes on health. 

HIGH IMPORTANCE — HIGH FEASIBILITY LOW IMPORTANCE — 

HIGH IMPORTANCE — LOW IMPORTANCE — 

20 Eliminating Tobacco-Related Health Disparities 
Conclusions

Eliminating Tobacco-Related Health Disparities 

represents the first report to identify critical 

steps that are needed in research to help reduce tobacco use and its consequences 

among underserved and understudied populations in 

the United States. Procedures for developing and refining recommendations included 1) experts who presented data at the NCTHD, 2) work groups at the 

NCTHD that helped to formulate and discuss recommendations, and 3) the concept mapping exercise 

following the conference. Each step helped to produce what is presented in this summary report—nine 

cluster priorities that establish directions for researchers; practitioners; and local, state, and national 

organizations. 

These recommendations highlight the considerable gaps in the research, and the human and financial resources needed to implement plans that will ultimately and directly benefit communities and the 

overall health of the nation. Although the concept 

mapping participants ranked the recommendations 

on importance and feasibility, we recognize that depending on the context (community, state, local, and/ 

or national level), some of these recommendations 

may be more important or more feasible than others. 

What is presented here, however, provides guidance 

for those who are planning research and programs 

that target tobacco-related health disparities. 

Research funding is critical at multiple levels. 

Testing the relevance, applicability, efficacy, and effectiveness of programs will provide additional evidence that can be disseminated at the local, state, 

and national levels. In addition, there may be a need 

to re-evaluate how, what types, and what are the best 

mechanisms for funding studies that aim to reduce 

tobacco-related disparities. Funding is also needed 

to support training and mentoring. Building capacity to conduct disparities studies calls for the need 

to increase the training of researchers. The recent 

Institute of Medicine Report, Ensuring Diversity in the 

Health Care Workforce, indicates that African Americans, Hispanics, American Indians, Alaska Natives, 

and some Asian and Pacific Islander groups are poorly represented in the health professions, with representation falling far below their representation in the 

general population. Furthermore, this report states 

that increasing the racial and ethnic diversity among 

health professionals is important because diversity is 

associated with improved access to health care.59 

serve minority and medically underserved 

ing and cultural competencies of all 

trainees.59 

Racial and ethnic minorities are significantly more likely than their White peers to 

communities . . . . Diversity in the health 

profession’s training settings may assist 

in efforts to improve cross-cultural trainIt is also important to improve the level of skills 

training for existing researchers through multidisciplinary training and begin to develop strategies that 

help change the culture of research. 

There is a wealth of science that has been produced over the years, yet many populations do not 

have access to it. Therefore, additional steps and 

strategies are needed to disseminate and communicate science to communities that may use it to develop their own programs. Although these recommendations provide some direction about how to do that, 

community-research collaborations will strengthen 

our ability to better disseminate science. Finally, 

while funded research is not directed to change policy, science has always been used to inform policies in 

many areas of health. Additional studies will help us 

build our science base to better inform policies that 

impact health disparities and help us to reach the 

2010 goals to reduce health disparities. 

CONCLUSIONS 21 
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11 US Department of Health and Human Services. 

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chronic lung disease in the workplace. A report of 

the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers 

for Disease Control and Prevention, National 

Center for Chronic Disease and Health Prevention and Health Promotion, Office on 

Smoking and Health; 1985. 

12 US Department of Health and Human Services. 

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report of the Surgeon General. Atlanta, GA: US 

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13 US Department of Health and Human Services. 

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US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease and 

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Office on Smoking and Health; 1988. 

22 Eliminating Tobacco-Related Health Disparities 
14 Trinidad DR, Gilpin EA, Lee L, Pierce JP. Do 

the majority of Asian American and African 

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Med. 2004;26:156–158. 

24 O’Hare T, Van Tran T. Substance abuse among 

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15 Harrell JS, Bangdiwala SI, Deng S, Webb JP, 

Bradley C. Smoking initiation in youth: the 

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25 Centers for Disease Control and Prevention. 

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16 Conrad KM, Flay BR, Hill D. Why children 

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Prevalence of cigarette use among 14 racial/ 

ethnic populations –United States, 1999–2001. 

MMWR Morb Mortal Wkly Rep. 2004;53:49–52. 

17 Semmer NK, Lippert P, Fuchs R, Cleary PD, 

Schindler A. Adolescent smoking from a functional perspective: the Berlin-Breman study. 

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27 Austin SB, Ziyadeh N, Fisher LB, Kahn JA, 

Colditz GA, Frazier AL. Sexual orientation 

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18 Waldron I, Lye D. Employment, unemployment, occupation, and smoking. Am J Prev 

Med. 1989;5:142–149. 

28 Brawarsky P, Brooks DR, Wilber N, Gertz RE 

Jr, Klein Walker D. Tobacco use among adults 

with disabilities in Massachusetts. Tob Control. 

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Ary DV, Biglan A. Longitudinal changes in 

adolescent cigarette smoking behavior: onset 

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Unger JB, Cruz TB, Rohrbach LA, et al. English language use as a risk factor for smoking 

initiation among Hispanic and Asian American adolescents: evidence for mediation by 

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Health Psychol. 2000;19:403– 410. 

29 

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Hughes JR. Possible effects of smoke-free 

inpatient units on psychiatric diagnosis and 

treatment. J Clin Psychiatry. 1993;54:109–114. 

21 Chen X, Unger JB, Cruz TB, Johnson CA. 

Smoking patterns of Asian-American youth in 

California and their relationship with acculturation. J Adolesc Health. 1999;24:321–328. 

31 Hammarstrom A, Janlert U. Early unemployment can contribute to adult health problems: 

results from a longitudinal study of school 

leavers. J Epidemiol Community Health. 

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22 Fraser D, Piacentini J, Van Rossem R, Hein D, 

Rotheram-Borus MJ. Effects of acculturation on 32 Caraballo RS, Giovino GA, Pechacek TF, et al. 

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Balcazar H, Peterson G, Cobas JA. AcculturaRacial and ethnic differences in serum cotinine levels of cigarette smokers: Third 

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tion and health-related risk behaviors among 

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33 Perez-Stable EJ, Herrera B, Jacob P III, 

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34	 Wewers ME, Ahijevych KL, Dhatt RK, et al. 

Cotinine levels in Southeast Asian smokers. 

Nicotine Tob Res. 2000;2:85–91. 

35	 Centers for Disease Control and Prevention. 

Work, Smoking, and Health: A NIOSH Scientific Workshop, 2000. 

36	 Centers for Disease Control and Prevention. 

Cigarette smoking among adults in the United 

States, 2000. MMWR Morb Mortal Wkly Rep. 

2002;51:642–645. 

37	 Tseng M, Yeatts K, Millikan R, Newman B. 

Area-level characteristics and smoking in 

women. Am J Public Health. 2001;91:1847–1850. 

38	 Faulkner DL, Thomas KY. Stat bite: race/ 

ethnicity of young U.S. smokers counseled 

about tobacco use. J Nat Cancer Instit. 

2001;93:12. 

39	 Centers for Disease Control and Prevention. 

Receipt of advice to quit smoking in Medicare 

managed care–United States, 1998. MMWR 

Morb Mortal Wkly Rep. 2000;49:797– 801. 

40	 Doescher MP, Saver BG. Physicians’ advice to 

quit smoking. The glass remains half empty. 

J Fam Prac. 2000;49:543–547. 

41	 Tomar SL, Husten CG, Manley MW. Do dentists and physicians advise tobacco users to 

quit? J Am Dent Assoc. 1996;127:259–265. 

42	 Agency for Healthcare Research and Quality. 

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Research and Quality, 2004. Available at: 

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43	 Shopland DR, Anderson CM, Burns DM, Gerlach KK. Disparities in smoke-free workplace 

policies among food service workers. J Occup 

Environ Med. 2004;46:347–356. 

44	 Arcury TA, Quandt SA, Preisser JS, Bernert JT, 

Norton D, Wang J. High levels of transdermal 

nicotine exposure produce green tobacco 

sickness in Latino farm workers. Nicotine Tob 

Res. 2003;5:315–321. 

45	 Smith EA, Malone RE. The outing of Philip 

Morris: advertising tobacco to gay men. Am J 

Public Health. 2003;93:988–993. 

46	 Goebel K. Lesbians and gays face tobacco targeting (editorial). Tob Control. 1994;3:65–67. 

47	 Conkin D. Tobacco $$ for the gay community: 

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48	 Offen N. Demonstrators booted from GLAAD 

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49	 Engardio JP. Outing the Marlboro Man. San 

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50	 US Department of Health and Human Services. 

The health consequences of smoking. A report of the 

Surgeon General. Atlanta, GA: US Department 

of Health and Human Services, Centers for 

Disease Control and Prevention, National 

Center for Chronic Disease and Health Prevention and Health Promotion, Office on 

Smoking and Health; 2004. 

