A Policy Roadmap for Health Equity

Tobacco use and nicotine addiction is not simply a matter of personal choice; it can also be influenced by economic and demographic factors, stress, and marketing. For generations, the tobacco industry has deliberately targeted Black communities with menthol cigarettes, flooding neighborhoods with marketing and discounts designed to create lifelong customers. The consequences have been devastating, and they continue to impact Black communities today.

This policy guide discusses three areas where tobacco industry strategies have hit Black communities the hardest, and shares resources and ideas for taking action where you live.

Every community is different, so the first step is understanding your own community's needs. Throughout this guide, you'll find resources to help you assess what's happening around you, connect with local leaders and coalitions, support friends and family who want to quit, and advocate for change.

This handbook also includes a discussion guide to help start conversations with family, friends, coworkers, and students about nicotine addiction and the impact of tobacco in the Black community.

Menthol Cigarettes and Other Flavored Tobacco

Tobacco companies deliberately targeted Black Americans in advertisements for menthol cigarettes, which are easier to smoke and harder to quit, and placed them in Black neighborhoods. Tobacco companies also sponsored Black cultural events, placed ads in Black magazines, and distributed targeted discounts and promotions. At one point, some tobacco companies even handed out free menthol cigarettes in Black neighborhoods. As a result, more than 80% of Black smokers use menthol cigarettes, and according to one study, Black Americans account for 41% of all premature deaths caused by menthol cigarettes.

More recently, Big Tobacco has continued to invest in keeping menthol on the market. Flavored cigarettes were banned in 2009; however, an exception was made for menthol products. The tobacco industry has expanded its reach with other flavored products including cigars and cigarillos, e-cigarettes, and oral nicotine pouches. Black Americans are also disproportionately impacted by these products, especially cigars and cigarillos, and use e-cigarettes and nicotine products at high rates as well. Due to these factors, Black Americans are also more likely to be exposed to secondhand smoke.

You can find more information about menthol cigarettes here.

Keep reading for more information on what you can do to fight back against menthol cigarettes and other flavored tobacco products in your neighborhood.

Retailer Density and Price

The tobacco industry has strategically targeted Black Americans (and other historically marginalized groups) with tobacco advertising in stores, and by lowering the cost of tobacco products through promotions, coupons, and discounts. Tobacco retailers and advertisements are also often more heavily concentrated in areas with a greater number of nonwhite residents. For example, in major cities like Washington, D.C., there are up to 10 times more tobacco advertisements in neighborhoods with mostly Black residents compared to other neighborhoods. Little cigars, cigarillos, and menthol tobacco products are also cheaper in neighborhoods with a majority of Black or young adult residents, a technique used by the tobacco industry to increase demand.

In 2021 (the most recent year for which we have data), the industry spent $7.65 billion on in-store advertising, price discounts, and promotions for cigarettes and $454.2 million for e-cigarettes. The reason the tobacco industry invests so much in the retail environment is simple: it works. Many studies show that when discounts and promotions are advertised in stores, tobacco sales go up by as much as 30%.

Learn more about the retail environment and retailer density in Truth Initiative's report on the retail environment. 

Continue reading to learn how you can help reduce the number of tobacco retailers in your community.

Policy Exemptions for Hookah

In addition to menthol cigarettes and cigars and cigarillos, exceptions in flavored tobacco laws have been made for hookah use. This centuries-old waterpipe is used for smoking flavored tobacco called shisha, which is heated by charcoal to create smoke that is inhaled through a hose and mouthpiece. Although people largely perceive hookah as less harmful and addictive, an average hour-long hookah session can expose users to as much smoke as 100 cigarettes, posing many of the same risks.

According to one study, about 25% of Black college students had used hookah before, perhaps because hookah bars are often located near college campuses. Black Americans are disproportionately impacted by hookah use, and middle-class Black and Hispanic individuals are also at higher risk of smoking hookah.

Despite the health consequences associated with hookah use, many policies that prohibit the sale of flavored tobacco products do not cover hookah, keeping it available even in places that don't allow flavored cigars or vapes. In fact, California's statewide flavored tobacco restriction, one of the strongest in the country, exempts hookah.

Read more about hookah here.

