Although cigarette smoking has declined by more than 70% since the first surgeon general report on the dangers of tobacco in 1965, the full 837-page report finds that both tobacco use and secondhand smoke exposure remain disproportionately higher among ethnic minorities and people from lower socioeconomic backgrounds. 

“Tobacco-related health disparities are a social injustice, in addition to an economic and health burden,” the summary of the report says. “Addressing disparities requires reflection on the complex history of the commercialization of tobacco and both past and present-day experiences of racism, discrimination, and targeted marketing by the tobacco industry.”

According to the report, smoking is the top cause of preventable deaths in the United States, with 1 in 5 deaths across the country linked to tobacco. The report estimates that approximately 470,000 people die due to cigarette smoking each year and more than 19,000 die annually from exposure to secondhand smoke. 

Diseases associated with smoking include cancer, cardiovascular disease, and chronic obstructive pulmonary disease.

Approximately 400,000 white adults are estimated to die from tobacco-related illness each year, compared to 50,000 black and 15,000 Hispanic adults, but these numbers are more salient when viewed as a percentage of the population.

“Despite large absolute differences in the numbers of smoking-attributable deaths by race and ethnicity, smoking accounts for a similar proportion of deaths among non-Hispanic Black (18%) and non-Hispanic White (20%) people and about 10% of deaths among Hispanic people,” the report summary indicates.

As of 2021, only 11.5% of the total U.S. population smokes cigarettes, but socioeconomic factors play a significant role.

Smoking rates are nearly twice as high for adults living in poverty compared to those above the poverty line, as well as for high school students who identify as lesbian, gay, or bisexual compared to heterosexual teenagers.

Adults with less than a high school education are four times more likely to smoke than those with a college degree. 

Rates of smoking are also higher among “adult workers in manual labor and service jobs,” “adults living in the South and Midwest,” and “youth and adults living in rural areas,” according to the report. 

“All Americans deserve to live a healthy life, free from tobacco-related disease, disability, and death,” Murthy said in a video statement posted on X Tuesday morning. “The good news is that we have proven interventions that can close these gaps and eliminate the leading cause of preventable disease and death for all Americans.”

The report also takes aim at menthol cigarettes, in particular, as the primary reason why declines in smoking use and secondhand smoke exposure have been slower among the black and Hispanic populations.

“Policies that restrict the availability of menthol cigarettes can reduce smoking initiation and prevalence among adolescents, young adults, Black people, and other population groups that have disproportionately higher use of menthol cigarettes,” the report summary reads. 

Ethnic minority groups, women, and people with lower incomes are statistically more likely to use menthol tobacco products, which are often more difficult to quit than unflavored tobacco. But federal prohibitions on menthol tobacco products have been very unpopular.

President Joe Biden’s administration has faced significant pushback from the black community regarding his call to ban menthol-flavored tobacco products. 

The proposed menthol ban may have also cost Vice President Kamala Harris critical votes in the 2024 election against President-elect Donald Trump in the key swing state of North Carolina.