51	 US Department of Health and Human Services. 

Reducing the health consequences of smoking. A 

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Health Prevention and Health Promotion, 

Office on Smoking and Health; 1964. 

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csr/1975_2001/. Accessed January 3, 2005. 

53	 Singh GK, Miller BA, Hankley BF, Edwards 

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24 Eliminating Tobacco-Related Health Disparities 
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REFERENCES 25 
Appendix A: National Conference on 

Tobacco and Health Disparities Agenda 

Forging a National Research Agenda to Reduce

Tobacco-Related Health Disparities

December 11–13, 2002 • The Westin Innisbrook Resort • Palm Harbor (Tampa Bay), Florida 

Tuesday, December 10, 2002 

5:00 p.m.– 8:00 p.m. POSTER SESSION SETUP 

EXHIBITS SETUP 

Wednesday, December 11, 2002 

7:00 a.m.– 8:00 a.m. REGISTRATION AND CONTINENTAL BREAKFAST 

8:00 a.m.– 8:45 a.m. WELCOME AND OPENING REMARKS 

Pebbles Fagan, Ph.D., M.P.H. Harold Freeman, M.D. 

National Cancer Institute National Cancer Institute 

Bethesda, Maryland Bethesda, Maryland 

Jeff Krischer, Ph.D. 

H. Lee Moffitt Cancer Center and


Research Institute


University of South Florida


Tampa, Florida


8:45 a.m.– 10:05 a.m. OPENING PLENARY 

Race, Social Disparities, and Scientific Research 

MODERATOR 

Mary Northridge, Ph.D., M.P.H. 

Columbia University


New York, New York


SPEAKERS 

Social Disparities and Tobacco Control: Race, Tobacco Science, and Society 

Opportunities for Scientific Research Gary King, Ph.D. 

Glorian Sorensen, Ph.D., M.P.H. The Pennsylvania State University 

Dana-Farber Cancer Institute University Park, Pennsylvania 

Boston, Massachusetts 

DISCUSSANTS 

Ken Resnicow, Ph.D. Aida Giachello, Ph.D. 

Emory University Midwest Latino Health Research, 

Atlanta, Georgia Training and Policy Center 

Chicago, Illinois 

26 Eliminating Tobacco-Related Health Disparities 
10:05 a.m.– 10:20 a.m. 

10:20 a.m.– 11:35 a.m. 

BREAK 

BREAKOUT SESSIONS 

I.	 Capacity and Infrastructure: A Strategic Framework in 

Support of Research and Practice 

MODERATOR 

Jeanette Noltenius, M.A., Ph.D. 

Rick Swartz and Associates 

Washington, DC 

SPEAKERS 

Providing the Foundation for Public 

Health Strategies to Eliminate 

Disparities 

Kevin Collins, M.P.A. 

Centers for Disease Control and 

Prevention 

Atlanta, Georgia 

DISCUSSANT 

Rod Lew, M.P.H. 

Participatory Research: A Model for the 

Application of Community Development 

and Community Competence TobaccoRelated Disease Research Program 

Phillip Gardiner, Dr.P.H. 

University of California 

Oakland, California 

Asian Pacific Partners for Empowerment and Leadership 

Oakland, California 

II. Capacity and Infrastructure: Emergent Surveillance, 

Programs, and Networks 

MODERATOR 

Alexandria Stewart 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

SPEAKERS 

Examples of Initiatives 

LaDonna BlueEye 

University of Oklahoma Health 

Sciences Center 

Oklahoma City, Oklahoma 

Challenges of Insufficient Capacity and 

Infrastructure and the Importance of 

Community Competence in the LGBT 

Community 

Greg Greenwood, Ph.D. 

University of California, San Francisco 

San Francisco, California 

Evaluation and Development of a 

National African American Tobacco 

Prevention Network 

Sherry Watson-Hyde 

National African American Tobacco 

Prevention Network 

Lake Mary, Florida 

APPENDIX A : N A T I O N A L C O N F E R E N C E O N T O B A C C O A N D H E A LT H D I S P A R I T I E S A G E N D A 27 
DISCUSSANTS 

Bertha Mo, Ph.D., M.P.H. Lawrence Shorty, B.A. 

The Praxis Project University of North Carolina at Chapel Hill 

Washington, DC Chapel Hill, North Carolina 

III. Building Tobacco Capacity and Research 

Infrastructure: Promising Practices 

MODERATOR 

Patricia Sosa, J.D. 

Campaign for Tobacco-Free Kids 

Washington, DC 

SPEAKERS 

Examples of Promising Practices 

Kipling Gallion, M.A. 

Baylor College of Medicine 

San Antonio, Texas 

DISCUSSANT 

Patricia Sosa, J.D. 

Campaign for Tobacco-Free Kids 

Washington, DC 

IV. Building Tobacco Capacity and Research 

Infrastructure: Tobacco, Alcohol, and Disparities 

MODERATOR 

Helen Lettlow, M.P.H. 

American Legacy Foundation 

Washington, DC 

SPEAKERS 

Howard University Program for 

Collaborative Alcohol Research 

Robert Taylor, M.D., Ph.D. 

Howard University 

Washington, DC 

Research Opportunities for Alcohol/ 

Smoking Issues Among Minorities 

R. Thomas Gentry, Ph.D. 

National Institute on Alcohol Abuse 

and Alcoholism 

Bethesda, Maryland 

DISCUSSANT 

Faye Calhoun, Ph.D., M.S. 

Aida Giachello, Ph.D. 

ining and Policy Center 

Chicago, Illinois 

NIAAA Strategic Plan for Addressing 

Health Disparities 

Faye Calhoun, Ph.D., M.S. 

National Institute on Alcohol Abuse 

and Alcoholism 

Bethesda, Maryland 

Midwest Latino Health Research, 

Tra

National Institute on Alcohol Abuse and Alcoholism 

Bethesda, Maryland 

28 Eliminating Tobacco-Related Health Disparities 
V. Epidemiology: Data from Longitudinal Studies 

MODERATOR 

Gillian Barclay, D.D.S., M.P.H., Dr.P.H. 

Harvard School of Public Health 

Boston, Massachusetts 

SPEAKERS 

11:35 a.m. – 1:50 p.m. 

CARDIA Study Black Women’s Health Study 

Stephen Hulley, M.D., M.P.H. Lynn Rosenberg, Sc.D. 

University of California, San Francisco Boston University 

San Francisco, California Boston, Massachusetts 

DISCUSSANT 

Sharon Marable, M.D., M.P.H. 

State of Rhode Island Department of Health 

Providence, Rhode Island 

LUNCHEON PANEL 

Tobacco Control Policy and Disparate Populations 

MODERATOR 

Makani Themba-Nixon 

The Praxis Project 

Washington, DC 

SPEAKERS 

Results from CTFK Survey on African Data Needs Related to Secondhand 

American Latinos: Tax and Clean Smoke Exposure, Clean Indoor Air 

Indoor Air Policies, and Disparate Populations 

Nichole Veatch, B.A. Elva Yañez, M.S. 

Campaign for Tobacco-Free Kids The Praxis Project 

Washington, DC Washington, DC 

Data Needs Related to Policies that 

Affect Disparate Populations 

Rod Lew, M.P.H. 

Asian Pacific Partners for Empowerment 

and Leadership 

Oakland, California 

DISCUSSANT 

Makani Themba-Nixon 

The Praxis Project 

Washington, DC 

1:50 p.m.– 2:15 p.m. BREAK 

APPENDIX A : N A T I O N A L C O N F E R E N C E O N T O B A C C O A N D H E A LT H D I S P A R I T I E S A G E N D A 29 
2:15 p.m.– 3:30 p.m. BREAKOUT SESSIONS 

I.	 Behavioral and Psychosocial Research: 

Low Income, Occupation, and Social Class 

MODERATOR 

Sherry Mills, M.P.H., M.D. 

Abt Associates, Inc.


Bethesda, Maryland


SPEAKERS 

Working Populations and Social Class Low-Income Populations 

Elizabeth Barbeau, Sc.D., M.P.H. Karen Emmons, Ph.D. 

Dana-Farber Cancer Institute Dana-Farber Cancer Institute 

Boston, Massachusetts Boston, Massachusetts 

DISCUSSANTS 

Clara Manfredi, Ph.D.	 Noel Chrisman, Ph.D., M.P.H. 

University of Illinois at Chicago University of Washington 

Chicago, Illinois Seattle, Washington 

II. Behavioral and Psychosocial Research:


Working with LGBT Populations


MODERATOR 

Deborah McLellan, M.H.S. 

Dana-Farber Cancer Institute


Boston, Massachusetts


SPEAKERS 

Efforts to Reduce LGBT Tobacco Use Disparities 

Perry Stevens, M.P.A.	 William Furmanski, B.A. 

Centers for Disease Control and Center for Tobacco Cessation 

Prevention Washington, DC 

Memphis, Tennessee 

DISCUSSANTS 

Greg Greenwood, Ph.D.	 Scout, M.A. 

