Stronger Together

Together, We’re Stronger Than Big Tobacco

The tobacco industry targets specific groups of people by marketing and promoting tobacco products in their neighborhoods and communities. Because of this, some groups of people use tobacco at higher rates, are exposed to more secondhand smoke, and have more tobacco-related diseases, contributing to health inequities in our state.

But the people of Hawaiʻi are fighting back and holding Big Tobacco accountable for the harm it causes.

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Tobacco products, including cigarettes, vapes, chew, and cigars rob people of the chance to attain their best possible health.

The tobacco industry exploits and discriminates against Hawaiʻi’s diverse communities with predatory practices for profit. It’s advertising and products are promoted all over our state with some communities targeted more than others.

Who does Big Tobacco target?

The Tobacco Industry Documents show that local people, as opposed to tourists, were the target of the tobacco companies’ marketing in Hawaiʻi.

Bar graph of cigarette smoking among Hawaii's priority populations

Source: Hawaiʻi Behavioral Risk Factor Surveillance System (BRFSS) 2021

Click on the interactive images below to read about our most targeted communities:

NATIVE HAWAIIANS (Kānaka Maoli)

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PEOPLE WITH LOW INCOME OR LOW SOCIOECONOMIC STATUS

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PEOPLE LIVING WITH BEHAVIORAL HEALTH CONDITIONS

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LESBIAN, GAY, BISEXUAL, TRANSGENDER, QUEER (LGBTQ) COMMUNITIES

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YOUTH

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How do menthol tobacco products hurt Hawaiʻi?

    • Menthol added to cigarettes make it easier to smoke and harder to quit.xxi  The tobacco industry has marketed mentholated brands to racial and ethnic minorities and youth.xxii
      • The tobacco industry investment in Hawai’i decades ago has manifested in high rates of consumption today. A report published in 2022 found that Hawai’i has the highest menthol cigarette market share (68%) in the country.xxiv
      • In 1983, a tobacco industry market research report saw growth potential in the Hawaii and stated that “Hawaii is a menthol market.” xxv
      • In 2021, 86.6% of Native Hawaiian and 83.6% Filipino adults who smoked used menthol cigarettes. xxvii

Why are flavored tobacco products harmful?

    • Among high school students who report using e-cigarettes, nearly 9 out of 10 students use flavored e-cigarettes1
    • Currently, there are at least 15,500 unique e-cigarette flavors available online. Many are fruit and candy flavorings that are attractive to kids, such as fruit punch, funnel cake, orange, soda, and strawberry.2
    • Children are biologically hard-wired to eat sugar since it activates the brain’s “feel good” hormone and gives a sense of pleasure.3 Adding sweetness to vape juice takes advantage of the brain’s reward system and may create a dangerous association between candy and drugs4
    • According to the FDA, “The evidence shows that the availability of a broad range of flavors is one of the primary reasons for the popularity of [e-cigarettes] among youth. The majority of youth who use [e-cigarettes] report using a flavored [e-cigarette] product, and the use of flavored [e-cigarettes] has increased over time.”5

    References:

    1. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students — National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1173–1182. DOI: http://dx.doi.org/10.15585/mmwr.mm7244a1.
    2. Campaign for Tobacco-Free Kids. (2023) Electronic Cigarettes:
      An Overview of Key Issues [Fact sheet].https://assets.tobaccofreekids.org/factsheets/0379.pdf)
    3. Mennella, J. A., Bobowski, N. K., & Reed, D. R. (2016). The development of sweet taste: From biology to hedonics. Reviews in endocrine & metabolic disorders, 17(2), 171–178. https://doi.org/10.1007/s11154-016-9360-5
    4. Greenberg, D., & St Peter, J. V. (2021). Sugars and Sweet Taste: Addictive or Rewarding?. International journal of environmental research and public health, 18(18), 9791. https://doi.org/10.3390/ijerph18189791
    5. FDA, Technical Project Lead (TPL) Review of PMTAs, September 17, 2021, https://www.fda.gov/media/152504/download.

