Photo Credit: Ton Bangkeaw
Long gone are the days when cigarette smokers frequented restaurants and other public spaces; when people smoked freely undeterred by threats of cancer; when nearly everyone, regardless of income or geography, took part in the social ritual of lighting up. From 1965—when the Surgeon General first released its report on the negative effect smoking has on health—to 2017, the number of Americans who smoke declined from 41.9 percent to 15 percent. However, despite the relative progress over the fifty year fight against tobacco use, it is still affecting over 43.8 million people, many of whom are poor or live in rural areas.
Cigarettes still kill nearly half a million people in the United States each year, according to the Center for Disease Control and Prevention. That number is 15 times the number of deaths related to the opioid crisis.
While the rich have given up their cigarettes, among Americans without a highschool diploma the smoking rate remains more than 40 percent. 18 to 20 percent more people living in rural areas acquire lung cancer compared with their city-dwelling counterparts. And researchers agree that the economically disenfranchised die more from cigarettes than any other group of Americans.
Debbie Seals, a 60 year old grandmother who worked with Girl Scouts of the USA but now volunteers teaching classes for the American Lung Association, has had first hand experience with the way class influences smoking. In her hometown of Martinsville, VA cigarettes are everywhere—strip malls, gas stations, advertisements, convenience stores, in people’s cars, on the street—a stark difference, she notes, from the wealthier parts of the state.
Like much of Appalachia, Martinsville has suffered culturally and economically following the decline of the once booming textile mills and furniture factories. All children in elementary and middle school automatically qualify for free and reduced-price meals because so many families face extreme poverty.
As a volunteer running clinics to help people quit smoking, Seales has noticed how the blighted circumstances her students inhabit influence their tobacco addiction. “People down here smoked because of the stress in their life,” she told the Washington Post. “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.”
For example, Victoria Cassell, one of Seale’s former students who attended her seven-week program every year for four years, has had difficulty quitting because of other struggles in her life. Her sister died, her husband began to have heart problems, and her daughter and grandson moved back home. Deciding to quit forced her to have lunch alone at the factory where she works because all of her other co-workers smoke. After three days without a cigarette, an argument with a coworker made her desperate for tobacco. She went to a friend and bummed a cigarette.
A study by Christine Sheffer at the City College of New York found that, compared with poor people, those with a high socioeconomic status were 55 percent more likely to quit smoking after three months and 2.5 times more likely to quit after six months.
In the study, more than 2,700 smokers were given nicotine patches and cognitive-behavioral therapy. The number of attempts was the same regardless of socioeconomic status but wealthier people had a greater success rate.
Researchers agree that community-based tobacco treatment programs like the one Seale leads can reduce the role socioeconomics plays in smoking, but it does nothing to change poverty related factors like stress, coping resources, and psychological issues, exposure to other smokers, and treatment resources. An article in the Huffington Postconcluded that “the poorer the smoker, the poorer the treatment resources.”
With smoking mostly eradicated in well-off communities, much of America’s upper and middle classes view tobacco use as an obsolete epidemic. “If you’re educated and live in a well-off area, the smoking problem we’re talking about these days is now largely invisible to you,” Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, explained to the Washington Post. “In some places, you can go days without bumping into a smoker. So you start to hear the question, why push more resources into this? Meanwhile the need is getting even greater, because the people left smoking are the ones who can least afford to.”
Funding for advocacy groups trying to eliminate smoking is dropping rapidly. Many experts claim that this may be one of the reasons that smoking rates, which declined exponentially for years, have stagnated. Under former Mayor Michael Bloomberg, New York Citylaunched major programs to discourage smoking—establishing higher cigarette taxes, banning smoking in bars and restaurants, and enforcing restrictions on outdoor smoking—so that by 2010 the city’s smoking rate was at an all time low of 14 percent. However, by 2014, the rate had climbed up to 16 percent. Officials suspect that the anti-smoking cutbacks of 50 percent in those four years caused the rate to slide.
“The thing that makes tobacco different from other public health epidemics is that if you suddenly decide the problem is solved and you’re going to walk away from it, unlike polio, there’s an extremely powerful industry spending billions of dollars [that’s] going to fill that void very quickly,” Dave Dobbins, chief operating officer of the American Legacy Foundation, explained.
Without necessary legislation and proper funding allocated to groups fighting tobacco, the industry has continued to soar. Over the past 10 years, since 2007, profit margins have gone up 77 percent. Every time a federal or state tax increases on cigarettes, the tobacco companies raise the prices. So when taxes go up, so do profit margins.
Like all small markets, tobacco companies face very little competition. Since the mid-nineties when politicians and awareness groups began to crack down on smoking with federal regulations, the industry consolidated into two companies: Altria and Reynold’s American. In 2009, the FDA attained regulatory control over tobacco, making it harder for new players to enter the market. Thus they continue to grow, even as the number of smokers in the United States stagnates or declines.
In an interview with NPR, Wall Street Journal reporter Jennifer Maloney explained that the industry is not dying anytime soon. “The industry believes that for the foreseeable future they’ll be handle to generate a good amount of revenue from cigarettes. But they know that this won’t last forever, so they are using this money to develop new alternative products such as e-cigarettes on the hopes that one day, as Americans shift from smoking cigarettes to other products. They’ll be ready to deliver those products”.