University of California, San Francisco The Fenway Institute 

San Francisco, California Boston, Massachusetts 

III. Behavioral and Psychosocial Research: Mental 

Illness, Institutionalization, Religion, and Tobacco Use 

MODERATOR 

Steve Ridini, Ed.D. 

The Medical Foundation


Boston, Massachusetts


30 Eliminating Tobacco-Related Health Disparities 
SPEAKERS 

Tobacco-Related Health Disparities Forging Faith-Based Partnerships 

in Patients with Major Mental Illness for Tobacco Control 

Anne Eden Evins, M.D. Joyce Moon Howard, Dr.P.H. 

Massachusetts General Hospital Columbia University 

Boston, Massachusetts New York, New York 

Bans on Smoking in Prisons and Jails 

Gregory Falkin, Ph.D. 

National Development and Research 

Institutes, Inc. 

New York, New York 

DISCUSSANTS 

Charyn Sutton, B.A. LaSimba Gray, Jr., D.Min., M.Div., M.Ed. 

The Onyx Group New Sardis Baptist Church 

Bala Cynwyd, Pennsylvania Memphis, Tennessee 

BREAK 

BREAKOUT SESSIONS 

I. Prevention of Tobacco Use and Nicotine Addiction: 

Environmental Tobacco Smoke (ETS) in the Home 

MODERATOR 

Benjamin Griffin, M.P.A. 

Environmental Protection Agency 

Washington, DC 

SPEAKERS 

ETS in the Home 

Melbourne Hovell, Ph.D., M.P.H. 

San Diego State University 

San Diego, California 

DISCUSSANT 

Nina Jones 

University of Arizona 

Flagstaff, Arizona 

Disparities in Children’s Exposure to 

Secondhand Smoke at Home–United 

States, 1993–1999 

Angela Trosclair, M.S. 

Centers for Disease Control and 

Prevention 

Atlanta, Georgia 

3:30 p.m.– 3:45 p.m. 

3:45 p.m.– 5:00 p.m. 

II. Prevention of Tobacco Use and Nicotine Addiction: 

Early Prevention and Adolescent Cessation 

MODERATOR 

Pebbles Fagan, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, Maryland 

APPENDIX A : N A T I O N A L C O N F E R E N C E O N T O B A C C O A N D H E A LT H D I S P A R I T I E S A G E N D A 31 
SPEAKERS 

Early Prevention and Adolescent 

Cessation for Youth at Multiple Risk 

Anthony Biglan, Ph.D. 

Oregon Research Institute 

Eugene, Oregon 

DISCUSSANTS 

Steven Schinke, Ph.D. 

Columbia University 

New York, New York 

Sandra Headen, Ph.D. 

Social and Cultural Influences on 

Initiation 

People 

Phyllis Ellickson, Ph.D. 

RAND 

National African American Tobacco 

Prevention Network 

Raleigh, North Carolina 

Jennifer Unger, Ph.D. 

University of Southern California 

Alhambra, California 

Tobacco Use Cessation Among Young 

Steve Sussman, Ph.D., F.A.A.H.B. 

University of Southern California 

Alhambra, California 

Santa Monica, California 

III. Prevention of Tobacco Use and Nicotine Addiction: 

Social and Cultural Influences on Initiation 

MODERATOR 

Felicia Hodge, Dr.P.H. 

University of Minnesota 

Minneapolis, Minnesota 

SPEAKERS 

African American and Puerto Rican 

Tobacco Use: A Longitudinal Study 

Judith Brook, Ed.D. 

Mount Sinai School of Medicine 

New York, New York 

DISCUSSANTS 

John Elder, Ph.D., M.P.H. 

San Diego State University 

San Diego, California 

IV. Community and State: Creating and Sustaining 

Capacity-Building Efforts 

MODERATOR 

Kevin Collins, M.P.A. 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

SPEAKERS 

Engaging Priority Populations 

Carla Freeman, M.A. 

American Medical Association 

Las Vegas, Nevada 

The Los Angeles County Alcohol, 

Tobacco, and Other Drug Policy 

Coalition (LACATOD): A Model for 

Capacity Building and Maintaining 

Effective Coalitions 

Nora Manzanilla, B.S. 

Tobacco Enforcement Program 

Office of the Los Angeles City Attorney 

Los Angeles, California 

32 Eliminating Tobacco-Related Health Disparities 
DISCUSSANTS 

David Harrelson Angelina Esparza, B.A. 

Washington State Department of Health U.T.M.D. Anderson Cancer Center 

Olympia, Washington Houston, Texas 

Brenda Bell Caffee 

Caffee, Caffee and Associates 

Hattiesburg, Mississippi 

5:00 p.m.– 5:30 p.m. BREAK 

5:30 p.m.– 7:00 p.m. Networking Reception and Poster Presentations 

Bridging the Gap Among Research, Practice, and Policy 

Sponsored by American Legacy Foundation 

Thursday, December 12, 2002 

7:00 a.m.– 8:00 a.m. REGISTRATION AND CONTINENTAL BREAKFAST 

8:00 a.m. – 9:30 a.m. PLENARY SESSION 

Biological Factors Influencing Tobacco Use and Risk: 

Differences Among Populations 

MODERATOR 

Deborah Winn, Ph.D. 

National Cancer Institute


Bethesda, Maryland


SPEAKERS 

Quitting Success Among Menthol Nicotine Metabolism and Topography 

Cigarette Smokers Among African Americans and Whites 

Jasjit Ahluwalia, M.S., M.P.H., M.D. Karen Ahijevych, Ph.D. 

University of Kansas Medical Center The Ohio State University 

Kansas City, Kansas Columbus, Ohio 

Can a Defective Gene Be Good For You? 

Smoking, Cancer, and Population Variation 

Rachel Tyndale, M.Sc., Ph.D. 

University of Toronto


Toronto, Ontario


DISCUSSANT 

Eric Moolchan, M.D. 

National Institute on Drug Abuse


Baltimore, Maryland


APPENDIX A : N A T I O N A L C O N F E R E N C E O N T O B A C C O A N D H E A LT H D I S P A R I T I E S A G E N D A 33 
9:30 a.m.– 9:45 a.m. 

9:45 a.m.– 11:00 a.m. 

11:00 a.m.– 11:15 a.m. 

11:15 a.m.– 12:30 p.m. 

BREAK 

PLENARY SESSION 

Epidemiology: Small Populations and Tobacco Research 

MODERATOR 

Deirdre Lawrence, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, Maryland 

SPEAKERS 

Multiple Asian Pacific Islander 

Populations 

Grace Ma, Ph.D., C.H.E.S. 

Temple University 

Philadelphia, Pennsylvania 

Vietnamese Populations 

Tung Nguyen, M.D. 

University of California, San Francisco 

San Francisco, California 

DISCUSSANT 

Deirdre Lawrence, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, Maryland 

BREAK 

BREAKOUT SESSIONS 

Prevalance of Tobacco and Tobacco 

Use Patterns Among Alaska Natives 

Caroline Renner, M.P.H. 

Alaska Native Tribal Health Consortium 

Anchorage, Alaska 

I. Treatment of Nicotine Addiction: Cessation Among 

Rural and Older Populations 

MODERATOR 

Ann Ward, M.A. 

The Pennsylvania State University 

University Park, Pennsylvania 

SPEAKERS 

Rural Populations 

Mary Ellen Wewers, Ph.D., M.P.H. 

The Ohio State University 

Columbus, Ohio 

DISCUSSANTS 

Linda Jouridine, Ed.D. 

University of Kentucky 

Lexington, Kentucky 

Older Populations 

Craig Stotts, R.N., Dr.P.H. 

University of Tennessee 

Memphis, Tennessee 

Neal Rick Boyd, Ed.D., M.S.P.H. 

The George Washington University 

Washington, DC 

34 Eliminating Tobacco-Related Health Disparities 
II. Basic Biology 

MODERATOR 

Mirjana Djordevic, Ph.D. 

National Cancer Institute 

Bethesda, Maryland 

SPEAKERS 

12:30 p.m. – 2:00 p.m. 

Transdermal Nicotine Exposure, 

Salivary Cotinine, and Green Tobacco 

Sickness in Latino Farm Workers 

Sara Quandt, Ph.D. 

Wake Forest University 

Winston-Salem, North Carolina 

DISCUSSANT 

George Hammons, Ph.D. 

Philander Smith College 

Little Rock, Arkansas 

LUNCHEON PANEL 

Marketing 

Sponsored by American Legacy Foundation 

MODERATOR 

Philip Graham 

American Legacy Foundation 

Washington, DC 

SPEAKERS 

Existing Research in Industry Marketing 

and Future Directions for Research 

Pamela Clark, Ph.D. 

Battelle Centers for Public Health 

Research and Evaluation 

Baltimore, Maryland 

DISCUSSANT 

Curtis Spence, B.S. 

Claymar Enterprise 

Providence, Rhode Island 

2:15 p.m.– 2:30 p.m. BREAK 

Importance of UDP– 

Glucuronosyltransferases in Risk 

for Tobacco-Related Cancers 

Phillip Lazarus, Ph.D. 

