Smoking a habit for the poor

When smoking first swept the United States in the early decades of the 20th century, it took hold among the well-to-do. Cigarettes were high-society symbols of elegance and class, puffed by doctors and movie stars. By the 1960s, smoking cigarettes had exploded, helped by the distribution of cigarettes to soldiers in World War II. Half of all men and a third of women smoked.

But as evidence of smoking’s deadly consequences has accumulated, the broad patterns of use by class have shifted: Smoking, the leading cause of preventable death in the country, is now increasingly a habit of the poor and the working class.

While previous data established that pattern, a new analysis of federal smoking data released on Monday shows that the disparity is increasing. The national smoking rate has declined steadily, but there is a deep geographic divide. In the affluent suburbs of Washington, only about one in 10 people smoke, according to the analysis, by the Institute for Health Metrics and Evaluation. But in impoverished places like this — Clay County, in eastern Kentucky — nearly four in 10 do.

“It’s just what we do here,” said Ed Smith Jr., 51, holding up his cigarette in a hand callused from his job clearing trees away from power lines. Several of his friends have died of lung cancer, and he has tried to quit, but so far has not succeeded.

“I want to see my grandson grow up,” he said.

The new study, which evaluated federal survey data from 1996 to 2012 to produce smoking rates by county, offered a rare glimpse beneath the surface of state-level data. It found that affluent counties across the nation have experienced the biggest, and fastest, declines in smoking rates, while progress in the poorest ones has stagnated. The findings are particularly stark for women: About half of all high-income counties showed significant declines in the smoking rate for women, but only 4 percent of poor counties did, the analysis found.

This growing gap in smoking rates between rich and poor is helping drive inequality in health outcomes, experts say, with, for example, white women on the lowest rungs of the economic ladder now living shorter lives.