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After decades of declining US smoking rates overall, most remaining smokers have low income, no college education, no health insurance or a disability, according to research from the Colorado School of Public Health at CU Anschutz.

About 15 percent of US adults – more than 36 million – continue to smoke cigarettes. Half to three-fourths of them have one or more low-socioeconomic disadvantages, and the lowest socioeconomic categories have the highest smoking rates. The study concludes that continuing tobacco use is now concentrated among the least advantaged portion of society.

“It’s unusual to find part of the population experiencing high rates of a health problem and also representing the majority of affected people,” said study author Arnold Levinson, associate professor of community and behavioral health at the Colorado School of Public Health at CU Anschutz. “But with smoking, we have this unusual situation: Americans with lower socioeconomic status today are suffering from epidemic smoking rates, and they make up nearly three-fourths of all our remaining smokers.”

The research, published February in the Journal of Health Care for the Poor and Underserved, used data from a national survey which the University of Colorado directed in 2012.

The continued epidemic can’t be blamed on lack of desire to quit or efforts to quit. According to the report, numerous studies have found no socioeconomic differences in smokers’ desires to quit or attempts to quit. Instead, the disparities persist and have widened because lower socioeconomic smokers who try to quit are less likely to succeed.

“In the last half-century, public health efforts helped cut the smoking rate by more than half, but we probably need to change our strategies for helping smokers quit,” Levinson said. “The methods that worked for the upper half of society don’t seem to be working well for the other half.”

According to the Centers for Disease Control, cigarette smoking remains the leading cause of preventable disease and death in the US, causing more than 480,000 premature deaths every year, or one of every five deaths.

Levinson said, “Now the nation’s public health system has a dual moral obligation toward smokers of low socioeconomic class. We must eliminate the disparity in smoking rates, and we must provide cessation-supporting services to the new majority of smokers.”