Earlier this year, the United States Surgeon General released a report that marked the 50th anniversary of the first Surgeon General Report that highlighted the consequences of smoking. The 2014 report, available here, acknowledged the successful decline of adult smoking rates. In 1965 nearly 43% of adults smoked compared to 18% of adults in 2014. However, there is still work to be done.
The risks of tobacco are clear. Smoking increases the risk for coronary heart disease, stroke, many types of cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, stroke, heart attacks, bronchitis, and low birth weight in newborns. Despite all we know, smoking is still the leading cause of preventable death in the United States and is responsible for one out of five deaths. New trends in types of tobacco products (for example e-cigarettes) and tobacco use along demographic indicators such as socioeconomic levels need to be addressed. A recent report from the Population Health Metrics found that while smoking rates are decreasing quickly in more affluent communities, the rates are staying the same among the poor.
Tobacco use in 1965
Tobacco is used differently now than it was in 1965 when the Surgeon General released the first report that warned American of the harmful effects of tobacco. In 1965, 43% of adults smoked. Smoking cigarettes was seen as something of status - rich people smoked cigarettes because they could afford to do so. Smoking was common in the workplace, in restaurants, and in schools. Kids didn’t learn about the harm of tobacco in health class. Advertisements like the ones below were everywhere. You can see many more advertisements like these here.everywhere.
Tobacco use today
Tobacco use and smoking is no longer something for the wealthy. Instead smoking rates are higher in poor communities. Below is a map of federal smoking data by county. There is a correlation between smoking prevalence and county wealth. For example, Clay County in Eastern Kentucky is one of the country’s most impoverished counties and has the highest smoking rates.
On an individual level, 29 percent of adults who are below the poverty level smoke, compared to 18% of adults who are at or above the poverty level.
Now smoking is more common among adults who do not graduate high school - one-in-four adults without a high school level education smoke compared to one-in-ten adults with postgraduate degrees.
Another change from 1960 is tobacco advertising. The Family Smoking Prevention and Tobacco Control Act was passed in 2009 that gave the FDA authority to regulate the manufacture, distribution, and marketing of tobacco products to protect public health. Jurisdictions have also banned smoking in public places such as restaurants. Cigarettes are now heavily taxed making them more expensive to purchase. Despite the federal, state, and local regulations smoking rates remain high, especially among low socioeconomic groups.
Why rates of tobacco use are higher in poor communities
There are several possible factors and reasons why poor communities have higher rates of tobacco use.
- Stress. For many people tobacco use is a coping mechanism. For low socioeconomic people, stress is chronic and often caused by community violence and joblessness.
- Targeted marketing. Researchers have found that there are fewer tobacco advertisements in the higher socioeconomic communities compared to the lower socioeconomic communities. Point of Sale tobacco marketing (including advertisements, price promotions, and product displays in stores) disproportionately affects youth, racial minorities and people of low income/education. For example, retailers located in minority and low-income neighborhoods are more likely to advertise tobacco products in store windows.
- Less access to cessation programs. Compared to white collar workers, blue collar workers have less access to to cessation programs to help them quit. Blue collar workers are more likely to start smoking and less likely to quit.
Hope for the future
Anti-tobacco advocate groups as well as the federal government are working to raise awareness about the higher rates of tobacco use among poorer Americans. Awareness and data are a key part of solving a problem.
In addition to awareness, the Affordable Care Act changed Medicaid to support cessation. Medicaid enrollees smoke at a rate that is 50 percent higher than the general public so the cessation through Medicaid could help many Americans. In 2010, the ACA required all Medicaid programs to cover comprehensive tobacco cessation for pregnant woman. In 2014 the ACA required coverage of tobacco cessation medications in all states in 2014. Recently companies have been vocal about selling tobacco products. A few months ago, CVS, a major drug store, announced it would no longer sell tobacco products.
Great strides have been made in the fight against tobacco. However, an alarming number of families are impacted negatively by tobacco products so there is still work to do. As the fight against tobacco continues, it is important to not blame the individual who uses tobacco but instead to support those trying to quit.
