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Abstract: Industry has played a complex role in the rise of tobacco-related diseases in the United States. The tobacco industry's activities, including targeted marketing, are arguably among the most powerful corporate influences on health and health policy. We analyzed over 400 internal tobacco industry documents to explore how, during the past several decades, the industry targeted inner cities populated predominantly by low-income African American residents with highly concentrated menthol cigarette marketing. We study how major tobacco companies competed against one another in menthol wars fought within these urban cores. Little previous work has analyzed the way in which the inner city's complex geography of race, class, and place shaped the avenues used by tobacco corporations to increase tobacco use in low-income, predominantly African American urban cores in the 1970s-1990s. Our analysis shows how the industry's activities contributed to the racialized geography of today's tobacco-related health disparities.
Key words: Smoking, tobacco industry, African Americans, racial disparities, inner city geography.
Despite significant reductions in overall smoking rates in the United States, smoking among poor, less educated, and underserved populations remains higher than among the general population.1-5 For example, prevalence rates for low-income African Americans have been reported to range from 33% to 59%,6-11 compared with 21% for the general population.12 Tobacco company advertising and promotion are associated with increased cigarette consumption; their presence and pervasiveness serve as external cues to smoking.13 Tobacco companies have strategically targeted marginalized communities,14-25 who may have limited information about specific and relative health risks of smoking and few social supports and resources such as tailored cessation programs.26-29 Tobacco-related diseases have hurt lower-income urban communities, where lack of educational opportunity is compounded by lack of access to health care, few employment opportunities, and environmental injustice.7,30
Tobacco use is a major contributor to health disparities in the United States.5,31 Ageadjusted mortality rates for tobacco-related cancers,32-37 cardiovascular disease and stroke are higher among African Americans than among White Americans.38 Tobacco-related health disparities are defined as "differences in the patterns, prevention, and treatment of tobacco use; the risk, incidence, morbidity, mortality, and burden of tobacco-related illness that exist among specific population groups in the United States; and related differences in capacity and infrastructure, access to resources, and environmental tobacco smoke exposure."30, p. 211 Individual level...