“We’ve won the war on cigarette smoking” is a mantra among health-conscious middle- and upper-class Americans. But within the remarkable half-century-long public health success story of declining overall rates of smoking is a disturbing subplot: Those still puffing away are a substantially more disadvantaged group than ever before.
In a 2008 Gallup poll of over 75,000 Americans, the rate of smoking among people making less than $24,000 a year was more than double that of those making $90,000 or more. In the era portrayed in TV’s “Mad Men,” smoking cheapest cigarettes http://www.mydiscountcigarette.net/buy/zimbru was a normative behavior that was not associated with poverty. Indeed, because they had less money and were more religious, the poor if anything were somewhat less likely to smoke than middle-class people.
But once the health risks of smoking became widely known, the better-off began kicking the habit: High-income families decreased their smoking by 62 percent from 1965 to 1999, versus only 9 percent for low-income families.
Smoking became analogous to a bad neighborhood that kept getting worse because everyone who had the resources to move out did so, leaving a progressively beaten-down group behind. Poorer smokers simply have a hard time quitting, for at least three reasons:
• Lower-income smokers take longer and deeper drags on each cigarette than their remaining better-off counterparts. This strengthens their addiction (e.g., craving) and makes it more difficult to turn a resolution to quit into an enduring change.
• Because income tends to segregate where people work and live, poor smokers often have to make quit-attempts alongside people who are continuing to smoke, but wealthier smokers usually do not. The last physician in a hospital who still smokes will face social disapproval from colleagues for smoking and receive social approval from those same individuals for quitting; the first worker on a roadside cleanup crew who tries to quit may face precisely the reverse social incentives from his smoking coworkers.