Big Tobacco Targets Vulnerable Communities

Big tobacco is targeting vulnerable groups and creating lifelong tobacco addictions. Smoking cessation programs are there to help, but can be hard to access.   

Cigarettes, cigarillos, little cigars, e-cigarettes, nicotine gum, nicotine toothpicks… the list goes on. Jennifer Wall, the director of Tobacco Free Rhode Island, is standing in front of me, sifting through her plastic briefcase that is nearly the size of the coffee table we are sitting at. For the most part, the products she shows me look more like pieces of candy than tobacco or nicotine products. And, as Wall will soon explain to me, that is the point. 

The tobacco and vaping industries are spending millions of dollars an hour to market their products. And they are targeting specific groups. Pregnant women, the BIPOC community,  people with mental illness, the LGBTQ+ community, young adults ages 12-25, low-income individuals, and the homeless population are being disproportionately affected by tobacco addiction. And beating a tobacco addiction is a long and difficult process, made more difficult by a lack of funding. The amount of money allocated to the state of Rhode Island for tobacco prevention is far below the CDC’s recommendation. This includes funding for treatment, which depending on the person, usually consists of counseling and/or nicotine replacement therapy. 

“They’re like 50 millions steps ahead of the game all the time,” says Wall in reference to the tobacco industry. She says that, although it is illegal to buy flavored cigarettes or e-cigarettes in Rhode Island, the industry has started selling what they call little cigars or cigarillos with flavors. The only real difference is the weight, but they are able to flavor them, and tax them for less. “Flavors attract kids. It's the market,” says Wall. Especially when it comes to e-cigarettes, the industry has a vast array of flavor options created to target young people. “It's flavored. It's cheap. It's flashy. I'm not going for the tobacco flavored Marlboro cigarettes,” says Wall. 

In addition, they are intentionally confusing when it comes to products that they advertise as addiction treatment. They sell things like lozenges and gum, that often are not FDA approved, but lead the customers to believe they are approved cessation products. 

The industry is intentional about the way it sells its products. In most convenience stores, nicotine and tobacco products are at eye-level right behind the counter. “Eye level is buy-level,” Wall says. The industry does this so that young people see these flashy products, and start their addiction at a very young age. Most of these products are deliberately accessible enough for kids to steal, but, regardless, many of the convenient stores aren’t even asking kids for their IDs. 

Carolyn James, a community outreach coordinator at CODAC, explains some of the ways that low-income communities and other groups are targeted. The industry will often run promotions at groceries stores or Bodegas, handing out flyers and coupons for cigarettes. They advertise online through social media and on billboards in targeted communities. Or they will often hand out free swag if someone buys a pack of cigarettes. The industry oversaturates low income communities with tobacco retailers. And, although cigarettes can no longer be advertised on TV, the industry is still able to advertise e-cigarettes. 

One example James gives of targeted marketing is that the tobacco industry has worked hard to market menthol flavored cigarettes to the African American population. They advertised them as easier and less painful to smoke, and then hooked the African American community on menthol. 

“It's almost like a David and Goliath battle, if you think about it. Because public health and grant funding is up against an industry that's spending a million dollars an hour,” says Wall. James says that many people want to quit, but it is a very difficult process. On average, it takes about 11 quit attempts to be successful. 

The best smoking cessation options vary from person to person. Some people respond well to in-person support or one-on-one counseling. Irene Glasser, a Brown Professor and former smoker, says that there is a program called Nicotine Anonymous, a 12-step peer support group that functions much like AA. Others, especially young people, prefer virtual counseling options such as texting.There are other helpful tools, such as books where you have to rate each cigarette you smoke, or strips of paper that wrap around the cigarettes that ask you to write down the date and time it is smoked. Counseling options are most effective when coupled with a nicotine replacement therapy (NRT). There are numerous different FDA approved NRTs, ranging from gum to patches to inhalers. 

Angela Butler, a respiratory therapist at Miriam Hospital, explains her smoking cessation approach—motivational interviewing. She works mostly with smokers who have asthma or COPD. She says that it is important to listen for “change talk” during motivational interviewing. Some patients are not ready to quit, and Angela handles this by informing them about the health risks of continuing to smoke. She asks open ended questions, and figures out the best ways to help a patient through recovery. Each patient is different, and will respond to different methods, so it is important to form partnerships and meet the patient where they are. 

Smoking cessation programs must adapt depending on the person, which is especially important when it comes to the homeless population. According to Glasser, about 73% of the adult homeless population smokes cigarettes, in comparison to about 15% of the general population. “It is very unequal in terms of who’s smoking, and then it is unequal in terms of who is getting any services,” says Professor Glasser. 

When Glasser and her colleague Eric Hirsch did a study on smoking cessation, they found through the Health Department of Rhode Island that there is only one smoking cessation professional who receives funding to provide free treatment programs to uninsured or underinsured smokers. The homeless shelters and service agencies are prioritizing necessities such as housing and food, and therefore do not have the bandwidth to provide smoking cessation services. And, it cannot be assumed that homeless people even have phones to access virtual services. “I've learned from my patients who are homeless what they do and what they do not do. And the nicotine is what makes them feel good. And at the same time it's hurting them, but that's their buddy,” says Butler. 

Wall says that a major barrier is getting information out to many of these targeted populations. Tobacco Free Rhode Island tries to present resources in a friendly way to the LGBTQ+ population, but there is a risk that the treatment programs they are advertising could be unwelcoming towards LGBTQ+ identifying people. Or, they want to provide resources in Spanish for Spanish speakers, but many of the treatment programs do not have translators. They want to educate young people on their options, but youth under the age of 18 cannot be prescribed NRTs. 

When it comes to addiction awareness, “Most people are much more aware of drugs, and then second alcohol, and then third nicotine. The death rate is probably the reverse,” says Dr. Glasser. Cessation programs exist, but the challenge is getting the resources to targeted communities, and keeping them motivated as Big Tobacco pours money into keeping them addicted. 

Georgia Kennedy-Bailey studies political science at Brown University, she loves her dogs and going to the beach. 

Big Tobacco Targets Vulnerable Communities Commentary:

My goal for this story changed throughout my interview process. At first, I wanted to write about the lack of smoking cessation programs accessible for people experiencing homelessness. As I spoke with more people, I found out how many different groups were struggling with tobacco addiction, so I shifted my focus. My interview with Jennifer Wall really opened my eyes to the strategies big tobacco uses to get people hooked on tobacco products. For this piece, my interviews were very helpful as I was able to talk to a lot of people doing very different kinds of work. I had a lot of information from these interviews, and found difficulty deciding which information I should focus on in my article. I also wish I had had more time to work on this piece. I did not decide on a topic until relatively late into the semester, and I think if I had more time I could have completed more interviews and written a more focused article. 

Sources: 

• National Institutes of Health (Smoking Cessation and Social Justice)

• Jennifer Wall Interview May 1st

• Carolyn James Interview April 26

• Irene Glasser Interview April 24

• Angela Butler Interview May 2