Tobacco control measures have reduced overall smoking rates in the United States from 42 percent in 1965 to 15 percent by the middle of this decade, but a new American Cancer Society report says several vulnerable subpopulations continue to smoke at high rates.
The populations include those in lower education and/or socioeconomic groups; from certain racial or ethnic groups; in the lesbian, gay, bisexual, and transgender community; with mental illness; and in the military, particularly among those in the lowest pay grades, according to research published in CA: A Cancer Journal for Clinicians.
Investigators led by Jeffrey Drope looked at several subpopulations Here’s what they reported:
Smoking prevalence decreased in all education groups over the last half century, but the largest decrease has been among those who are college-educated. Fifty years ago, smoking prevalence for all education groups was fairly clustered, with nearly 40 percent of college-educated individuals smoking, along with approximately 45 percent of those in all other education groups.
Today, 6.5 percent of college-educated people continue to smoke. The percentage stands at triple that – 23.1 percent – among those with a high school education or less.
All income groups experienced overall declines in smoking over the last few decades. The largest drops came with higher socioeconomic groups. In 2015 and 2016, current tobacco use prevalence was about 10 percent for adults in higher income households – greater than 400 percent of the federal poverty level – compared with almost 25 percent for adults in households below the poverty line.
The trend mostly has been a downward here for both men and women, but there also remains considerable variation. Individuals who are of American Indian or Alaskan Native descent exhibit the highest smoking prevalence (24.3 percent male and 23.4 percent female), and women in this group also experienced a recent upward trend after a nearly two-decade downward trend. Individuals of Asian and Hispanic/Latino descent have the lowest prevalence of smoking (12.6 percent male and 3.5 percent female).
The burden from smoking has been particularly high on individuals struggling with mental illness. Past 30-day cigarette smoking prevalence among people with a past year serious mental illness was more than double those without a past-year mental illness (27.9 percent versus 12.9 percent). There is also significant variation among different mental illnesses. Smoking prevalence was highest among those with schizophrenia, at nearly 60 percent. Individuals with such disorders may also experience additional risk factors, such as the easy availability of tobacco in some treatment centers, according to the Cancer Society.
A recent analysis found smoking among individuals with a serious psychological distress accounted for two-thirds of the difference in life expectancy relative to nonsmokers without a serious psychiatric disorder. Evidence suggests that some individuals with mental illness may have a genetic predisposition toward addiction and/or may self-medicate using nicotine.
Smoking prevalence rates among lesbian, gay, bisexual, and transgender (LGBT) men and women in the United States are significantly higher than those among heterosexuals. Studies show the social stresses of living in a society that can be hostile to those in the LGBT community contribute to the higher prevalence. Furthermore, the authors say, the tobacco industry has for many years marketed specifically to the LGBT community, placing advertisements in community media outlets, attending pride festivals to hand out coupons for discounted cigarettes, and promoting their products in LGBT bars.
Smoking in the military has trended significantly downward in recent decades, mirroring the general population. In 1980, more than half of military personnel reported smoking. By 2011, smoking prevalence had dropped to less than one-quarter. Smoking rates are still significantly higher in the military than in the general population (24 percent in 2011, the most recent reliable survey). And disparities by pay grade within the military persist. For service members in the lowest four pay grades of enlisted members, smoking prevalence remained around 30 percent in 2011. In contrast, smoking prevalence in the highest six pay grades of commissioned officers had dropped below 5 percent.
Smoking prevalence varies considerably across states, from 8.7 percent in Utah to 26.2 percent in Kentucky. There is a smoking belt leading from Michigan to Mississippi, including several adjacent states in the Midwest and Appalachia, where smoking prevalence is substantially above the national average. The Truth Initiative calls this “Tobacco Nation” and points to several driving factors, including policy, culture, and the strong and persistent influence of the tobacco industry in this region. New York State reports an adult smoking rate of 14.4 percent, and estimates that smoking kills about 28,000 state residents each year.
“The high prevalence of cigarette smoking among vulnerable populations is one of the most pressing challenges facing the tobacco control community,” write the authors. “More attention to and support for promising novel interventions, in addition to new attempts at reaching these populations through conventional interventions that have proven to be effective, are crucial going forward to find new ways to address these disparities.”
Those who would like to quit smoking for free can vist the New York Smokers’ Quitline at nysmokefree.com or call 866-697-8487.