TOBACCO PREVENTION A ND CONTROL
Community Voices: Highlights to Date
REDUCING TOBACCO-RELATED HEALTH INEQUITIES
In 2015, the Minnesota Department of Health, Tobacco Control Program initiated a six- month
Community Input Process to gather information and gain insight from individuals around the
state on the harms of tobacco in the community, interventions to decrease commercial tobacco
use and exposure, and strategies to address tobacco related health inequities. This process
included over 15 in-person group sessions, individual interviews and an on-line survey. The data
collection phase will continue through mid-January.
As of December 2015, over 220 people have participated in-person and over 100 people have
contributed to the online survey. To collect community-specific information, input sessions
were largely convened based on the population groups most impacted by the harms of
commercial tobacco and include the following: African American, American Indian, Asian
American, East African, Hispanic/Latino, LGBTQ, and West African. Sessions were also convened
by region (greater Minnesota and Twin Cities metro). The final report will also include findings
from a recent summit on the tobacco related needs of people with mental illness and substance
use disorders.
Key Themes
The following are interim findings from the input gathered to date and only include broad
themes. Community-specific findings and recommendations are not included. A final summary
report will be developed after all findings and recommendations have been compiled, analyzed
and then reviewed by an advisory committee formed for this process.
Tobacco-related Threats and Issues
Commercial tobacco is often seen as a lesser threat compared to other issues that are reported
as more serious or imminent, such as: feeding one’s family, addressing immigration concerns,
providing stable housing, or the abuse of other chemical substances. These social, cultural, and
environmental factors are important to be considered as part of tobacco-related efforts.
There is a lack of awareness and understanding of the health risks of commercial tobacco
products, especially newer products (including flavored products and electronic cigarettes). In
particular, recent immigrant groups are not as knowledgeable about the health risks. There is a
shortage of culturally specific and language resources and services, which may contribute to
this lack of knowledge. Often, community-specific efforts tend to be limited in scope and
funded by short-term grants.
COMMUNITY VOICES: HIGHLIGHTS TO DATE
Commercial tobacco use is a deeply embedded social norm in many communities. Often
communities are not aware of their high use rates. Nor do they view commercial tobacco use as
a significant problem, in part, because it is often used for the social aspect of belonging and
perceptions of “stress relief.” High rates of smoking prevalence and cultural ties to tobacco in
many communities contribute to the acceptance and misconceptions about the health effects
of smoking.
Tobacco products are widely available in community stores and easily accessible, especially by
youth. High density neighborhoods have an abundance of tobacco retailers and prevalence of
tobacco product marketing and advertisements.
Strategies for Reducing Commercial Tobacco Use
Suggested strategies for reducing commercial tobacco use vary among community groups and
depend on the priorities and particular threats within each community. However, strategies
were most likely to focus on youth prevention, including those that address pricing and access
to tobacco products. All community groups noted that increasing access to culturally relevant
cessation services is a significant need.
Increasing the cost of commercial tobacco is essential, but should be considered as one piece of
broader efforts. Making tobacco products more expensive through increasing taxes was
mentioned more than other methods, such as prohibiting coupon redemption or requiring
minimum pack sizes.
Increasing the purchase age to 21 would be important for reducing youth rates of tobacco use
and would send a message about the importance of the issue; however, there is concern that in
communities where tobacco use is an accepted norm, young adults would likely still be able to
access tobacco through friends and family. There are also concerns around youth targeting.
Strategies that limit use and access to new or other tobacco products (including e-cigarettes
and shisha or hookah) and flavored tobacco products (including menthol) are also important.
Increasing the availability of tobacco-free environments, including housing, community spaces,
and worksites are important, but there is concern about the required enforcement from peers
and neighbors. Tobacco-free worksite efforts are often targeted at professional workplaces, but
are needed among production and labor worksites because those working in these industries
may use cigarettes as the only way to get a break.
Strong enforcement is also important, but strategies should focus on penalizing the supplier
rather than criminalizing the user.
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COMMUNITY VOICES: HIGHLIGHTS TO DATE
Strategies for Quitting
Among community groups most impacted by the harms of tobacco there is a tendency to seek
support within their own cultural community, and people are most likely to use their faith,
family, and community support systems to quit smoking. They seek assistance from people who
will understand their situation, know their needs, and who have also quit using tobacco. Family
members, especially children, can be motivators for quitting.
This emphasis on relationships may make people less likely to use a quitline, which many do not
perceive to be culturally relevant (e.g., spoken language, acknowledges cultural context, etc.)
People may not be aware of what cessation services are available and are unlikely to use
cessation services that are not culturally relevant. Embedding cessation activities into existing
services and community networks, or pairing with other higher priorities, may be key.
People in greater Minnesota may be most likely to use nicotine replacement therapies or
prescription medications, or talk to a healthcare provider or go to the doctor’s office to get help
quitting. Metro area community groups acknowledged the importance of healthcare providers’
roles with cessation but cited barriers, such as: lack of health insurance, not having a regular,
trusted provider, and cultural norms towards not using doctors for preventative services. There
is concern about potential cost and barriers to access associated with using nicotine
replacement therapies.
Cultural Strengths and Considerations
Strengths of the community must be built upon and leveraged to increase understanding and
mobilization of community action. Each community’s cultural context must be honored.
Cultural specifics may differ, but across population groups, relationships (with family, friends,
faith, etc.) are central.
Peer-to-peer communication and support is key. There is a need for culturally specific
community navigators with training and access to resources and services.
Community-based organizations and community leaders have existing relationships with those
they serve. In every community, there are key figures (imams, ministers, elders, etc.) that are
influential; these relationships should be leveraged and may provide opportunities to pair
tobacco-related activities with existing community-based programs or networks.
Community Needs
Opportunities for sustained and adequate funding are important. There is a critical need for
continuous and long-term investment and resources into communities.
Small community organizations should have fair access to funding and find it difficult to
compete with larger ones. There are many small organizations that represent communities
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COMMUNITY VOICES: HIGHLIGHTS TO DATE
well, and are most in tune with community needs, but are frustrated by their lack of success in
getting funding to do the work.
Community-specific data is needed to identify problems related to commercial tobacco use.
Data collected should be disaggregated by population subgroups.
Almost every community group noted that culturally relevant and peer-to-peer messaging for
adults and youth (e.g., media campaigns, use of positive modeling, etc.) is important and should
be incorporated into overall efforts. Youth and young adults relate more to peers speaking
candidly about their experiences, rather than fear-based media. There is an opportunity to
increase the use of social media to message to youth about tobacco use and exposure, but
messages need to be catchy or memorable.
Minnesota Department of Health
Tobacco Prevention and Control
PO Box 64885, St. Paul, MN 55164
651-201-3535
[email protected]
www.health.mn.gov/tobacco
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1/7/2016
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