Income Level, Educational Attainment, and Mental Health Status Impact Disparities in Tobacco Use1
New York, NY – Governor Andrew Cuomo recently announced historically low tobacco use rates in New York State, with 14.5 percent of adults and 7.3 percent of high school students using tobacco.2 While these numbers are a cause for recognition, they do not tell the complete story. Tobacco continues to be the single largest preventable cause of disease and premature death, killing more than 28,000 individuals in New York State every year.3 Furthermore, significant disparities in tobacco use prevalence rates persist. Those New York adults with low incomes, less than a high school education, and serious mental illness continue to use tobacco at rates well above the general population, exacerbating disparities in health-related outcomes among these populations.1
According to the New York State Bureau of Tobacco Control, 27.5 percent of New York adults with less than a high school education and 26.8 percent of those with an income less than $15,000 per year use tobacco. Tobacco use prevalence rates are even higher among New York adults who report poor mental health, with one-third (33.7 percent) of this population using tobacco, a rate more than double of that among the general adult population.1
In an effort to decrease tobacco use rates among these populations, the New York State Department of Health Bureau of Tobacco Control funds 10 regional contractors to work with health systems and mental health treatment facilities that specifically serve these populations. Through the Health Systems Improvement for a Tobacco-Free New York program, these regional contractors support health care and mental health settings to integrate evidence-based tobacco dependence screening and treatment into standard delivery of care. The Bureau of Tobacco Control also funds CAI to serve as the Center of Excellence for Health Systems Improvement (COE for HSI) for a Tobacco-Free New York. In this role, CAI supports the efforts of the 10 regional contractors by providing technical assistance, develops tools and resources for use by regional contractors and their partnering health systems, and works on the State-level to promote policies that will facilitate the integration of evidence-based tobacco dependence treatment into care. The ultimate goal of the Health Systems Improvement for a Tobacco-Free New York program is to assure that every tobacco user who visits a health care provider is assessed for tobacco use and offered tobacco dependence treatment, including no cost or low-cost cessation medication, at every visit.
“Health systems that serve the most vulnerable populations are critical players in reducing the unacceptably high tobacco use prevalence rates that persist among individuals with low incomes, less than a high school education, and serious mental illness,” said Elizabeth Jones, Director of the COE for HSI. “It’s a logical course of action to work with the health and mental health settings that serve these individuals to implement systems that will assure that every patient is asked about his or her tobacco use at every clinical encounter and that all tobacco users who want to quit are connected to the services and support they need to be successful. This systems-level approach has the potential to decrease disparities in tobacco use and, ultimately, disparities in health outcomes.”
For more information about the work of the COE for HSI, visit www.tobaccofreeny.org.
About CAI: CAI is a global nonprofit organization dedicated to improving the health and well-being of underserved populations worldwide. For 35 years, CAI has provided customized capacity building services to health and human service organizations in over 23 countries and in all 50 states. Offering over 1,500 training programs annually, CAI's passionate staff works to fulfill its mission: to use the transformative power of education and research to foster a more aware, healthy, compassionate and equitable world. For more information about CAI, visit www.caiglobal.org.
About the Center of Excellence for Health System Improvement: With funding from the New York State Department of Health Bureau of Tobacco Control, CAI serves as the Center of Excellence for Health Systems Improvement (COE for HSI) for a Tobacco-Free New York. The COE for HSI promotes large-scale systems and policy changes to support the universal provision of evidence-based tobacco dependence treatment services. The COE for HSI aims to support 10 Regional Contractors throughout New York State working regionally with health care systems and organizations that serve those populations for which tobacco use prevalence rates have not decreased in recent years - adults with low income, less than a high school education, and/or serious mental illness. Focused on providing capacity-building assistance services around topics like how to engage and obtain buy-in from leadership to implement the kinds of systems-level changes that will result in identification and intervention with every tobacco user who seeks care, the COE for HSI also will offer materials and resources to support contractors in their regional work. For more information about the COE for HSI, visit www.tobaccofreeny.org.
 New York State Department of Health. (2015). Bureau of Tobacco Control StatShot, Vol. 8, No. 2/Feb 2015. Retrieved from https://www.health.ny.gov/prevention/tobacco_control/reports/statshots/volume8/n2_adult_smoking_prevalence_in_2013.pdf.
 New York State Governor’s Office. (2015). Governor Cuomo Announces New York's Smoking Rates Reduced to Lowest Levels in Recorded State History [Press Release]. Retrieved from https://www.governor.ny.gov/news/governor-cuomo-announces-new-yorks-smoking-rates-reduced-lowest-levels-recorded-state-history.
 Centers for Disease Control and Prevention. (2014). Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved from http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm?s_cid=cs_3281.