H. Lee Moffitt Cancer Center and 

Research Institute 

University of South Florida 

Tampa, Florida 

Counter Marketing 

Philip Graham 

American Legacy Foundation 

Washington, DC 

APPENDIX A : NATIONAL CONFERENCE ON TOBACCO AND HEALTH DISPARITIES AGENDA 35 
2:30 p.m.– 3:45 p.m. 

3:45 p.m.– 4:00 p.m. 

4:00 p.m.

BREAKOUT SESSIONS 

I. Marketing: What Tobacco Industry Documents Tell Us 

MODERATOR 

Anne Joseph, M.D., M.P.H. 

University of Minnesota 

Minneapolis, Minnesota 

SPEAKERS 

Tobacco Industry Targeting of Gays 

and Lesbians 

Ruth Malone, R.N., Ph.D. 

University of California, San Francisco 

San Francisco, California 

DISCUSSANT 

Monique Muggli, M.P.H. 

Independent Consultant 

Saint Paul, Minnesota 

Tobacco Industry Targeting of African 

Americans 

Valerie Yerger, M.A., N.D. 

University of California, San Francisco 

San Francisco, California 

II. Harm Reduction: Marketing and Product Consumption 

MODERATOR 

Mirjana Djordjevic, Ph.D. 

National Cancer Institute 

Bethesda, Maryland 

SPEAKERS 

Target Marketing of Menthol Cigarettes Surveillance of Harm Reduction 

Timothy Dewhirst, B.P.H.E., M.A. Products and Population Usage 

University of British Columbia Harold Pollack, M.P.P., Ph.D. 

Vancouver, British Columbia University of Michigan 

Ann Arbor, Michigan 

DISCUSSANTS 

Donna Roy, M.A., M.P.H. Richard Pollay, Ph.D. 

Massachusetts Department of University of British Columbia 

Public Health Vancouver, British Columbia 

Boston, Massachusetts 

CLOSING AND PREPARATION FOR WORK GROUPS 

Kevin Collins, M.P.A. 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

NETWORKING OPPORTUNITIES 

36 Eliminating Tobacco-Related Health Disparities 
4:00 p.m.– 4:15 p.m. FACILITATORS AND NOTE TAKERS MEETING 

Friday, December 13, 2002 

7:00 a.m.– 8:00 a.m. CONTINENTAL BREAKFAST 

8:00 a.m. 

8:15 a.m. 

– 8:15 a.m. 

– 9:15 a.m. 

INTRODUCTION TO ROUND ROBIN WORK GROUPS 

Pebbles Fagan, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, Maryland 

ROUND ROBIN WORK GROUPS 

Epidemiology 

FACILITATOR 

Gary King, Ph.D. 

The Pennsylvania State University 

University Park, Pennsylvania 

Psychosocial Risk Factors 

FACILITATOR 

Deborah McLellan, M.H.S. 

Dana-Farber Cancer Institute 

Boston, Massachusetts 

Tobacco Harm Reduction 

FACILITATOR 

Mirjana Djordjevic, Ph.D. 

National Cancer Institute 

Bethesda, Maryland 

Capacity and Infrastructure 

FACILITATORS 

Helen Lettlow, M.P.H. David Banks, Ph.D. 

American Legacy Foundation American Legacy Foundation 

Washington, DC Washington, DC 

Policy 

FACILITATORS 

Patricia Sosa, J.D. Sallie Anne Petrucci, M.P.H., C.H.E.S. 

Campaign for Tobacco-Free Kids The Robert Wood Johnson Foundation 

Washington, DC Princeton, New Jersey 

APPENDIX A : NATIONAL CONFERENCE ON TOBACCO AND HEALTH DISPARITIES AGENDA 37 
9:20 a.m.– 10:20 a.m. 

Community and State 

FACILITATORS 

Kevin Collins, M.P.A. 

Centers for Disease Control and 

Prevention 

Atlanta, Georgia 

Basic Biology 

FACILITATOR 

Deirdre Lawrence, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, Maryland 

Marketing 

FACILITATOR 

Perry Stevens, M.P.A. 

Centers for Disease Control and Prevention 

Atlanta, Georgia 

Surveillance 

FACILITATOR 

Barbara Wingrove, M.P.H. 

National Cancer Institute 

Bethesda, Maryland 

Treatment of Nicotine Addiction 

FACILITATOR 

Sherry Mills, M.P.H., M.D. 

Abt Associates, Inc. 

Bethesda, Maryland 

Prevention of Tobacco Use 

FACILITATOR 

Linda Jouridine, Ed.D. 

University of Kentucky 

Lexington, Kentucky 

ROUND ROBIN WORK GROUPS 

Epidemiology 

Psychosocial Risk Factors 

Tobacco Harm Reduction 

Capacity and Infrastructure 

Policy 

Alexandria Stewart 

Centers for Disease Control and 

Prevention 

Atlanta, Georgia 

38 Eliminating Tobacco-Related Health Disparities 
10:40 a.m. 

11:40 a.m. 

10:20 a.m. 

– 11:40 a.m. 

– 1:00 p.m. 

– 10:35 a.m. 

Community and State 

Basic Biology 

Marketing 

Surveillance 

Treatment of Nicotine Addiction 

Prevention of Tobacco Use 

BREAK 

ROUND ROBIN WORK GROUPS 

Epidemiology 

Psychosocial Risk Factors 

Tobacco Harm Reduction 

Capacity and Infrastructure 

Policy 

Community and State 

Basic Biology 

Marketing 

Surveillance 

Treatment of Nicotine Addiction 

Prevention of Tobacco Use 

WORKING LUNCHEON 

Report Back from Round Robin Work Groups and 

Next Steps 

Pebbles Fagan, Ph.D., M.P.H. 

National Cancer Institute 

Bethesda, Maryland 

APPENDIX A : N A T I O N A L C O N F E R E N C E O N T O B A C C O A N D H E A LT H D I S P A R I T I E S A G E N D A 39 
Appendix B: Summary of Panel

Presentations 

WEDNESDAY, DECEMBER 11, 2002 

Opening Plenary : Race, Social Disparities, and 

Scientific Research 

SPEAKERS 

Glorian Sorensen, Ph.D., M.P.H., Social Disparities and 

Tobacco Control: Opportunities for Scientific Research 

Gary King, Ph.D., Race, Tobacco Science, and Society 

DISCUSSANTS 

Ken Resnicow, Ph.D. 

Aida Giachello, Ph.D. 

MODERATOR 

Mary Northridge, Ph.D., M.P.H. 

Dr. Glorian Sorenson emphasized the need for greater 

consideration of social and contextual factors. She suggested that research should aim to understand the interacting effects of multiple sources of inequalities on patterns of tobacco use, integrate health promotion and 

health protection strategies to effect macro-level behavioral changes, and increase analysis of existing data 

sources by extending partnerships among researchers 

and community-based organizers. Long-term efforts 

should focus on exploring the appropriate intervention 

methodology for effective interventions and examine 

factors related to successful dissemination strategies. Dr. 

Gary King provided a brief overview of the history of the 

interplay between health and race in the United States 

from theoretical and empirical perspectives. He discussed strategies for advancing the scientific discussion 

and empirical use race in tobacco science as a means to 

address health disparities. He identified two phases of 

minority health research that highlight research and interventions to reduce racial disparities in health. Drs. 

Ken Resnicow and Aida Giachello suggested that, as minority populations continue to account for a larger proportion of American society, the need for increased understanding about group differences and health 

behaviors becomes more urgent. Tobacco control researchers and program communities should continue to 

examine group disparities using an ethnic/social perspective. This could be accomplished by adding a culture-specific component to general interventions in diverse settings. One particular concern for the tobacco 

control community should be recognition that issues 

such as racism influence differences in health outcomes. 

Problems must be examined with respect to every relevant culture or ethnic group if we are to successfully reduce health disparities. 

Panel 1: Capacity and Infrastructure: A Strategic 

Framework in Support of Research and Practice 

SPEAKERS 

Kevin Collins, M.P.A., Providing the Foundation for Public 

Health Strategies to Eliminate Disparities 

Phillip Gardiner, Dr.P.H., Participatory Research: 

A Model for the Application of Community Development 

and Community Competence Tobacco-Related Disease 

Research Program 

DISCUSSANT 

Rod Lew, M.P.H. 

MODERATOR 

Jeanette Noltenius, M.A., Ph.D. 

Mr. Kevin Collins discussed the importance of taking 

community characteristics (e.g., history, culture, race, 

literacy, generational diversity) into account when assessing capacity and creating infrastructure. Dr. Phillip 

Gardiner suggested that the participatory approach 

must provide co-learning experiences as well as empowering opportunities that attend to existing social inequalities. Moreover, this approach should facilitate 

communication among all partners and shared funding 

sources in all phases of the research and intervention. 

