Not All Tobacco Marketing Is Created Equal

Among African-American tobacco users, Black & Mild cigarillos are extremely popular—and the brand’s marketers know it. In an attempt to target their primary customer base, the company recently released three new flavors named after musical styles pioneered by African-Americans: Rhythm, Blues, and Jazz. Following a tradition that includes Joe Camel and Virginia Slims, Black & Mild’s move is evidence that tobacco companies are actively marketing diverse tobacco products to specific communities as cigarette sales continue to decline.

Use of non-cigarette tobacco and tobacco-related products—including e-cigarettes, blunts, smokeless tobacco, and hookah—has grown rapidly in the United States over the last decade, and the public health community is working hard to catch up: new research is underway to help us more fully understand each product and its health risks; the populations who use them; how best to regulate them, and more. Among these researchers is Daniel Giovenco, assistant professor of Sociomedical Sciences, who joined the Mailman School in November last year.

Risk, Measured and Scaled

While no form of tobacco can be considered safe, experts are increasingly acknowledging that products fall on a continuum of risk. At the most harmful end is tobacco that is burned and inhaled, such as cigarettes and cigars. Non-combusted products, including smokeless tobacco and e-cigarettes, fall somewhere lower on the scale. Many public health advocates, including Giovenco, see the benefits of risk reduction when risk elimination is not possible or realistic.

“Take someone who smokes two packs of cigarettes a day, has failed multiple quit attempts, and has resigned to continue smoking,” Giovenco says. “If quitting is unattainable, I would encourage that person to switch to a less risky product such as smokeless tobacco or e-cigarettes to reduce harm to themselves and those around them. Of course, complete cessation should always be the first recommendation, but for a subgroup of smokers who cannot or do not want to quit, lower risk tobacco products may be a lifesaving alternative.”

This harm reduction philosophy is a controversial one, especially for campaigners who have fought for decades to end cigarette smoking. To them, the emergence of new tobacco products can represent stalled progress or even a step backward. But harm reduction has worked in other settings. Giovenco points to needle exchange programs, which have helped reduce the spread of HIV.

Different Communities, Different Addictions

Funded through the NIH Director’s Early Independence Award, Giovenco recently began work on a five-year project that will examine the health implications of diverse tobacco product marketing in neighborhoods.

In his pilot studies, Giovenco discovered that the deadliest tobacco products on the harm continuum are heavily marketed in neighborhoods with a higher proportion of racial/ethnic minority residents, whereas reduced risk products are more prevalent in majority white communities. His current project expands that pilot to better understand how exposure to this marketing may be associated with residents’ harm reduction behaviors and subsequent disparities.

One aim of the study will focus specifically on the New York City, New Jersey, and Philadelphia metropolitan areas. Despite the short distance between them, these regions diverge when it comes to tobacco control policies. In New York City, a pack of cigarettes can cost $15 compared to under $6 in parts of Pennsylvania. Flavored tobacco cannot be sold in New York City, but can be purchased in New Jersey and Pennsylvania, and all three states have slightly different smoke-free air laws.

“Place matters,” says Giovenco. “Where we live has a huge influence on our behaviors and health outcomes, especially when it comes to cigarette smoking. But we don’t know enough about the promotion of other tobacco products, including reduced risk products, and how it might contribute to disparities in cessation, harm reduction, or sustained addiction.”

Giovenco will link tobacco marketing data collected through store audits with local health survey data to investigate this relationship. He’ll also closely monitor national tobacco sales data over time to understand how a region’s demographic makeup and tobacco control policies are associated with the popularity of diverse products.

The ultimate goal, Giovenco says, is to inform the regulation of tobacco products in a way that reduces the disparities that exist today. “I hope my research can chart a course for risk-based regulation and answer questions about the validity and equity of tobacco harm reduction.”