Tobacco Use Disparities by Socio-Economic Status

During the first half of the 20th century, smoking increased rapidly across all socioeconomic groups. With the dissemination of knowledge and growing awareness about smoking-related harms since the mid-1950s, smoking prevalence started to decline first and more rapidly among the more educated and higher income people.¹ People with higher level of education and income are now less likely to smoke; among those who currently smoke, individuals with higher level of education and income are also more likely to quit.² As a result, the smoking prevalence continues to be higher among people with limited education and limited incomes causing these populations to shoulder a disproportionate share of the real cost of tobacco use and raising concerns about tobacco-related health inequities (Figure 2.3.1 and Figure 2.3.2).

Numerous social and commercial determinants of health influence the level of exposure to most risk factors for poor health including tobacco use. Social determinants are conditions in which people work and live that are related to their health, including economic conditions, neighborhood and built environments, social and community contexts, and access to education and health care.³ Adults working in better conditions have lower odds of using tobacco than individuals with less flexibility and more hours in their work schedules, further contributing to disparities in tobacco use and health. Disadvantages in employment and occupational characteristics are associated with higher odds of tobacco use among working adults (Figure 2.3.3). Residents in neighborhoods with limited incomes are exposed to higher density of tobacco retailers and retail advertising and demonstrate lower rate of success in smoking cessation.^4,5 Additionally, tobacco companies have historically focused on people with limited incomes and people who have been marginalized in their marketing campaigns.^6,7,8 For example, the tobacco industry has historically marketed to individuals with lower income and provided them with free cigarettes, despite knowing of the link to cancer and the addictive nature of nicotine.⁹