Mr. Rod Lew added that we should assess the current 

state of research in this capacity and infrastructure. In 

addition, panel attendees discussed the need to define 

race and involve historically Black colleges and universities in capacity-creating efforts. 

Panel 2: Capacity and Infrastructure: Emergent 

Surveillance, Programs, and Networks 

SPEAKERS 

LaDonna BlueEye, Examples of Initiatives 

Greg Greenwood, Ph.D., Challenges of Insufficient 

Capacity and Infrastructure and the Importance of 

Community Competence in the LGBT Community 

Sherry Watson-Hyde, Evaluation and Development of a 

National African American Tobacco Prevention Network 

DISCUSSANTS 

Bertha Mo, Ph.D., M.P.H. 

Lawrence Shorty, B.A. 

MODERATOR 

Alexandria Stewart 

40 Eliminating Tobacco-Related Health Disparities 
Native American and lesbian, gay, bisexual and transgender (LGBT) populations have disproportionately high 

rates of smoking. Ms. LaDonna BlueEye indicated that 

there are few resources to conduct research in Native 

American communities and methods to assess appropriate interventions are lacking. Dr. Greg Greenwood indicated that research on the LGBT population is almost 

nonexistent. It appears that the LGBT population in general, and older LGBT persons in particular, show an interest in quitting. To address tobacco consumption and 

morbidity and mortality rates among African Americans, 

Ms. Sherry Watson-Hyde indicated that the National 

African American Tobacco Prevention Network will provide support, resources, and enhanced communications 

in African American communities. 

Panel 3: Building Tobacco Capacity and 

Research Infrastructure: Promising Practices 

SPEAKERS 

Kipling Gallion, M.A., Examples of Promising Practices 

Aida Giachello, Ph.D., Examples of Promising Practices 

DISCUSSANT AND MODERATOR 

Patricia Sosa, J.D. 

Mr. Gallion stated that researchers should invest in community networks instead of merely in research outcomes. This approach will promote optimally fruitful future research and best use of financial resources. He 

cited the Redes en Accion program as an example of a National Cancer Institute initiative that utilizes a network 

approach. Dr. Giachello stressed the need for developing a solid infrastructure that includes training, resource development, and evaluation components. This 

infrastructure will help to bridge the challenges of implementing evidence-based strategies in communities. 

Dr. Giachello further emphasized using a coalition-centered approach to build centers for applicable research 

and the need to build rapport and trust within the community one is working. 

Panel 4: Building Tobacco Capacity and 

Research Infrastructure: Tobacco, Alcohol, 

and Disparities 

SPEAKERS 

Robert Taylor, M.D., Ph.D., Howard University Program 

for Collaborative Alcohol Research 

R. Thomas Gentry, Ph.D., Research Opportunities for 

Alcohol/Smoking Issues Among Minorities 

Faye Calhoun, Ph.D., M.S., NIAAA Strategic Plan for 

Addressing Health Disparities 

DISCUSSANT 

Faye Calhoun, Ph.D., M.S. 

MODERATOR 

Helen Lettlow, M.P.H. 

Dr. Faye Calhoun stated the mission of the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) 

Strategic Plan to Address Health Disparities 2002–2006 as 

seeking to improve access, quality, and acceptance of 

care for alcohol and tobacco, and to conduct research 

on alcohol and tobacco use as chronic diseases with potential relapse. Research on tobacco and alcohol disparities should focus on collaborative, multidisciplinary research and increased communication through the 

formation of a network. Dr. Calhoun recommended 

that this multidisciplinary research primarily focus on 

young people, since initiation and experimentation 

occur most often with them. The goals of the strategic 

plan include transferring research knowledge to practice and experiential knowledge to research; building 

multidisciplinary, multiethnic collaborating teams; and 

building capacity (e.g., involving minority clinicians, investigators, and populations) in minority-serving institutions to contribute to alcohol research. Dr. Gentry presented data that show the high co-morbidity of smoking 

and drinking. Eighty percent of lifetime smokers drink 

and 60 percent of lifetime drinkers smoke. He stressed 

the need to address issues of synergistic effects, youth 

initiation, and prudence in addressing tobacco and alcohol use simultaneously. Dr. Gentry closed by raising 

questions about the nature of the problem of concurrent alcohol and tobacco use, and called for the need to 

investigate environmental, social, psychological, and 

physiological factors, as well as research into the synergistic effects of the two substances. He emphasized the 

issue of race and ethnicity as frequent markers for other 

causes of health disparities, including immigration status, acculturation, socioeconomic status, unemployment, insurance coverage, education, and access to 

health care. 

Plenary 5: Epidemiology: Data from Longitudinal 

Studies 

SPEAKERS 

Stephen Hulley, M.D., M.P.H., CARDIA Study 

APPENDIX B : SUMMARY OF PANEL PRESENTATIONS 41 
Lynn Rosenberg, Sc.D., Black Women’s Health Study 

DISCUSSANT 

Sharon Marable, M.D., M.P.H. 

MODERATOR 

Gillian Barclay, D.D.S., M.P.H., Dr.P.H. 

Dr. Stephen Hulley presented the results of the CARDIA Study, which examined the predictability of race in 

smoking and quitting patterns among White and 

African American adults. When adjusting for socioeconomic variables, no differences were found between the 

initiation and cessation rates of the two groups. Higher 

education was found to be an important protective factor for smoking initiation and increased cessation rates. 

Furthermore, despite increased smoking prevalence 

and risk of developing heart disease among African 

Americans, White men had more coronary calcification 

than African American men. The independent risk factors for coronary calcification include being of older 

age, Caucasian, male, and smoking cigarettes. Dr. Lynn 

Rosenberg presented some results from the Black 

Women’s Health Study. She noted that the study revealed disparities between White and African American 

women. African American women had an increased risk 

of dying from breast cancer before age 45 years as compared to White women, and lupus occurred more often 

among Black women than White women. This study 

also revealed several factors associated with smoking 

among Black women: drinking, age, body size (being 

thinner), less exercise, and earlier menopause onset. 

Luncheon Panel : Tobacco Control Policy and 

Disparate Populations 

SPEAKERS 

Nichole Veatch, B.A., Results from CTFK Survey on 

African American Latinos: Tax and Clean Indoor Air 

Rod Lew, M.P.H., Data Needs Related to Policies that Affect 

Disparate Populations 

Elva Yañez, M.S., Data Needs Related to Secondhand 

Smoke Exposure, Clean Indoor Air Policies, and 

Disparate Populations 

DISCUSSANT AND MODERATOR 

Makani Themba-Nixon 

Ms. Nichole Veatch, Mr. Rod Lew, and Ms. Elva Yañez 

presented data from several studies on African American, Asian, and Latino perspectives on tobacco product 

taxes and clean indoor air regulations. The speakers 

noted that taxes are often regressive and create a financial burden on the poor. However, taxes provide immediate encouragement to quit. In addition, those with 

fewer resources often experience decreased access to 

services. Although the majority of the revenue from regressive taxes is generated from the poor, programs 

funded by taxes mostly serve the middle class. The 

speakers recommended that funds generated from tobacco taxes be earmarked specifically for tobacco control and health services for the underserved. Some data 

revealed high acceptance of increased taxes on tobacco 

products among minority communities, and support increased dramatically when the benefits for preventing 

youth smoking were presented. However, differences 

existed among racial and ethnic groups for the best rationale for raising taxes. Whites said spending on social 

programs targeted to youth is the best reason to increase taxes. Blacks said raising cigarette taxes would 

help pay for health care and education without raising 

other taxes. Data about attitudes toward policies to limit 

exposure to secondhand smoke showed little difference 

among racial and ethnic groups. However, African 

Americans felt affected by secondhand smoke at a higher percentage than was reported by Whites. Minority respondents reported that people who work where smoking is allowed have less choice to work there, and that 

language and illegal residency status are main barriers 

to working in a smoke-free workplace. In addition, Mr. 

Lew presented data from previously secret tobacco industry documents that show that the tobacco industry 

perhaps knew more about how to reach Asian Americans and Pacific Islanders than the tobacco control 

movement. All speakers suggested a number of recommendations, including conducting national research 

with sample sizes of special populations large enough to 

draw generalizable conclusions, disseminating data effectively to mobilize communities to create and support 

policies, framing tobacco control issues as opportunities 

for cultural/minority community empowerment, and 

ensuring the inclusion of minority community members on community planning boards. 

Panel 1: Behavioral and Psychosocial Research: 

Low Income, Occupation, and Social Class 

SPEAKERS 

Elizabeth Barbeau, Sc.D., M.P.H., Working Populations 

and Social Class 

Karen Emmons, Ph.D., Low-Income Populations 

42 Eliminating Tobacco-Related Health Disparities 
DISCUSSANTS 

Clara Manfredi, Ph.D. 

Noel Chrisman, Ph.D., M.P.H. 

MODERATOR 

Sherry Mills, M.P.H., M.D. 