Below, we include ideas for how you can protect people in your community and ensure that hookah doesn't slip through the policy cracks.

E-cigarette Use

E-cigarettes, also known as vapes, have become stronger and cheaper in recent years, exposing users to larger amounts of nicotine than ever before. Historically, Black Americans have reported lower prevalence of e-cigarette use compared to White Americans, although use has risen among young Black Americans. E-cigarettes contain nicotine, which is highly addictive and harmful to young people in any form. Because e-cigarettes can deliver large amounts of nicotine in each puff, addiction can happen quickly.

Nicotine addiction has real consequences for young people. Nicotine use can harm the developing brain and make young people more susceptible to addiction later in life, and nicotine addiction can increase stress and intensify symptoms of depression and anxiety. This is especially relevant for Black Americans, who may already experience increased stress due to discrimination, racism, economic instability, and fewer available mental health resources.

Taking Action in Your Community

Here are some ideas and tools for taking action in your community:

Help those who use tobacco to quit.
Quitting tobacco has countless short- and long-term benefits, and breaking the cycle of nicotine addiction can lead to improved mood and better mental health. You can empower anyone — whether young or old, healthy or sick — to quit smoking or vaping by sharing quitting resources and reminding them of the benefits of living nicotine-free. You can also make a difference by advocating for quitting resources at your school, youth organization, church, or other cultural institution. Even starting a conversation with friends or family about nicotine addiction can make a difference.

Understand the impact of tobacco and nicotine in your community.
Count how many hookah bars, vape shops, and other tobacco outlets you see in your community. Alternatively, count how many are within walking distance from your town's school, church, or other buildings where young people congregate. You can also count how many tobacco advertisements you can spot in your community, keeping an eye on how advertisements change depending on your location. You can find resources for tobacco retailer assessments at CounterTobacco.org's STARS and VSTARS pages.

Find a tobacco control coalition in your community.
If possible, connect with a tobacco control coalition in your neighborhood to see what they're doing and talk about how they can support you and your community. If you don't have a local tobacco coalition, you can start one!

Contact your elected officials.
Use the worksheet below to find your federal, state, and local elected officials.

Decision makers can range from members of U.S. Congress, your Governor or State Legislature, or your City or County Council. Members of your school board or local board of health may also have a role in making tobacco-related decisions.

Elected officials may make policies, but decisions can be influenced by those who are not elected. Those types of leaders can range from community organizers (such as your local NAACP unit), church leaders, parent organization leaders, and others. Reach out to them and encourage them to take action to protect your community from tobacco. The community asset mapping tool from NAACP can help you map this out.

Encourage your school to implement tobacco-free campus policies.
Schools present an important avenue for youth tobacco education and prevention. But, it's important that schools do not use punitive measures to punish those who smoke or vape, but rather use a supportive approach to help young people quit. Truth Initiative provides free educational programming to address smoking, vaping, cannabis, and prescription drug abuse prevention. These curricula are free and accessible online, and offer EX Program as a quitting resource to help those who are currently vaping to quit.

Collect personal stories from your community about how tobacco has impacted people's lives.
Hearing directly from someone about how the tobacco industry has affected them can be compelling and powerful — and could be meaningful for conversations with decision makers and organizers.

Raise the alarm about tobacco in your community through local channels.
Write to your local paper, local radio, social media account, or community podcast to bring attention to the impact of tobacco in your community. Feel free to reach out to Truth Initiative to request sample letters, facts, or talking points.

Guide to Elected Officials

You can find your elected officials in a number of ways.

Federal Officials
The U.S. Congress makes the laws of the United States. Each person in the U.S. is represented by one U.S. Representative and two U.S. Senators.

• U.S. House of Representatives: you can use this zip code look-up tool to find who represents your area in the U.S. Congress.
• U.S. Senate: you can find your U.S. Senators and how to contact them on Senate.gov.

