Poverty and Smoking

So my last post introduced my new favorite toy, the Bureau of Labor Statistics' Consumer Expenditure Survey. Blair Benjamin over at Asset Almanac (one of few, and much-needed, anti-poverty blogs) had some kind words to say about my use of the data.

It really is a pretty powerful set of numbers, once you get to crunching them. For example, I mentioned that the proportion of income that the lowest quintile and highest quintile of US income earners spend on tobacco are vastly different: the bottom quintile spends 1.4 % of expenditures on tobacco, while the top only spends .03 %. That means that the poor proportionately spend 467% more on tobacco than do the top-earners.

The correlation between tobacco use and poverty is actually an international phenomenon: across the world, poorer (and poorer educated) people, especially men, are more likely to die than their wealthier counterparts, with smoking accounting for more than half the difference
between mortality rates.

Here in the U.S., the CDC found that

• smoking prevalence was highest among adults who had earned a General Educational Development (GED) diploma (43.2%) and those with 9--11 years of education (32.6%)
  
  
• prevalence generally decreased with increasing education. Adults aged 18--24 years (24.4%) and 25--44 years (24.1%) had the highest prevalence.
  
  
• the prevalence of current smoking was higher among adults living below the poverty level (29.9%) than among those at or above the poverty level (20.6%)

The health consequences of concentrated disadvantage are major, and smoking is the most blatant offender. Obviously the two major issues here are economics and health: people are spending money on a self-destructive habit that they could be saving or putting toward more productive use.

The pressing question is why we think there's such a socioeconomic disparity when it comes to smoking: why do poor people smoke more? There are three lines of thought that come to mind:

(1) Lack of education. This is somewhat obvious in the sense that education is strongly correlated to smoking behavior. Interestingly, the correlation seems to be to general education, rather than particular anti-smoking campaigns. In fact, education correlates with pretty much every measure of success, including good health.

(2) Culture. Culture is often thrown around as an (irritatingly) obtuse term, but here I think it has some use. Back in 2002, sociologist Philippe Bourgois wrote a book called In Search of Respect that clearly detailed the social patterns and cultural cues that differentiated low-income urban communities in the midst of social disorganization and 'mainstream' America. What Bourgois makes clear is this: what it takes to 'make it' in poor neighborhoods is a hell of a lot different than what is needed for conventional success. Smoking then, could serve as a social tool, a status symbol, regardless of how much information is had about it. To what extent is smoking part of a subculture (the same way that other drugs can be), rather than an individual vice?

(3) Stress/strain. Studies have found that women smoke to suppress negative feelings, and men smoke to promote positive ones. Low-income individuals have also articulated their habits as a tool of boredom, release, and privacy (page four of this study). In this case, smoking is kind of a social 'fix', trying to compensate for strain or social isolation.

Taking these three together as possibilities, we have a pretty overwhelming picture where smoking is related to education, culture, and social isolation. Assuming more than one of these possibilities is true (which seems likely based on existing research), than we have smoking being less of a pure health issue and more of a comprehensive poverty issue. Our initial concern--cutting down the amount that low-income folks spend on tobacco--may be much more closely linked to general community development and poverty relief than initially assumed.

The more we think of issues in this multi-layered sense, the clearer it is that 'quick fixes' are no replacement for the fundamentals of life--education, integration, connection--that bring with them a wealth of positive consequences. That's why it's so important to keep pushing on these fronts, because of their cumulative impact on all facets of life--even how much of your paycheck you blow on a pack of smokes.

Expect me to keep babbling on about the Consumer Expenditure Survey and its implications in the near future.