The speakers commented that the concept of class is a 

social phenomenon, which includes the combined effects of levels of education and income, as well as type 

of occupation. Despite a decrease in smoking prevalence among all occupational categories, blue-collar 

and service workers smoke at twice the rate of white-collar workers. All workers attempt to quit at similar rates, 

yet white-collar workers are more successful at maintaining abstinence. Perhaps this is due to their ability to receive more help with quitting in their workplace. It is 

equally important to look at both race and occupation 

when determining causality. Moreover, even when controlling for age, race, ethnicity, and education, occupation has a significant effect on determining cessation 

success. Data show that lower socioeconomic status correlates with an increased likelihood of smoking and decreased likelihood of quitting. Specific settings should 

be targeted for change to help eliminate this disparity, 

such as the health care arena and the home environment. Improvements to health care practices are recommended, such as implementing the PHS Guidelines to 

Treating Tobacco Use and Dependence and increasing Medicaid coverage for tobacco cessation services. In addition, telephone counseling and targeted print materials 

are promising low-cost strategies for increasing cessation success for low-income populations. Dr. Noel Chrisman stated that community-based participatory research (CBPR) is a worthwhile science that can enhance 

and inform existing research projects. He emphasized 

the need to form, strengthen, and expand community 

relationships for CBPR to succeed, and advocated for a 

greater balance between science and service for researchers to deliver benefits to the community. The recommendations for funders included seeking out reviewers who are familiar with community work, providing 

grant supplements for establishing community partnerships, and funding research on the methodology of 

community intervention. 

Panel 2: Behavioral and Psychosocial Research: 

Working with LGBT Populations 

SPEAKERS 

Perry Stevens, M.P.A., Efforts to Reduce LGBT 

Tobacco Use Disparities 

William Furmanski, B.A., Efforts to Reduce LGBT 

Tobacco Use Disparities 

DISCUSSANTS 

Greg Greenwood, Ph.D. 

Scout, M.A. 

MODERATOR 

Deborah McLellan, M.H.S. 

Dr. Greg Greenwood presented research that demonstrates the huge discrepancy in smoking prevalence between the general U.S. adult population at 23 percent, 

and the adult LGBT population at 48 percent. However, because little data have been collected about tobacco use among LGBT populations, Dr. Greenwood recommended including sexual orientation on household 

surveys to increase the amount of data about LGBT 

populations. Mr. Perry Stevens indicated that the tobacco industry has tried to encourage and maintain LGBT 

tobacco use through advertising strategies. Countermarketing efforts should include antitobacco advertising in LGBT-focused publications, enacting nondiscrimination policies in tobacco cessation agencies and 

programs, and promoting antitobacco messages at 

LGBT events. Mr. William Furmanski encouraged the 

LGBT community to take advantage of the American 

Legacy Foundation’s LGBT National Forum, which 

awards grants that address cultural competency, community outreach, advertising/public relations, and education strategies. Scout stated that one of the projects 

funded through the American Legacy Foundation 

found that one-half of health centers do not currently 

focus on LGBT tobacco control activities or services, 

but would do so if they had adequate resources. As part 

of this study, think tank discussions were conducted 

with health centers in different parts of the United 

States to determine how cessation programs could be 

more effective. Both practical and financial reasons 

were cited for lack of successful quit attempts, such as 

lack of social support and affordability of nicotine replacement therapy. 

Panel 3: Behavioral and Psychosocial Research: 

Mental Illness, Institutionalization, Religion, 

and Tobacco Use 

SPEAKERS 

Anne Eden Evins, M.D., Tobacco-Related Health 

Disparities in Patients with Major Mental Illness 

Gregory Falkin, Ph.D., Bans on Smoking in 

Prisons and Jails 

APPENDIX B : SUMMARY OF PANEL PRESENTATIONS 43 
Joyce Moon Howard, Dr.P.H., Forging Faith-Based 

Partnerships for Tobacco Control 

DISCUSSANTS 

Charyn Sutton, B.A. 

LaSimba Gray, Jr., D.Min., M.Div., M.Ed. 

MODERATOR 

Steve Ridini, Ed.D. 

Dr. Gregory Falkin stated that although no formal studies have been conducted among prison populations, 

smoking prevalence is estimated at about 75–80 percent, with many prisoners tending to be minorities. He 

also stated that tobacco use has been banned in many 

prisons, but there is variability in enforcement. He also 

noted that a prison is a complicated environment in 

which to conduct tobacco control interventions. Although inmates are provided information about quitting, there is a lack of cessation counseling, and tobacco 

control policies are not uniformly enforced among the 

institutions. Dr. Joyce Moon Howard stated that faithbased partnerships are particularly effective in African 

American communities, where most churches have been 

owned and operated by African Americans. Partnering 

tobacco control organizations with faith-based organizations takes advantage of the implicit trust inherent in religious organizations in those communities, which facilitates cessation efforts. She also offered examples of past 

faith-based tobacco control efforts, such as The Robert 

Wood Johnson Heart Body and Soul Initiative, which encouraged collaboration between Johns Hopkins University and churches. Dr. Anne Eden Evins reported that 

adults with mental illness smoke at drastically higher 

rates than the general adult population (70–90 percent 

versus 23 percent) and that they also suffer higher rates 

of tobacco-related morbidity and mortality. In addition, 

contrary to commonly held stereotypes, the mentally ill 

population expresses a similar desire to quit smoking 

(70 percent) as the general population. It is unclear 

what the exact effects of smoking cessation are on the 

mentally ill and their specific illnesses, quality of life, 

symptoms, and affective disorders (e.g., depression, 

bipolar disorder). The evidence underscores the need 

to conduct more research within this population and 

develop innovative and effective strategies to address 

smoking. Dr. Eden Evins proposed recommendations 

that call for more research to identify best practice 

guidelines for smoking cessation treatment for mentally ill patients. 

Panel 1: Prevention of Tobacco Use and Nicotine 

Addiction: Environmental Tobacco Smoke (ETS) 

in the Home 

SPEAKERS 

Melbourne Hovell, Ph.D., M.P.H., ETS in the Home 

Angela Trosclair, M.S., Disparities in Children’s Exposure 

to Secondhand Smoke at Home–United States, 1993–1999 

DISCUSSANT 

Nina Jones 

MODERATOR 

Benjamin Griffin, M.P.A. 

Dr. Melbourne Hovell presented data on protecting 

children from secondhand smoke exposure, and discussed behavioral coaching as one means of protection. 

Dr. Hovell commented that the tobacco control community could use the issue of protecting children from 

secondhand smoke to promote cessation services, diminish the strength of tobacco promotions, and decrease the social acceptability of tobacco use. Ms. Angela Trosclair reported that African Americans and 

Hispanics/Latinos are less likely to report smoking regularly in the home, and smoking in the home is less 

common in the West than in the South. Risk factors for 

secondhand smoke exposure in the home include low 

levels of education and income. Ms. Trosclair showed 

data that indicated a decrease in prevalence of in-home 

smoking for all education and income groups. Ms. Nina 

Jones emphasized that the first steps for a smoke-free 

homes program organizer are to make contact with and 

seek guidance from the Bureau of Housing and Urban 

Development, assisted living facilities, and apartment 

management. Programs should focus on infants and 

children, the elderly, cultures and communities with 

higher usage rates, the mentally ill, and the disabled. 

An effective program is based on science, and guidance 

from local community leaders can provide input on the 

cultural appropriateness of the program. 

Panel 2: Prevention of Tobacco Use and Nicotine 

Addiction: Early Prevention and Adolescent 

Cessation 

SPEAKERS 

Anthony Biglan, Ph.D., Early Prevention and Adolescent 

Cessation for Youth at Multiple Risk 

44 Eliminating Tobacco-Related Health Disparities 
Steve Sussman, Ph.D., F.A.A.H.B., Tobacco Use Cessation 

Among Young People 

DISCUSSANTS 

Steven Schinke, Ph.D. 

Phyllis Ellickson, Ph.D. 

MODERATOR 

Pebbles Fagan, Ph.D., M.P.H. 

Dr. Anthony Biglan stated that adolescent smoking occurs in the context of several problem behaviors, such 

as drinking, illicit drug use, antisocial behavior, and 

risky sexual behavior. Comprehensive approaches are 

needed to prevent tobacco use and promote cessation 

for adolescents. He recommended that researchers 

evaluate interventions that target problem behaviors, 

and determine how they might apply to smoking. He 

also suggested conducting research that tests the effectiveness of interventions on multiple problem behaviors. Dr. Steven Sussman discussed the design and outcomes of 66 cessation studies on youth cessation. Of the 

different theories applied in these studies, programs 

based on motivational enhancement, response-contingent reinforcement theory, achieved the most successful quit rates. When considering modality, classroombased programs and school clinics were the most 

successful. However, there were elements missing from 

most of these studies. For example, only 28 of the interventions took race and ethnicity into account, and only 

46 included follow-up data. The panelists concluded 

that research should focus on involving support systems 

for adolescents, examining multiple problem behaviors 

from a developmental perspective, and employing less 

traditional interventions for prevention and cessation. 

