Poverty and Smoking

This chapter examines the association between poverty and tobacco use. It provides a comprehensive review of the data on smoking prevalence and consumption levels in different socio-economic groups, both within individual countries and internationally. It finds that smoking is more common among poor men (variously defined by income, education, occupation, or social class) than rich men in nearly all countries. In high-income countries, the social gradients of smoking are clearly established for men: Smoking has been widespread for several decades, and smoking-attributable mortality can be measured reliably. