Smoking Keeps Its Grip on Urban Poor

Misconceptions, marketing are boosting rates to double the national average, researchers say

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By Amanda Gardner
HealthDay Reporter

FRIDAY, Oct. 16 (HealthDay News) -- A full 42 percent of people in Milwaukee's poorest neighborhoods smoke -- more than twice the national U.S. average -- sacrificing $9 on a pack of cigarettes even while most of the households reported earning less than $15,000 a year.

Even more troubling is the fact that a large number of these low-income smokers hold beliefs that make them less likely to quit, according to ongoing research from the University of Wisconsin-Madison.

Over the past 40 years or so, the overall smoking rate in the United States has decreased to about 20 percent, but those gains have taken place largely among people with resources, namely money and education, said Bruce Christiansen, an associate scientist with the University of Wisconsin Center for Tobacco Research and Intervention in Madison, who is one of the researchers on what's known as the "ZIP Code" project.

"With public health, we got 80 percent of the people who were going to quit smoking to quit smoking. That's great, but the next 20 percent is going to be tough," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in New Orleans. "Smoking tends to be a disease of poverty and lack of education. Thirty years ago, 50 percent of the population smoked and now we're down to roughly 25 percent. What we have left is a very select group of people."

That select group includes people with mental health issues, which, according to the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA), smoke 44 percent of all cigarettes.

Not only are these groups often specifically targeted by Big Tobacco, they also tend to reside in areas without extensive health care systems and don't have insurance, Christiansen said.

This study, a partnership between the University of Wisconsin School of Medicine and Public Health and the Salvation Army, sent five interviewers door-to-door in two of Milwaukee's poorest ZIP codes.

Interviews were conducted primarily between 9 a.m. and 4 p.m. on weekdays, catching the "poorest of the poor," those who don't work. Many in the group would be hard to capture in a regular survey as they often don't have phones, Christiansen said.

Responses from 654 smokers living in low-income neighborhoods revealed the following:

  • People who smoked thought most other people smoked as well and, when asked, said that 73 percent of adults smoked, way higher than the 20 percent who actually do.
  • Almost two-thirds thought it was okay to smoke as long as it didn't impinge on others.
  • Almost half thought that medications intended to help people quit smoking were actually more dangerous and addictive than cigarettes.
  • More than half (56 percent) had never heard of the free Wisconsin Tobacco Quit Line despite efforts to promote the service. In fact, Christiansen noted, some respondents said that going to jail was the best way to quit (at least temporarily).
  • Thirty-eight percent had never actually tried to dispense of the habit. "It was amazing how many people said they hadn't tried to quit," Christiansen said. "They thought that everyone is doing it so it's okay."

Christiansen and his colleagues haven't finished analyzing the results yet but want to take the research a step further. "Can we change beliefs and, if we can change them, does that increase uptake of [quit-smoking] treatment?" he wondered. "Then we'll look at what it takes to change beliefs."

Christiansen's group has started an initiative called "Tobacco-Free Advocates," which trains individuals in the community to bring short (10-minute) messages to local groups.

"They talk about willpower, that it's a muscle you can build, dealing with urges, that medications can give willpower a chance to work," he said. "They're very brief messages. Then we made the advocates available to them."

And when the researchers come across households without any smokers, they offer them a bright green sign to place in the window that says: "Another smoke-free home in this community."