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African American people suffer tobacco-related health problems and death at a rate that’s cruelly disproportionate. That’s why Healthy Places by Design and a coalition of respected groups are working against this systemic injustice. Because we focus on creating the conditions for health equity through local, place-based strategies, we’re particularly grateful to collaborate with Black-led organizations who are making a meaningful difference.

The Problem

According to the Centers for Disease Control and Prevention, cigarette smoking remains the leading cause of preventable disease, disability, and death in the United States. Beyond the obvious health burden and loss of life, tobacco use has led to billions of dollars in lost productivity and health care expenditures. While African American people tend to start smoking later in life, they are more likely than other racial and ethnic groups to have related health problems. In fact, they are more likely to die from smoking-related diseases (e.g., heart disease, diabetes, cancer) than Hispanic people and Non-Hispanic, White people.ⁱ Additionally, African American people are typically less able to quit smoking despite three-fourths of smokers wishing they could.

Our nation has a complex and troubling history related to tobacco. The early tobacco economy exploited enslaved Africans for the plant’s production and processing, even before our nation was formed. Big Tobacco later targeted African American people with marketing and advertising efforts heavily focused on certain tobacco products. Tobacco advertisers originally denigrated African American people as caricatures in tobacco advertising aimed at White consumers.

But Big Tobacco’s tactics shifted to broaden sales, suddenly portraying African American people with more human imagery. The industry also pushed Menthol cigarettes, which were known to have stronger appeal in African American communities (Menthol cigarettes are preferred by 88% of African American smokers).ⁱⁱ In addition, Big Tobacco began investing in important African American institutions, such as Historically Black Colleges and Universities and sponsoring cultural events, such as KOOL Jazz Festivals.ⁱⁱⁱ Today, the marketing of Menthol cigarettes to African American communities remains a deliberate campaign to profit from the industry’s most harmful^iv and addictive product.

Evolving Threat

Much has changed in recent decades. Cigarette smoking, which was once accepted as a norm, is no longer allowed in many public and private places as states, local governments, and organizations adopted Smoke-Free policies to protect people from exposure to secondhand smoke. Meanwhile, the tobacco industry unleashed a host of new “vape” products that work differently from cigarettes but still contain nicotine (which is addictive) and other harmful ingredients. Younger generations, who are now inundated with advertising and enticing vape flavors including candy, desserts, mint, and menthol, are facing a whole new tobacco landscape than prior generations.

Tobacco prevention leaders working with youth find it ever more important to meet youth where they are, approaching tobacco use from a holistic health perspective and developing messaging and strategies that resonate with younger generations.

The Initiative

Committed to the idea that the people most impacted by an issue are vital for effective and equitable solutions, a group of African American-led organizations are charting a courageous path for health justice. They have linked arms as part of Robert Wood Johnson Foundation’s initiative, Building Capacity to Reduce Tobacco Inequities in the South and Midwest, to tackle tobacco not just as a public health crisis, but as a matter of social and health justice. As a partner of the Institute for the Advancement of Minority Health, the Healthy Places by Design team have joined these seasoned public health organizations to address tobacco, one of our nation’s oldest and most insidious scourges.

The grantees of RWJF’s Building Capacity initiative include:

• The Institute for the Advancement of Minority Health (IAMH) aims to reduce tobacco inequities among African American males (ages 12 and older) in the Mississippi Delta River Region using community-based participatory approaches to join with the community as full and equal partners. Working with non-profit partners, including Healthy Places by Design, IAMH coordinates learning cohorts, smoking cessation services, policy advocacy, capacity building workshops, and mini-grants to local community-based organizations. African American males, who are most impacted by tobacco, provide culturally specific information about the risk factors of tobacco use in rural Delta communities.
• The Center for Black Health & Equity (The Center) builds capacity and infrastructure within 15 states to advocate for stronger policy, systems, and environmental change policies to eliminate the sale of menthol and flavored commercial tobacco products or eliminate exposure to secondhand smoke. The Center has developed the Community Development Capacity Building Process and is actively guiding six coalitions through the process. The Center also published the foundational Health Justice in Tobacco Control Guide, featuring scientific research, detailed history, and in-depth practical instruction on how to use a community-model to effect policy change.
• The Black Women’s Health Imperative launched the Socially Emotionally Empowered Unapologetically Smoke-Free (SEE-US Program), which develops emotional wellness and advocacy skills while building the leadership capacity of Black women at HBCU campuses in the fight against Big Tobacco and their products. SEE-US mobilizes and empowers women to lead the fight against tobacco and vaping and elevating COVID-19-related tobacco and vaping marketing techniques as a social justice issue. Organizers utilize digital outreach, social media, and other technology to promote tobacco and vaping control on HBCU campuses and in surrounding communities. The program also increases awareness of smoking behaviors related to stress and anxiety resulting from COVID-19 and developing social-emotional wellness and coping behaviors for Black women.
• Louisiana Public Health Institute has developed Project ASIRT (Addressing Systemic Inequities to Reduce Tobacco Use), to address the high rates of tobacco use in Louisiana’s Black rural communities. ASIRT recognizes and addresses tobacco-related and systemic inequities by building community capacity through increased awareness of and access to cessation services, community engagement and mobilization, and policy change at the local and state level.
• H.E.A.R.T. COALITION, Inc. builds capacity to implement a policy banning sales of menthol and other flavored tobacco products in Atlanta and Fulton County Georgia. H.E.A.R.T. organizers have created the No Menthol Movement ATL Coalition and a legislative educational campaign to reduce the burden from menthol cigarettes and other tobacco products in Atlanta.
• Save a Girl, Save a World leads the Smoking Prevention through Equity, Advocacy and Knowledge (SPEAK)UP Project. SPEAKUP educates, empowers, and engages young women at HBCUs about the hazards of tobacco use and its predatory nature that impacts health and well-being in their communities. Ultimately, SPEAKUP motivates young women to organize, become advocates, and develop leadership skills for being change agents.

Together, with RWJF’s support, these organizations seek to reduce tobacco use in communities whose people are directly targeted and disproportionately impacted by its destructive effects by investing in and mobilizing those most impacted by this historically oppressive industry.

Our team is honored to partner with IAMH and learn alongside all of these impressive leaders. Their commitment to engage the people most affected and confront the root causes of inequity and structural racism is inspiring. Bold leaders, advocates, and funders addressing other pressing health concerns, such as food and nutrition security, safe opportunities for physical activity, reliable transportation, and affordable housing can use these same approaches as we set our sights on root solutions and social justice.

Photo Courtesy OOH TODAY