America’s new tobacco crisis: The rich stopped smoking, the poor didn’t

Also, the pleasures available to the impoverished are by definition fewer and smaller than the wealthy. Cigarettes should appear undesirable by those than can easily afford superior enjoyable experiences. A pack of cigarettes is one of the most luxurious pleasures available if all you have is $5.

The poor aren't stupid. They are just making the best of poor hand they were dealt.

This fits what I have always heard: That education is more predictive of smoking than income. I am homeless, as are my two adult sons. We do not smoke. I have about six years of college.

Some random thoughts, in no particular order and not backed up by citations:

Smoking helps control depression. One anti-depression medication has a shockingly high side effect of causing people to stop smoking.

Smoking suppresses appetite. I strongly suspect this is one of the reasons that so many homeless people smoke: Because they sometimes don't eat for up to three days at a time.

Smoking also seems to be common in certain situations where it is the only stress relief. Many years ago, I volunteered at a homeless shelter in Vacaville, CA. All the employees seemed to smoke. They had enormous difficulty giving it up because there was nothing else to do on their breaks but either smoke or sit with co workers and talk, who were themselves smoking.

If you want to combat this, trying to education the least educated peoples is probably a better path than framing it as a poor vs rich thing. Poverty grows out of lack of education, but some very educated people don't have much money for various reasons.

I run the San Diego Homeless Survival Guide in part because I am convinced that good information is sorely lacking and is a genuine means to start solving the difficult problems of the poorest of the poor in the U.S.

Not to mention all the states with a lottery, which can also be thought of as a tax on poor people who are bad at math.

This seems like class warfare.

Slum dwellers and "city trash" on one hand, and 150 year old clean shaven organic vegan genetically modified uberlords on the other.

Warlocks vs Elois all over again...

Think of a slogan like "Only the poor still smoke" or "it's what losers do" and how it would impact people. Suddenly you'd be embarrassed of being seen smoking.

I'm sorry but this is facile. "Stress" and "problems" cause people to smoke only in the broadest sense of the word "cause". Something else is at work, here, and my hunch is that it's cultural. I've found that in much of blue-collar America, smoking is something of a status symbol.

> Advocacy groups say funding for smoking cessation is dropping

It seems like an uphill battle to let the tobacco industry tell everyone to smoke, and then try and undo that with anti-smoking campaigns. Is there a reason we can't rein in or eliminate tobacco advertising?

What always puzzles me is if the lower socioeconomic class is disproportionately affected by smoking and money issues, why are sin taxes the only political solution?

Some interesting fact on the quitting front, there are some vape shops that actually help people quit by gradually lowering the amount of nicotine over time.

To contrast, I was recently in South Africa at a wedding full of people of all ages (all white, though). We noted that out of 100+ guests only 2 were smokers. A recent study shows that the overall rate in both whites and blacks is about 15%, while in coloureds it is 40%. It's interesting because it shows more of a race divide rather than class divide.

Income Disparities in Absolute Cardiovascular Risk and Cardiovascular Risk Factors in the United States, 1999-2014 https://www.ncbi.nlm.nih.gov/pubmed/28593301

This study shows that in the 15 years studied, only the smoking rate of high income individuals has decreased from 14% to about 9%. Those at the poverty level or below has remained about 36.5% who are smokers (some of those will be the mentally ill and/or substance abusers) and middle income is about 24% who are smokers.

Former NYC Mayor Mike Bloomberg with his latest donation of $360 million in December, now donated a total of $960 billion to combat tobacco in low- and middle-income countries (e.g. China, Russia, Bangladesh, but also Turkey). Bill Gates added another $125 million.

The plan is to implement the World Health Organization's (WHO) MPOWER program which has been implemented in NYC since 2001. Raising the cost of tobacco has over half the effect of getting people to quit or never start. Also very important is banning smoking in public places and hard-hitting, scary, advertisements spending about $1 to $2 per capita. Clinical interventions such as doctors speaking with patients about quitting, providing nicotine replacement therapy, and telephone counseling support are also important. But most of the gains are from the public policy initiatives.

A frustration I have with the healthcare system in the US is that too little is sent on public health interventions such as MPOWER compared with the spending on clinical interventions. If you want to lower healthcare costs, ultimately more effort has to be put in public health interventions which is much more scalable and more effective than clinical interventions.

Under ObamaCare, smokers can be charged premiums 50% higher than non-smokers because the healthcare costs of smoking are so high, yet most insurance plans don't charge the premium nor does the ObamaCare let insurers really verify if someone is a non-smoker.

If you want to lower the high costs of healthcare, nationally implement MPOWER in the US as well as other public health interventions. ObamaCare made a huge mistake when they did not implement the tobacco tax policies of Canada, UK, France and other nations which have universal care which is pay for the healthcare partially with high tobacco taxes in the range $5 to $7 per pack or more. Our federal tax is about $1. Raising that of these other nations would result in tens of billions of dollars for paying for healthcare while helping people, especially the poor, to quit smoking.

Perhaps in the past more rich smoked because it wasn't so manifest how bad smoking was for a person.

Also culture. In more well off circles being a smoker may raise an eyebrow or two now as opposed to the past.