Furthermore, recommendations were made to develop 

consensus on measurements, conduct more rigorous 

studies with follow-up, examine context effects, and 

begin effects mediation work. Long-term recommendations encouraged researchers to explore combined prevention and cessation programs and provide greater access to effective programs. 

Panel 3: Prevention of Tobacco Use and Nicotine 

Addiction: Social and Cultural Influences on 

Initiation 

SPEAKERS 

Judith Brook, Ed.D., African American and Puerto Rican 

Tobacco Use: A Longitudinal Study 

Jennifer Unger, Ph.D., Social and Cultural Influences 

on Initiation 

DISCUSSANTS 

John Elder, Ph.D., M.P.H. 

Sandra Headen, Ph.D. 

MODERATOR 

Felicia Hodge, Dr.P.H. 

Dr. Judith Brook indicated that among African American and Puerto Rican adolescent smokers, family, peer, 

and personality measures are related to adolescent 

smoking, and that both groups display less consistency 

in their smoking behavior than White adolescents. She 

concluded that family bonding has a direct effect on 

smoking. Dr. Jennifer Unger presented data on informational (i.e., peers provide information about positive 

and negative consequences) and normative (i.e., conforming to smoking behavior) social influences on tobacco use. Media and marketing strategies are also powerful forces shaping initiation. Cultural influences 

change with the individual’s perception of his/her context, and culture is defined as more influential than 

race and ethnicity. Cultural values may be protective of 

risk factors for initiation and may change as the adolescent becomes acculturated. Study outcomes show later 

onset of smoking among Asians and African Americans 

and earlier onset among American Indians, with particularly low prevalence among Asian girls. Recommendations encouraged researchers to explore how adolescents conceptualize their culture, identify elements of 

cultural identity, follow diverse cohorts of adolescents 

living in diverse contexts to disentangle cultural and social effects, explore gene-environment interactions, 

evaluate the effectiveness of culturally targeted prevention programs relative to generic programs, and explore the influences of global culture on smoking behaviors worldwide. 

Panel 4: Community and State: Creating and 

Sustaining Capacity-Building Efforts 

SPEAKERS 

Carla Freeman, M.A., Engaging Priority Populations 

Nora Manzanilla, B.S., The Los Angeles County Alcohol, 

Tobacco, and Other Drug Policy Coalition (LACATOD): 

A Model for Capacity Building and Maintaining 

Effective Coalitions 

DISCUSSANTS 

David Harrelson 

Brenda Bell Caffee 

Angelina Esparza, B.A. 

APPENDIX B : SUMMARY OF PANEL PRESENTATIONS 45 
MODERATOR 

Kevin Collins, M.P.A. 

Ms. Carla Freeman discussed the need for engaging 

communities, particularly priority populations, in the 

policymaking process. She argued that including communities is vital for meaningful and sustainable policy 

change. This inclusion depends on the willingness of a 

coalition or organizing group to share resources and 

become familiar with the community’s needs. Ms. Nora 

Manzanilla spoke about the Los Angeles County Alcohol, Tobacco and Other Drug Policy Coalition program 

dedicated to achieving restrictions on alcohol and tobacco billboards near sensitive areas. The campaign 

built and relied on community partnerships that employed face-to-face meetings and maintained constant 

communication to achieve this policy change. The panelists emphasized that community members should be 

active participants in all aspects of the program. Additionally, organizers should be apprised of the community’s history and immediate political climate to be maximally effective. 

THURSDAY, DECEMBER 12, 2002 

Plenary 1: Biological Factors Influencing Tobacco 

Use and Risk : Differences Among Populations 

SPEAKERS 

Jasjit Ahluwalia, M.S., M.P.H., M.D., Quitting Success 

Among Menthol Cigarette Smokers 

Rachel Tyndale, M.Sc., Ph.D., Can a Defective Gene Be 

Good for You? Smoking, Cancer, and Population Variation 

Karen Ahijevych, Ph.D., Nicotine Metabolism and 

Topography Among African Americans and Whites 

DISCUSSANT 

Eric Moolchan, M.D. 

MODERATOR 

Deborah Winn, Ph.D. 

Dr. Jasjit Ahluwalia’s first study indicated that quit rates 

at 6 months (21 percent) were slightly lower for menthol smokers than in two prior bupropion studies 

(27–35 percent) with White, middle-class participants. 

The second study found that menthol cigarette smokers 

were more likely to be women and to report greater difficulty quitting than nonmenthol cigarette smokers. Dr. 

Ahluwalia concluded that the research community 

needs to better understand the reasons for lower cessation rates experienced by younger menthol smokers 

who are using bupropion, the role of cigarette taste and 

satisfaction on a smoker’s ability to quit, and whether 

other pharmacological aids are less effective for menthol smokers as compared to nonmenthol smokers. 

Data presented by Dr. Rachel Tyndale indicated that 

African Americans, who metabolize nicotine at slower 

rates, smoke fewer cigarettes per day and experience 

less risk for becoming dependent than Caucasians. 

When defective, CYP2A6 (the gene that regulates nicotine metabolism) decreases in carcinogenicity due to its 

decreased ability to activate procarcinogens, which in 

turn inhibits NNK activation (one of the main tobacco 

specific nitrosamines). While African American smokers have known variants on the CYP2A6 gene, those variants do not account for all of the behavior and disease 

outcome differences between Caucasian and African 

American smokers. Dr. Karen Ahijevych indicated that 

menthol cigarette smokers have higher levels of cotinine, display a shorter time to smoking their first cigarette of the day than nonmenthol smokers, and have 

larger puff volume and carbon monoxide levels. Mentholated cigarettes appear to significantly inhibit nicotine metabolism and may inhibit the detoxification of 

nicotine carcinogens. Research also indicates that the 

cotinine half-life was longer for menthol smokers than 

for nonmenthol smokers, and significantly longer for 

African Americans than Caucasians. Dr. Eric Moolchan 

stressed that tailored interventions hold promise for 

African Americans and other populations. He advocated for further investigation of translating smoking behavior and toxicological effects into pathophysiological 

consequences. 

Plenary 2: Epidemiology : Small Populations and 

Tobacco Research 

SPEAKERS 

Grace Ma, Ph.D., C.H.E.S., Multiple Asian Pacific 

Islander Populations 

Tung Nguyen, M.D., Vietnamese Populations 

Caroline Renner, M.P.H., Prevalence of Tobacco and 

Tobacco Use Patterns Among Alaska Natives 

DISCUSSANT AND MODERATOR 

Deirdre Lawrence, Ph.D., M.P.H. 

Dr. Grace Ma’s research indicated differences in prevalence and patterns of tobacco use among Asian Americans and Pacific Islanders. Vietnamese and Cambodians 

46 Eliminating Tobacco-Related Health Disparities 
have higher rates of smoking prevalence than the Chinese, with males in all groups having higher prevalence 

than females. For girls and young adult women, higher 

acculturation level was related to higher smoking risk, 

while the opposite was true for men. The high prevalence of smoking and high exposure to secondhand 

smoke represents a substantial opportunity for risk reduction and highlights a need to establish community 

partnerships with these populations. Additional research should be conducted to document the variations 

among more specific ethnic and regional groups. Dr. 

Tung Nguyen stressed that lung cancer is the leading 

cause of cancer death among Vietnamese American 

men and women. The prevalence of Vietnamese American smoking is estimated at 33 percent. This may be 

partly due to Vietnamese smoking behaviors in Vietnam, where approximately 71 percent of men and 4 

percent of women smoke. Research over the past 

decade has revealed that culturally appropriate media 

interventions sustained over time produce a decrease in 

male Vietnamese American smoking prevalence, and 

interventions that focus on the family environment are 

effective. Recommendations encouraged researchers to 

explore the role of cessation counseling, standard of 

care regime, and nicotine replacement therapy for Vietnamese men; examine the role of parental modeling, 

acculturation, and tobacco industry media on smoking 

initiation among adolescents; and examine the role of 

acculturation and tobacco industry media on smoking 

among Vietnamese women. Ms. Caroline Renner’s data 

demonstrated that about 43 percent of Alaska Natives 

smoke and 12 percent use smokeless tobacco. Eskimos, 

Indians, and Aleuts use tobacco in rituals and religious 

ceremonies; however, recreational use is rapidly rising, 

especially among women and children. Twenty-nine 

percent of Alaska Native pregnant women smoke and 

29 percent use smokeless tobacco. It is very common for 

preschool-aged girls and boys to begin using a smokeless tobacco product, Iq’mik. Many pregnant Alaska Natives expressed belief that Iq’mik was safer than smoking 

during pregnancy. Ms. Renner recommended research 

that assesses Alaska Native political and communitybased attitudes and promotes understanding of tobacco-related health effects and potential for treatment of 

nicotine addiction. Additional resources are needed to 

explore regional and cultural differences among Alaska 

Natives. Dr. Deirdre Lawrence emphasized that we need 

to address gaps in national assessment of tobacco use, 

predictors of use, and the surveillance of tobacco use 

within special populations. 