References

i. Hawaii State Department of Health, Hawaii Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2020). http://hhdw.org. Accessed on December 1, 2022.

ii. Look, M., Soong, S., & Kaholokula, J. (2020). Assessment and Priorities for Health and Well-Being in Native Hawaiians and Pacific Islanders. https://doi.org/10.13140/RG.2.2.22162.89286

iii. All Ways Advertising. 13 November 1985. Hawaii Research 851113-851119. Lorillard Records. jyjj0077 – HAWAII RESEARCH 851113 – 851119 – Industry Documents Library (ucsf.edu) (Accessed 2022 Jul 28)

iv. IAGW;UNK. 24 October 1968. Proposal for a Special Consumer Promotion in Hawaii Salem Cigarettes. RJ Reynolds Records. https://www.industrydocuments.ucsf.edu/docs/jqlw0083 (Accessed 2022 Aug 1)

v. CDCTobaccoFree. (2019, March 26). Cigarette and Tobacco Use Among People of Low Socioeconomic Status. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/disparities/low-ses/index.htm

vi. Hawaii State Department of Health, Hawaii Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2020). http://hhdw.org. Accessed on December 1, 2022.

vii. Truth Initiative. Why are 72% of smokers from lower-income communities? Truthinitiative.org. https://truthinitiative.org/research-resources/targeted-communities/why-are-72-smokers-lower-income-communities

viii. Henriksen L, Schleicher NC, Dauphinee AL, Fortmann SP. Targeted advertising, promotion, and price for menthol cigarettes in California high school neighborhoods. Nicotine Tob Res. 2012;14(1):116-121. doi:10.1093/ntr/ntr122.

ix. Levinson, A. H. (2017). Where the U.S. tobacco epidemic still rages: Most remaining smokers have lower socioeconomic status. Journal of Health Care for the Poor and Underserved, 28(1), 100–107. https://doi.org/10.1353/hpu.2017.0012

x. Centers for Disease Control and Prevention. (2023, February 10). People with mental health conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/campaign/tips/groups/people-with-mental-health-conditions.html

xi. Hawaii State Department of Health, Hawaii Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2020). http://hhdw.org. Accessed on December 1, 2022.

xii. Prochaska JJ, Smitha D, Young-Wolff KC. Smoking, mental illness, and public health. Annual Review of Public Health. 2017; 38: 165-185[accessed 2022 Feb 25].

xiii. Truth Initiative. August 23, 2017. How tobacco companies linked cigarettes and mental health. https://truthinitiative.org/research-resources/targeted-communities/how-tobacco-companies-linked-cigarettes-and-mental-health

xiv. Hawaii State Department of Health, Hawaii Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2020). http://hhdw.org. Accessed on December 1, 2022.

xv. Centers for Disease Control and Prevention. LGBTQ+ People Experience a Health Burden from Commercial Tobacco https://www.cdc.gov/tobacco/health-equity/lgbtq/health-burden.html    Accessed February 17, 2023.

xvi. Hawaii State Department of Health, Hawaii Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2020). http://hhdw.org. Accessed on December 1, 2022.

xvii. Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review | Tobacco Control (bmj.com) Tobacco use among sexual minorities in the USA, 1987 to May 2007: A systematic review. Tobacco Control, 18(4), 275–282. https://doi.org/10.1136/tc.2008.028241 85 King, B. A., Dube, S. R., & Tynan, M. A. (2012).

xviii. Centers for Disease Control and Prevention. June 27, 2022. LGBTQ+ People Encounter Barriers to Quitting Successfully. https://www.cdc.gov/tobacco/health-equity/lgbtq/quitting-tobacco.html accessed February 21, 2023.

xix. Truth Initiative. June 23, 2021. Tobacco use in LGBT communities. https://truthinitiative.org/research-resources/targeted-communities/tobacco-use-lgbt-communities

xx. Truth Initiative. June 23, 2021. Tobacco use in LGBT communities. https://truthinitiative.org/research-resources/targeted-communities/tobacco-use-lgbt-communities

xxi. Truth Initiative. Menthol fact sheet. https://truthinitiative.org/sites/default/files/media/files/2019/03/truth-initiative-menthol-fact-sheet-dec2018.pdf (Accessed January 20, 2023)

xxii. Ibid

xxiii. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Substance Abuse & Mental Health Data Archive. National Survey on Drug Use and Health, 2019.

xxiv. Walczak, J., “FDA Menthol Ban Would Boost Smuggling, Reduce Revenues, with Few Health Benefits” Tax Foundation, published online April 28, 2022.

xxv. Kennedy, J.C..  Marketing Research report. 1983. R.J. Reynolds. http://industrydocuments.library.ucsf.edu/tobacco/docs/rxpj0103

xxvi. All Ways Advertising. 13 November 1985. Hawaii Research 851113-851119. Lorillard Records. jyjj0077 – HAWAII RESEARCH 851113 – 851119 – Industry Documents Library (ucsf.edu) (Accessed 2022 Jul 28)

xxvii. Hawaii Health Data Warehouse, Hawai’i Behavioral Risk Factor Surveillance System (BRFSS), 2021. https://www.hawaiihealthmatters.org/indicators/index/view?indicatorId=12619&localeId=14&periodId=245&localeChartIdxs=1%7C2%7C6

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