Monograph 22 A Socioecological Approach to Addressing Tobacco-Related Health Disparities

  1. Behavioral Research Program
  2. Tobacco Control Research Branch (TCRB)
  3. Tobacco Control Monograph Series
  4. Monograph 22
Monograph 22 Cover

Tobacco use remains the nation’s leading cause of preventable premature death, including death from cancer, and progress in reducing tobacco use and related disease and death has not been equally distributed across population groups. This monograph examines the current evidence surrounding tobacco-related health disparities (TRHD) across the tobacco use continuum—initiation, secondhand smoke exposure, current use, frequency and intensity, cessation, relapse, morbidity, and mortality—and the implications for future research and implementation of effective strategies.

As this monograph demonstrates, a central challenge for cancer control is to ensure that all Americans benefit from advances in tobacco control research and practice.

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Ordering Information

Printed copies of the monograph Executive Summary are available upon request. Requests of 10 copies and fewer ship for free. To place your order, email ncidccpsbrpadvances@mail.nih.gov using the subject line “Tobacco Monograph print request”.

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Suggested Citation

U.S. National Cancer Institute. A Socioecological Approach to Addressing Tobacco-Related Health Disparities. National Cancer Institute Tobacco Control Monograph 22. NIH Publication No. 17-CA-8035A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2017.

View Individual Chapters

Chapters and key topics covered within each chapter are listed below. Chapters generally include an introductory section, details on methodology, a chapter summary, research needs, and a reference list.

  • Front matter (PDF, 689 KB)
    • Table of Contents
    • Figures and Tables
    • Acknowledgments
    • Abbreviations
    • Glossary
    • Forward

Section 1. Overview and Epidemiology

  • Chapter 1. Introduction and Overview (PDF, 795 KB)
    • Health Disparities
    • History of Research on TRHD
    • TRHD: A Multilevel Perspective
    • About This Monograph
    • Monograph Organization and Chapter Overviews
    • Future Directions in TRHD Research
    • Conclusion
    • Appendix I: Monograph Terms
  • Chapter 2. The Epidemiology of Tobacco-Related Health Disparities (PDF, 1.7 MB)
    • Youth Tobacco Use Behaviors
    • Cigarette Smoking Prevalence Among Young Adults
    • Menthol Cigarette Smoking Among Youth and Young Adults
    • Adult Tobacco Use Behaviors
    • Secondhand Smoke and Prenatal Tobacco Exposure
    • Tobacco-Related Cancer Incidence and Mortality
    • Methodological Limitations and Challenges in the TRHD Literature

Section 2. Intrapersonal/Individual Factors Associated with Tobacco-Related Health Disparities

  • Chapter 3. Genetics, Physiological Processes, and Tobacco-Related Health Disparities (PDF, 1.4 MB)
    • Genetic Factors Associated With Nicotine and Smoking
    • Genetic Factors Associated With the Risk for Lung Cancers
    • Genetics and TRHD: Current Knowledge and Future Directions
  • Chapter 4. Flavored Tobacco and Chemosensory Processes (PDF, 488 KB)
    • The Menthol Compound
    • Brief Review of the Chemical Senses
    • Cigarette Smoking and the Chemical Senses
    • Characteristics of Flavor Additives and Constituents
    • Chemical Senses and Variation
    • Taster Group and Variance Across Populations
    • Smoking Among Taster Groups
    • Chemosensation and TRHD
  • Chapter 5. Stress-Related Processes and Tobacco-Related Health Disparities (PDF, 1.7 MB)
    • Stress Processes and TRHD: Literature and Conceptual Frameworks
    • Physiological Stress Processes and Health in Racial/Ethnic and LGBT Groups
    • Perceived Stress and Tobacco Use: Overview
    • Racism and Discrimination and Their Relationship to Disparities
    • Psychological Disorders and TRHD
    • Examining Specific Psychological Stress, Trauma, and Smoking: Women and Intimate Partner Violence

Section 3. Interpersonal and Contextual Factors That Contribute to Tobacco-Related Health Disparities

  • Chapter 6. Social Relationships and Tobacco-Related Health Disparities (PDF, 868 KB)
    • Social Relationships and Disparities Across the Tobacco Use Continuum
    • Measures of Social Relationships and Tobacco Use
    • Literature Search Strategy 
    • Social Network Structure and Smoking
    • Social Influence, Social Comparison, and Smoking
    • Social Control and Smoking
    • Social Support and Smoking
    • Discrimination and Smoking
  • Chapter 7. Tobacco-Related Health Disparities Among Immigrant Populations (PDF, 650 KB)
    • U.S. Immigration Patterns 1800–2010
    • Countries of Origin and Smoking Behavior
    • Impact of Acculturation and Assimilation to the United States
    • Literature Search Strategy
    • Acculturation, Immigrant Status, and Smoking Behavior
    • Gender, Acculturation, Immigrant Status, and Smoking Behavior/Outcomes
    • Socioeconomic Status, Acculturation, Immigrant Status, and Smoking Behavior
    • Immigrant Ethnicity and Smoking Behavior
  • Chapter 8. Occupation, the Work Environment, and Tobacco-Related Health Disparities (PDF, 1.3 MB)
    • Disparities Across the Tobacco Use Continuum, by Occupational Characteristics
    • Effect of Occupation and Tobacco Smoking on Cancer Risk 
    • Contributions of the Work Environment to Disparities Along the Tobacco Use Continuum
  • Chapter 9. Socioeconomic Status and Tobacco-Related Health (PDF, 1.1 MB)
    • Educational Attainment and TRHD
    • Income and TRHD
    • Wealth and TRHD
    • Neighborhood SES and TRHD 
    • Life-Course SES and TRHD

Section 4—Societal Level Influences of Tobacco Use

Last Updated
October 20, 2022