Panel 1: Treatment of Nicotine Addiction: 

Cessation Among Rural and Older Populations 

SPEAKERS 

Mary Ellen Wewers, Ph.D., M.P.H., Rural Populations 

Craig Stotts, R.N., Dr.P.H., Older Populations 

DISCUSSANTS 

Linda Jouridine, Ed.D. 

Neal Rick Boyd, Ed.D., M.S.P.H. 

MODERATOR 

Ann Ward, M.A. 

Drs. Mary Ellen Wewers and Craig Stotts reviewed their 

research on rural and elderly populations. Dr. Wewers 

presented current surveillance data that demonstrate 

that treatments intended for rural smokers typically 

include programs that utilize family participation, telephone counseling, and/or nicotine replacement therapy 

and are based in churches and schools. In addition, 

some media campaigns, work-based programs, peerassisted smokeless tobacco cessation, and communitybased initiatives have all demonstrated success. Dr. 

Wewers stated that rural populations are faced with demographic and geographic disadvantages and have 

higher rates of cigarette consumption. Family participation is most important in African American and Caucasian rural smokers and both groups preferred school 

and church-based programs. Dr. Stotts presented research showing that elderly smokers who have quit successfully experience decreased health care costs, less 

negative health effects, and improved cognitive functioning. In one study among a rural elderly population 

of smokers, women were more likely to quit than men, 

and both cited advice and assistance from their primary 

care physicians as the greatest motivators. Print media 

was the most preferred format to receive quit information. Participants indicated no interest in computer- or 

Web-based formats to receive information. Dr. Stotts 

concluded that older smokers would still benefit from 

quitting, and that physicians should incorporate advice 

to quit in their visits with smokers of this population as 

well. Drs. Linda Jouridine and Neal Rick Boyd commented that the tobacco control community should 

carefully define groups of smokers and perhaps incorporate an anthropological perspective toward defining 

groups. They emphasized the importance of considering the role of addiction and self-medication in the 

APPENDIX B : SUMMARY OF PANEL PRESENTATIONS 47 
spectrum of nicotine dependence, especially among 

low-income populations. Another unique and significant aspect of rural populations that influences their attitudes toward smoking and tobacco cessation is the 

value they place on respect and independence. Moreover, many do not consider tobacco a problem, and may 

see it as a personal or community source of income. 

Since distance and remoteness can be barriers for 

smokers who wish to quit in rural communities, we 

should invest more in toll-free quitlines, which can be 

accessed from any location at no cost to the caller, and 

proactive efforts to take the treatments to smokers’ 

communities, rather than wait for smokers to seek 

them. 

Panel 2: Basic Biology 

SPEAKERS 

Sara Quandt, Ph.D., Transdermal Nicotine Exposure, 

Salivary Cotinine, and Green Tobacco Sickness in Latino 

Farm Workers 

Phillip Lazarus, Ph.D., Importance of UDP– 

Glucuronosyltransferases in Risk for Tobacco-Related Cancers 

DISCUSSANT 

George Hammons, Ph.D. 

MODERATOR 

Mirjana Djordjevic, Ph.D. 

Dr. Sara Quandt discussed her research on migrant tobacco workers. She reviewed the health consequences 

of prolonged transdermal exposure to nicotine migrant 

farmers who are predominately people of color. She explained that even among nonsmoking workers, dermal 

exposure leads to transdermal absorption, which increases salivary cotinine and causes a syndrome called 

green tobacco sickness. Her research is indicative of the 

value of cotinine as a biomarker of occupational exposure to nicotine. Dr. Quandt recommended assessing 

the association of susceptibility to green tobacco sickness using variation in cotinine metabolism and documenting the long-term health consequences of this syndrome. She advocated for the implementation of 

interventions to protect workers, such as barrier creams 

and personal protective equipment. Dr. Phillip Lazarus 

discussed the genetic influences on the development of 

tobacco-related cancers among disparate populations 

by examining DNA, cellular metabolism, and cellular 

regulatory proteins. Research should be conducted to 

determine whether individual genetic variations correlate directly with displayed characteristics, determine 

whether observed differences in smoking-related cancer risks correlate with genetic variations in multiple 

racial and ethnic groups, examine whether genetic variations correlate with altered function in vitro and in 

vivo, and assess whether high-risk genotypes for multiple enzyme systems are different in multiple race 

groups. Biological research seeks to establish mechanisms for determining the role of tobacco smoke in cancer risk and disease etiology among tobacco users in 

general. Additional studies should examine the effects 

of interactions of tobacco smoke with other environmental factors and determine if genotypic differences 

observed in multiple race or ethnic groups can be used 

as a determinant in health policy design. 

Luncheon Panel: Marketing 

SPEAKERS 

Pamela Clark, Ph.D., Existing Research in Industry 

Marketing and Future Directions for Research 

Philip Graham, Counter Marketing 

DISCUSSANT 

Curtis Spence, B.S. 

MODERATOR 

Philip Graham 

The presenters opened the discussion by reviewing the 

tobacco industry’s immense financial dedication to the 

marketing of their tobacco products. The tobacco industry spent $9.7 million in advertisements in the year 

2000, mainly in the form of magazine and billboard advertisements. A substantial portion of this figure is retained at the retail outlet level, where the tobacco industry pays for signage and product placement and 

conducts buy-downs to increase sales. This is particularly relevant when considering that teens smoke the most 

heavily advertised brands and have less cash flow than 

adults, thereby becoming most susceptible to the price 

incentives and inundation of signage at the neighborhood stores. The TruthTM campaign employed a grassroots model, utilizing street marketing by putting name 

and design on T-shirts and allowing the teens to participate in creating the commercials (i.e., the intervention). This increased TruthTM brand recognition to 

counter the tobacco product brand recognition they experience. The concluding discussion focused on several 

research questions that investigate topics ranging from 

determinants of the effect of point-of-purchase marketing on starting and maintaining smoking status, measurement of the reach and effectiveness of retail marketing and other grassroots programs against more 

48 Eliminating Tobacco-Related Health Disparities 
traditional media channels, mobilizing voters to pressure the retail industry to terminate ties with the tobacco industry, and potential differences in approach when 

working with diverse communities. Members of the audience suggested having the Latino community present 

in TruthTM campaigns and that efforts should include 

other types of entertainers in campaigns, such as mainstream hip-hop and rap performers (e.g., Snoop Dogg). 

Panel 1: Marketing: What Tobacco Industry 

Documents Tell Us 

SPEAKERS 

Ruth Malone, R.N., Ph.D., Tobacco Industry Targeting of 

Gays and Lesbians 

Valerie Yerger, M.A., N.D., Tobacco Industry Targeting of 

African Americans 

DISCUSSANT 

Monique Muggli, M.P.H. 

MODERATOR 

Anne Joseph, M.D., M.P.H. 

Drs. Ruth Malone and Valerie Yerger discussed ways the 

tobacco industry targets gay, lesbian, and African American groups. The tobacco industry resists admitting to a 

concerted effort to market to LGBT communities. 

Some current statistics show that LGBT communities 

smoke at increased rates, even in the absence of specialized advertising. This high prevalence rate indicates to 

the tobacco control community that an increased emphasis on counter-marketing toward these groups 

would be beneficial. Health care professionals need to 

focus on understanding the relationship between industry and marketing to diverse communities and cultures. 

Much research needs to be done in tobacco and disparities through monitoring, descriptive studies, and community research. In addition, future research should 

obtain and compile all tobacco industry documents 

from outside London, England, to encourage lawyers to 

continue searching the documents, to look at all nonpaper materials (audio), to branch out into other disciplines, and to increase exposure of this problem 

through the use of all media. 

Panel 2: Harm Reduction: Marketing and Product 

Consumption 

SPEAKERS 

Timothy Dewhirst, B.P.H.E., M.A., Target Marketing of 

Menthol Cigarettes 

Harold Pollack, M.P.P., Ph.D., Surveillance of Harm 

Reduction Products and Population Usage 

DISCUSSANTS 

Donna Roy, M.A., M.P.H. 

Richard Pollay, Ph.D. 

MODERATOR 

Mirjana Djordjevic, Ph.D. 

Panelists discussed the need to analyze the level of effectiveness of ethnic-focused marketing and to determine 

how to counter-market to diverse communities and cultures. They recommended that behavioral and psychological research should examine ways in which class, 

race, gender, sexual orientation, social context, and social networks shape smoking patterns. Research needs 

to be sensitive to the cultural differences of tobacco use 

in African American, LGBT, and American Indian communities, particularly with respect to smoking rates, cessation, brand preferences, and potential for tailored 

services and support. Specific recommendations include expanding community-based participatory research on existing projects, procuring supplements to 

existing projects, and funding additional research in 

these specific communities. 

APPENDIX B : SUMMARY OF PANEL PRESENTATIONS 49 
NIH Publication No. 05-5283

April 2005