State Officials
There are several State government officials you may want to interact with:

• State Governor: You can find your State's Governor on NGA.org's Current Governors page. Click on your governor and this site will give you their office address, phone number, and a link to their official website. Each Governor's official website may list additional ways to contact them. The Find your Legislator Tool from Plural Policy can also help you find your state legislators and federal representatives.
• The State legislature (State House or Assembly, and State Senators): writes state laws. You can find your state legislators by going to your state government's official website, and there will be links to finding your specific State Representative or Assembly Member, as well as State Senators.
• The State Attorney General (AG): The State AG is the top legal officer in the state. Your State's Attorney General can be found using the Find My AG tool from the National Association of Attorneys General.

Local Officials
Local elected officials can include City Council, County Council, school board members, or a local board of health. Not all localities have the same number or the same kind of local officials. Most localities have a government website that will have links to those who represent you at the local level.

Sample Email or Letter to an Elected Official

To the Office of [name of representative, senator, council member, or other]

My name is [your name] and I'm a [student, resident, activist, or other] located in [your state, city, town, or neighborhood].

I'm writing to you today to express my concerns about the impact of tobacco and nicotine addiction in our community, and to urge you to take action to protect the health of young people, families, and all who live in our community.

Tobacco and nicotine use remain among the most serious preventable threats to public health. Tobacco use is the leading cause of preventable death in the United States, claiming more than 490,000 lives each year, and the rise of e-cigarettes and oral nicotine pouches has put a new generation at risk of nicotine addiction.

The impact of tobacco and nicotine addiction is evident right here in our community. [Insert local or state data points - for example: in our school district, there are X number of tobacco shops, and X number are within a short walking distance from school. However, schools and clinics in the area only offer X number of quitting programs or resources]. Research consistently shows that well-designed tobacco control policies reduce youth initiation and help current users quit.

As a [student, teacher, parent, resident, or other] I have seen firsthand how quickly someone can become dependent on these addictive and too easily accessible products.

[If you have a personal story to share or a quote from someone else, include it here]. Our community deserves leadership that puts public health first, particularly given the tobacco industry's long history of targeting young people and vulnerable populations with predatory marketing.

For these reasons, I respectfully urge you to prioritize tobacco and nicotine prevention in your work and to support measures that protect our community — particularly our young people — from addiction and its lifelong consequences. Your leadership on this issue can help ensure that fewer young people in [your state] ever start down the path of nicotine dependence.

Thank you for your commitment to making [your state] a healthier place for all of us. I would welcome the opportunity to discuss this issue further and can be reached at [phone number or email].

Sincerely,
[Your handwritten signature]
[Your typed name]
[Your address, so the office can confirm you are a constituent]

Discussion Tips and Questions

Use this discussion guide to start a conversation about nicotine addiction and the impact of tobacco on the Black community. These questions can inspire discussions with family, friends, coworkers, and students.

Discussion tips:

• Lead with curiosity — ask lots of questions.
• Establish the facts — knowledge is power.
• Acknowledge all perspectives — everyone's personal experience is valid.
• Ask open-ended questions to better understand community experiences with tobacco use, addiction, and cessation.
• Collect community-level data or conduct a local census to better understand tobacco use and its impact.
• Ask community members where and how they see tobacco products being marketed in their neighborhoods.

Questions to consider:

• Tobacco companies purposefully put ads for menthol cigarettes in Black magazines and used themes of Black culture and nightlife. They also sponsored Black music festivals where they handed out promotional items and free cigarettes. Why would a tobacco company do something like this, and what impact does it have today?
• What changes when a community has more tobacco shops and ads compared to other neighborhoods? How could consistent and widespread tobacco marketing affect how people perceive smoking and vaping?
• What connections can we make between the tobacco industry and other industries that rely on addiction; such as fast food, sports betting and gambling, or even online shopping and social media? Do these industries target certain groups?
• Whose responsibility is it when someone gets addicted to a product?
• How or why can stress push someone toward using tobacco?
• How can we make small changes in our own lives to break the cycle of tobacco use?
• How can communities mobilize to address retail practices and marketing trends that contribute to tobacco use and addiction in Black communities?

Glossary of Useful Terms

These terms will help you understand and communicate about tobacco-related issues in your community.

Addiction: A chronic condition characterized by compulsive engagement in a behavior or use of a substance despite harmful consequences. Rather than being viewed as a moral failing or lack of willpower, addiction is now understood as a treatable medical condition that involves changes in brain circuits related to reward, motivation, memory, and impulse control.

