Smoking in the US: Higher in Poor and Less Educated

Smoking in the US: A Socioeconomic Gap

A June 13 article in the Washington Post described America’s new tobacco crisis. As the headline stated, “The rich stopped smoking, the poor didn’t.” Smoking in the US has decreased to an overall rate of 15% of adults. However, the socioeconomic gap has become bigger. The figure below shows that those who attended college or have a college degree have quit smoking at a greater rate than the less educated.
Smoking in the US

Smoking rates in the US from 1966 to 2015

It Wasn’t Always This Way In the 1900s it was glamorous to smoke. It was a habit of the rich, and many Hollywood stars were happy to be photographed smoking. Then came the 1964 Surgeon General’s Report of its deadly effects. During the next 3 decades, smoking in the nation’s highest income families fell by 62%. Among families of the lowest income, it decreased by just 9%. The Tobacco Industry Cigarette companies are focusing their marketing on lower socioeconomic communities to retain their customer base. The tobacco industry has also invested money in lobbying against smoking restrictions and taxes, especially in poorer, rural, and often Southern states where smoking remains the highest. Why the Difference?
One person smoking the US

Victoria Cassell, featured in the newspaper article, smokes a cigarette on the back deck of her house in Bassett, Va.

Debbie Seals, age 60 years, has traveled in rural Virginia to promote smoking cessation and a healthy life style, especially in the foothills of Virginia’s Blue Ridge Mountains. Seals noted that cigarettes are everywhere in Martinsville, a former booming center of textile mills and furniture factories, which now has abandoned factories and vacant storefronts. “People down here smoke because of the stress in their life,” Seals says. “They smoke because of money problems, family problems. It’s the one thing they have control over. The one thing that makes them feel better. And you want them to give that up? It’s the toughest thing in the world.” The Solution “The frustrating thing for folks in the public health community is we know from research exactly what would make the biggest difference,” said Brian King, deputy director for the Center for Disease Control and Prevention in Atlanta. “It’s bread-and-butter strategies like getting states to pass smoke-free laws, increase cigarette taxes, and funding tobacco cessation and prevention.”

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.