Strengthening Infrastructure and Self-Advocacy

The ongoing fight to eliminate commercial tobacco use in Black communities

August 25, 2023 | SUMMER 2023 ISSUE

The Center for Black Health & Equity is the leading nationally recognized public health entity for solutions impacting African American health. It engages health care organizations, public health officials, faith leaders, and Black communities in health promotion and disease prevention work.

To better understand how the organization is fighting for improved commercial tobacco cessation and prevention among Black communities—and how clinicians can support its efforts—we spoke with the Director of Equity-Centered Policies, Natasha Phelps, JD.

Director of Equity-Centered Policies, Natasha Phelps, JD

Director of Equity-Centered Policies
Natasha Phelps, JD

CHEST: Tell us more about the mission and vision of The Center for Black Health & Equity and the work it does with Black individuals and communities.

Phelps: The Center for Black Health & Equity was originally founded as the National African American Tobacco Prevention Network in 2000 to address a top priority health issue in the Black community—commercial tobacco-related death and disease.

While commercial tobacco use prevention is still at the core of our mission, over the years our portfolio has expanded to include a variety of different issue areas, including HIV/AIDS, COVID-19, food insecurity, mental health, Black maternal health, fibroids and women’s health, cancer prevention, and more.

Though our portfolio is wide-reaching, the mission of the organization is wholly focused on implementing and facilitating public health programs and services that promote health equity for African Americans or people of African descent. We’re committed to looking at some of the top health disparities facing African Americans and the deeply rooted systemic issues that drive them.

CHEST: How does the center go about accomplishing its mission?

Phelps: Primarily, we focus on building community capacity and infrastructure to provide the capacity for self-advocacy and long-term change. By providing training and assisting in the formation of focused coalitions, we give local constituents the tools they need to advocate for equity-centered policies and to make a real difference in their own communities.


State of Black Health Conference

CHEST: What are some specific health issues disproportionately impacting Black communities?

Phelps: It’s important to first note that there is diversity amongst Black people. There are specific health issues that are more time-sensitive when it comes to Black LGBTQ+ populations, Black elders, Black veterans, and other populations.

There are a number of health threats to the Black community—HIV/AIDS, COVID-19, long COVID and its associated disability, birthing justice/birthing mortality, mental health—both driven by inequities and disparities and also health outcomes.

Beyond the health impact experienced by many African Americans, we also focus on the root causes, including systemic racism, which in and of itself is a public health emergency, as has been noted by a lot of governments across the country.

CHEST: Tell us more about systemic racism as a public health emergency.

Phelps: When it comes to racism as a public health emergency, it's really about governments acknowledging the fact that race is unfortunately a top indicator of health outcomes and life expectancy.

There is a strong base of evidence that we see in public health when it comes to specific health outcomes. These are influenced by a variety of factors, including economic, environmental, and social conditions.

It's not conclusive that just because you're African American, it means for certain that you're not going to live to a certain age or that you're going to be diagnosed with certain medical conditions. But the likelihood of you, as an African American, being diagnosed with certain medical conditions and not living as long as somebody of a different race who lives in a different zip code is a true evidence-based factor.

Declaring racism as a public health emergency acknowledges that evidence base and that racism in and of itself is a threat to health and to life. Beyond likelihood of disease, this also includes race-related violence, police brutality, and other violence-related issues.

“Racism in and of itself is a threat to health and to life.”

CHEST: Can you share more about tobacco use and cessation as it pertains to Black communities?

Phelps: When we're talking about commercial tobacco use and cessation from nicotine products, there are some really specific things to consider when you're looking at the Black population.

Number one, when it comes to African Americans who smoke, about 90% smoke menthol-flavored products. With many introductions to tobacco use beginning with flavored tobacco products (including menthol), we know this to be an issue among youth. But when you look at African Americans, they actually tend to start smoking a little bit later than other racial and ethnic groups, and they smoke less products.

The problem is that because menthol is the preferred flavor of most African American people who smoke, they'll hold the product in longer. The cooling effect of menthol “tricks” the body, making it easier to breathe the tobacco in deeper and hold for longer, which brings nicotine into the bloodstream.

To quote Dr. Philip Gardiner, Co-Chair of the African American Tobacco Control Leadership Council, “Menthol makes the poison go down smoother.” Because of this drastically effective nicotine delivery method, we’ve also seen that while African Americans are more likely to attempt tobacco cessation than other ethnic and racial groups, they are less likely to succeed in quitting.

“Menthol makes the poison go down smoother.”

CHEST: What steps can health care providers take to provide better care, in general, for Black patients and communities?

Phelps: The first thing is when it comes to doing intake and looking at health indicators, it’s important to understand the determinants of health are broader than the basic “are you getting enough sleep?” and “do you smoke?” questions. It's also about acknowledging and addressing the social, environmental, and economic conditions that they’re living in.

African Americans have the highest rate of exposure to secondhand smoke mostly because of exposure in multiunit housing. So it's not just about the individual patient but also the environment that they live in. So not just asking questions of “are you a smoker?” but also “is anyone in your household a smoker?” and “do you live in multiunit housing/do you have smoking exposure in your housing?”

Ask a lot of those questions, and get patients hooked up with resources like their state Quitline services if the health care system resources are insufficient for their treatment plan.

The second part is that physicians are a vital part of prevention and treatment of commercial tobacco-related death and disease when it comes to advocacy, policy, and legislation. We need physicians talking about the importance of expanding Medicaid so that these economic barriers to treatment don't exist.

We know that a lot of commercial tobacco-related death and disease is preventable. So to know that some people just aren't seeking or getting cessation treatment because they can't afford it—we need physicians speaking to that. We also need physicians speaking to the importance of preventative policies like prohibiting the sale of flavored tobacco products, sharing how many lives can be saved and how health outcomes can be bettered by these types of policies.

“We need physicians talking about the importance of expanding Medicaid so that these economic barriers to treatment don't exist.”

Learn more about the Center for Black Health & Equity, and register for the 2023 State of Black Health conference, September 6 to 8, in San Juan, Puerto Rico.

Additional resources from Natasha Phelps:

No Menthol Sunday: An annual opportunity for faith communities to address the detrimental impact tobacco has on Black communities

We Want to Quit: Supporting Cessation in African American Communities
How to refute tobacco industry talking points

Video: Truth Be Told: New Orleans
Documentary trailer: Black Lives / Black Lungs