Progress Toward Elimination of Health Disparities

The following discussion highlights progress toward the elimination of health disparities. The disparities are illustrated in the Disparities Table (see Figure 27-2), which displays information about disparities among select populations for which data were available for assessment. The discussion of disparities is constrained by the data available for various populations. Limited data were available regarding disparities between ethnic and racial populations and in disability status.

Disparity exhibited a mixed pattern among racial and ethnic populations. The black non-Hispanic population had the best rates for 5 of the 13 objectives with significant racial and ethnic disparities (or disparities of 10 percent or more). The Hispanic population had the best rates for four of these objectives and the white non-Hispanic for three objectives. The Asian or Pacific Islander population had the best rate of working in worksites that prohibit smoking (27-12). Females had better rates than males for seven of the eight objectives with significant gender-specific disparities. Persons with at least some college had the best rates for the four objectives and subobjectives with significant education disparities, whereas middle/high-income persons had the best rates for the four objectives and subobjectives with significant income disparities. Finally, persons without disabilities had better rates of tobacco use (27-1a, b, and c) than persons with disabilities. Persons with disabilities had a better rate of smoking cessation attempts (27-5).

An example of success in reducing a disparity in adult tobacco use (27-1) was the reduction of the disparity between proportions of the black non-Hispanic and white non-Hispanic populations that smoked, which occurred between 1950 and 2000. The black non-Hispanic adult population smoked at higher levels than the white non-Hispanic population since the 1950s, but by 2001 smoking rates were equal among these two populations.^{3, 36, 37} Several factors may have contributed to this decline among the black non-Hispanic population, including the increased price of cigarettes,^{5, 33} media campaigns to raise awareness about the dangers of smoking,^{25, 26} and comprehensive community programs. In addition, the disparity reduction was augmented by development of targeted cessation materials, diversification of the tobacco control movement, and the increased program capacity and infrastructure initially promoted by the American Stop Smoking Intervention Study (ASSIST),³⁸ the Robert Wood Johnson Foundation, and CDC.³⁹

In contrast, an example of lack of progress toward the elimination of disparities was the consistently high use of tobacco products among the American Indian or Alaska Native population. In 2003, the proportion of the American Indian or Alaska Native population aged 18 years and older who smoked cigarettes (27-1a) was more than twice that of the Hispanic (best) population. Tribal support centers and a national network to facilitate capacity and infrastructure development within this community address this disparity.⁴⁰ Through the network, research and culturally appropriate cessation protocols and other interventions have been developed to reduce the high tobacco-use rates.

Spit tobacco use (27-1b) continued to demonstrate disparity across different education levels. Compared with the best group rate of persons with at least some college education, the rate for high school graduates differed by 50 percent to 99 percent. The rate for persons with less than a high school education differed by 100 percent or more.

Exposure to tobacco smoke at home among children (27-9) showed persistent disparities by race and ethnicity and by income level. The Hispanic population had the best rate in 1998, with half as many Hispanic children aged 6 years and under exposed to tobacco smoke as black non-Hispanic and white non-Hispanic children were. Among populations by income, children in poor and near-poor families were twice as likely to be exposed to tobacco smoke as children in middle/high-income families were. During the period 1988–94 and 1999–2000, the disparity in nonsmokers' exposure to environmental tobacco smoke (27-10) between the black non-Hispanic and the Hispanic (best) populations increased by 50 to 99 percentage points.

Several changes in disparity were observed in high school students' disapproval of smoking (27-17). Racial and ethnic disparities among 12th graders (27-17c) decreased between the Hispanic and black populations as well as between the white population and the best group. Disparity between black and white 10th graders (27-17b) also declined. However, disparity increased between Hispanic and black 10th graders (27-17b) and between black and white 8th graders (27-17a). Increases in disparities between males and females were also seen among 8th and 12th graders (27-17a and c).

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