In the 1960s, nearly half of all American adults smoked. After years of warning labels, lawsuits, and public health campaigns, most adults have quit smoking.

The share of American adults who smoke has dropped to just under 16 percent. But hidden in that public health victory is the troubling fact that America’s poor smoke more and die more from cigarettes than other Americans.

When it comes to smoking, the gap between the rich and the poor is enormous. In Yellowstone County, nearly 20 percent of adults smoke, according to the 2016-17 Community Health Needs Assessment for Yellowstone County. But among low-income adults, 37 percent are smokers. Nationally, the smoking rate remains above 40 percent among those with a high-school equivalency diploma, according to the Centers for Disease Control and Prevention.

Since nearly one-third of cancer deaths in the United States result from cigarette smoking, those cancer deaths hit low-income adults harder than other Americans.

Secondhand smoke also disproportionally harms family members in lower-income households. While just over 10 percent of Yellowstone County adults reported living in a home with a smoker, nearly 17 percent of lower-income adults lived in a home with at least one household member who smoked, according to the Community Health Needs Assessment. Living with adults who smoke can create significant health impacts on children, adding another generation harmed by tobacco use.

Secondhand smoke has more than 250 chemicals that are toxic or cause cancer, according to a report from the U.S. Surgeon General. Young children are more easily effected by these chemicals, since their bodies are still developing. Children exposed to secondhand smoke are also at increased risk for lung problems, ear infections, and sudden infant death syndrome.

In 1998, the Master Settlement Agreement made it illegal to advertise tobacco products in many public places and publications. Tobacco companies shifted advertising dollars to point-of-sale advertising, pouring $238.2 million into advertising at tobacco retail locations in 2014, according to the Truth Initiative. Point-of-sale advertising includes discounts and sales, placing tobacco products at eye-level, and using colorful packaging to make tobacco products more appealing. The Truth Initiative also notes that low-income communities are more likely to have tobacco retailers and, as a result, have greater exposure to point-of-sale advertising. According to one study, low-income areas in Philadelphia had 69 percent more tobacco retailers per person than high-income areas. Point-of-sale advertising in Montana has a huge effect on our state. Yearly, about $30 million dollars is spent marketing tobacco in Montana but health care costs directly related to smoking reach $440 million.

For smokers who want to quit, the good news is that resources are available in our community to lead a tobacco-free life. The Montana Quit Line offers cessation services free of charge to all Montana adults regardless of income or insurance status.

Elyse Monat, a Tobacco Prevention Health Specialist at RiverStone Health, can be reached at 247-3273 or elyse.mon@riverstonehealth.org.

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