Advocacy: Taking action to create change, either by influencing policies, raising awareness, or mobilizing your community to improve health and well-being.

Accountability: Ensuring that decision-makers (like elected officials, agencies, or corporations) are responsible for their actions and the impact those actions have on communities.

Cessation: Programs, treatments, and support systems that help people stop using tobacco or nicotine products.

Community Assessment: A process of gathering information, such as counting stores, ads, or products, to understand how tobacco affects your community and identify priorities for action.

Community Coalition: A group of organizations and individuals working together to address shared concerns, such as reducing tobacco use or improving public health.

Community Influencers: Trusted individuals or groups such as faith leaders, organizers, or local organizations who can shape opinions and motivate action in a community.

Culturally Appropriate Care: Health services that respect and reflect the cultural needs, values, and experiences of different communities.

Decision-Makers: People who have the authority to create or influence policies, including elected officials, school boards, and health departments.

Flavored Tobacco Products: Tobacco products with flavors (such as menthol, fruit, or candy) that make them more appealing, especially for young people.

Health Disparities: Differences in health outcomes between groups, often driven by inequities in access, resources, or targeted marketing.

Health Equity: Ensuring everyone has a fair and just opportunity to be as healthy as possible, regardless of race, income, or background.

Hookah: A centuries-old waterpipe that is used for smoking flavored tobacco called shisha, which is heated by charcoal to create smoke that is inhaled through a hose and mouthpiece. Despite common misconceptions, hookah use is harmful and linked to serious health risks.

Media Advocacy: Using media, such as newspapers, TV, radio, or social media to raise awareness and influence public opinion and decision-makers.

Menthol Cigarettes: Cigarettes with a cooling flavor that can make smoking feel smoother and harder to quit. These products have been heavily marketed to Black communities.

Nicotine: A highly addictive chemical found in tobacco and many nicotine products.

Point-of-Sale Advertising: Advertisements that are located in stores where tobacco products are sold (e.g., signs, displays, discounts). This is one of the tobacco industry's most powerful tools to attract customers, especially youth.

Policy (Public Policy): Rules, laws, or regulations created by governments or institutions that shape behavior, such as restrictions on flavored tobacco sales.

Prevention: Efforts to stop tobacco use before it starts, especially among young people (e.g., education programs, tobacco-free school policies).

Retail Environment: The places where tobacco products are sold, including stores, vape shops, and hookah lounges, along with the advertising and promotions in those spaces.

Retailer Density: The number of tobacco retail outlets in a specific area. Higher density increases exposure to tobacco products and advertising.

Targeted Marketing: Strategies used by companies to focus advertising on specific groups to increase product use, often based on race, age, or income.

Tobacco Control: Efforts (policies, programs, education) aimed at reducing tobacco use and its harmful effects.

Tobacco Industry Interference: Actions taken by the tobacco industry to influence policies or public perception — such as lobbying, donations, or marketing tactics.

Storytelling (Personal Stories): Sharing real-life experiences about how tobacco has affected individuals or families. Personal stories can be powerful tools for advocacy and policy change.

Substance use disorder: A clinical diagnosis defined as a problematic pattern of substance use leading to significant impairment or distress.

Youth-Oriented Spaces: Places frequently used by young people, such as schools, parks, and recreation centers, that are often targeted by nearby tobacco marketing.

About the Breath of Freedom Movement

The Breath of Freedom Movement is creating lasting partnerships and community-specific resources to help Black Americans quit nicotine. The movement is powered by Truth Initiative and the NAACP, combining a legacy of racial justice with tobacco cessation expertise.

Keep the conversation going
Join the Breath of Freedom coalition, an alliance of partners across Black-led organizations working to reclaim the narrative about tobacco use in Black communities and empower quitting.

Share resources for quitting nicotine
Access our free toolkit with downloadable resources to help end nicotine addiction.

Need help quitting nicotine?

EX Program by Truth Initiative is a free, confidential quitting program that can increase the odds of quitting nicotine with proven tools, expert resources, and community support.

Learn more at join.exprogram.com/joinfreedom or text JOINFREEDOM to 88709 to enroll for free.