Although smoking rates have dropped by more than half over the past 50-plus years, tobacco use remains the number one cause of preventable deaths in the United States.

And not everyone has benefited equally from reduced rates in smoking—there are deep disparities in tobacco use and quit rates, depending on where people live, how much money they make, and the color of their skin.

Tobacco products disproportionately harm people with lower incomes and less education; people with mental illness and substance use disorders; people who identify as lesbian, gay, bisexual, and/or transgender (LGBT); and racial and ethnic minorities.

What’s causing these inequities? Part of it is marketing. Tobacco control efforts have not focused on closing racial, ethnic and socio-economic gaps. In fact, we know that the tobacco industry targets certain populations—women, people who are black or Latino, and members of the LGBT community—with higher levels of marketing, exposing them to more tobacco product ads.

In addition, people in many of these groups are less likely to have health insurance—and, as a result, less likely to have access to smoking cessation products and services.

Tobacco use is a substantial barrier to our nation’s collective efforts to build a Culture of Health. Tobacco products addict their users—often during their formative teen years, with lifelong consequences for health. The U.S. Centers for Disease Control and Prevention reported that, in 2015, more than two-thirds of smokers wanted to quit and 55 percent had tried to quit within the past year—but only 7 percent had succeeded in the previous 6 to 12 months. And even more telling is the fact that 9 in 10 smokers regret having started in the first place.

Tobacco’s enormous toll on our society underscores why it’s so important to reduce its use in order to build a Culture of Health.

We have a unique opportunity now, as the federal Food and Drug Administration (FDA) considers making new rules on limiting nicotine in tobacco, further restricting flavored tobacco products, and exempting premium cigars from its authority to regulate tobacco. Here’s what RWJF recommends:

Reduce Nicotine to Non-Addictive Levels

Nicotine is what makes tobacco products addictive—and it’s a key factor in whether kids who try tobacco become regular smokers. Limiting nicotine to non-addictive levels in all combusted tobacco products can prevent kids from becoming addicted and help more smokers quit. This action might lower smoking rates across all groups and could be particularly beneficial for those with lower quit rates, including marginalized populations.

Further Restrict Flavored Tobacco Products

Although the Tobacco Control Act bans the sale of most flavored cigarettes, menthol cigarettes are still sold throughout most of the country and e-cigarettes and cigars are sold in flavors like cherry, vanilla, chocolate, and clove that appeal to young people. FDA has found that menthol cigarettes lead to increased smoking among young people, greater addiction, and reduced success in quitting smoking. They are also disproportionately used by and marketed to African-Americans, who are more likely than whites to die from a tobacco-related disease.

Continue FDA Oversight of Premium Cigars

There is no reason for FDA to loosen its regulation of cigars. They pose a significant public health risk since they are addictive, toxic, and both youth and adults smoke them. Tobacco is the only consumer product that leads to disease and death when used as intended.

For the past 27 years, RWJF has played an important role in strengthening tobacco control policies, improving access to cessation supports, and reducing the burden of tobacco. As a nation, we’ve made significant progress in reducing tobacco use. Despite this, we simply can’t let our guard down given persistent inequities in tobacco use and tobacco-related disease, disability, and death.

We have submitted statements on nicotine, flavored tobacco products, and premium cigars to FDA during its public comment period to urge strengthening tobacco control policies and encourage others to do the same.

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