Americans experiencing compounded social marginalization are at greater risk of initiating use of—and not cutting use of—tobacco products, according to a new Journal of the American Medical Association (JAMA) Internal Medicine study.
Measuring smoking prevalence over the course of the last decade, University of Southern California (USC) researchers found that disparities—particularly concerning smoking initiation and cessation—widened with each “additional disadvantage faced.” These included unemployment, poverty, lack of a high school diploma, disability, “psychological distress” and heavy drinking.
Rates of smoking drastically jumped with each disadvantage. Of the respondents with no reported disadvantage, almost 14 percent currently smoked. Of those listing five or six disadvantages, 58 percent did.
“If you are experiencing a lot of stress—whether it’s because you’re unemployed, struggling with an alcohol problem, or coping with mental illness—there’s evidence you’re more liable to smoke to manage stress,” Adam Leventhal, one of the study’s authors and the director of the Health, Emotion and Addiction Laboratory at the University of Southern California, explained. With each disadvantage, “They just keep piling on your risk of smoking.”
“The steep decline in smoking among Americans we’ve seen this decade is near historic,” Leventhal said. But it is not evenly spread: “Our results show that nearly all of this reduction was concentrated in people with little or no disadvantage, despite recent tax hikes on smoking, stricter cigarette regulation and available quit aids.”
As the study reaffirms, the harms of combustible tobacco disproportionately impact marginalized people. Not included in the study, queer and trans adults have been recorded by the Center for Disease Control and Prevention to smoke at significantly higher rates than their straight and cis counterparts. In 2016, the National Health Interview Survey found that 20.5 percent of LGB adults smoke cigarettes, compared to 15.3 percent of straight adults. Additionally, Native American and indigenous adults are the racial group with the highest prevalence of smoking. People with mental health diagnoses are yet another example of a group suffering disproportionate harms.
The new study’s findings come as the Food and Drug Administration continues to wage a campaign against e-cigarettes, boosting public misinformation about the reduction in harms offered by vaping. Irrefutable evidence of the disproportionate impact of smoking harms on marginalized populations underlines that tobacco harm reduction is a social justice issue.
Amidst the imperative to promote harm reduction tools for people who smoke, Leventhal points out that, “People also smoke for pleasure.”
“If you are limited in your life about the types of things you can do for fun because of your income or disability,” said Leventhal, “it is understandable why you would turn to a product that instantly and reliably delivers pleasure, like a cigarette.”
Leventhal added that “until we can do something about the life circumstances that drive disadvantaged populations to smoke, encouraging them to quit may be an uphill battle.”
All the more reason to use every tool at our disposal to reduce death and disease.