The Salina Post

Tobacco a factor in health inequalities


Photo by Andy Marso Mariana Ramirez, a social worker and project manager at Juntos, a Latino health advocacy organization, was among the speakers Thursday at the 2015 Kansas Conference on Poverty in Topeka.

The Legislature’s recent 50-cent per pack cigarette tax increase is helpful but not enough to stem the tide of tobacco use among populations already struggling with health issues, panelists at the 2015 Kansas Conference on Poverty in Topeka said.

Four public health experts who work with American Indians, Latinos, female prisoners and low-income mothers hosted last week’s panel discussion on health inequalities.

Tobacco use was only one part of a broad range of presentations that touched on things like the challenges of follow-up care for women released from prison, cultural resistance to researchers and the “toxic stress” that seeps into all members of families in poverty.

But for Christina Pacheco, who works with American Indian tribes that have some of the greatest health disparities of any ethnic group, tobacco is a key topic. Pacheco is a University of Kansas research professor who works with the Center for American Indian Community Health. She said smoking cessation efforts in American Indian populations face a number of complications, including tax issues.

The state cigarette tax applies to sales on Indian reservations but some federal taxes do not, meaning prices there likely will remain lower. “Having the reduced-price cigarettes so readily available makes it so much easier,” Pacheco said.

“Because that is one measure that has been effective for public health professionals at reducing smoking rates, (raising the) tax.” American Indians have the highest smoking rates of any ethnic group in the country at 26.1 percent. Pacheco said that creates serious health consequences for native tribes. “

A lot of the higher rates of cancer are attributable to cigarette smoking,” she said. “The other thing we look at is if you engage in one risky behavior you’re more likely to engage in a second, and they’re starting so young that once you get hooked it’s extremely hard to stop.” The reasons American Indians are more likely than other demographic groups to smoke cigarettes are complex, Pacheco said.

For many tribes, tobacco use is part of their traditional religion and culture. After the colonial takeover of America stripped that culture from them, recreational tobacco use began to fill the void. The key to reaching those communities, she said, is respecting their religious traditions while discouraging recreational tobacco use.

For instance, she said signs that just show the word “Tobacco” with a line through it will be considered quite offensive by some tribes and should be avoided. Pacheco also said tobacco companies have spent millions of dollars learning how to effectively market their products to groups like American Indians. Public health advocates, she said, have not always been as good at targeting their smoking cessation messages.

“Just because you put a feather on a brochure, that doesn’t mean American Indians are going to pick it up and read it,” Pacheco said. Public health advocates fought for a $1.50 per pack increase in the Kansas cigarette tax last session. Pacheco said those efforts should be coupled with other proven methods, like indoor smoking bans, to decrease the American Indian smoking rate.

Hispanics have the nation’s second-lowest smoking rate at 12.1 percent, but even at that level it has effects on the population’s health, said Mariana Ramirez, another panelist. Ramirez works with Juntos, a group focused on Latino health issues in rural and urban parts of Kansas.

Ramirez said those who immigrate to the United States from Latino countries generally enter in good health, because they walked a lot and had active jobs in their native countries. But once they arrive in the United States, they quickly adopt less healthy lifestyles and the health problems that come with them.

Then chronic conditions like hypertension and diabetes that are prevalent in the Latino community become more dangerous with even the occasional cigarette.

“If we have people who are obese, who have high blood pressure and on top of that they smoke, that doesn’t help, right?” Ramirez said. “Nicotine is a vessel constrictor, so you’re making it harder for your heart to pump.” Ramirez said her group is launching a smoking cessation pilot program for Spanish speakers. She said the increased state tax is a step forward, but not the end of the journey. “Anything helps,” Ramirez said.

“But we were really hoping it would be the $1.50 instead of just 50 cents.”

Andy Marso is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.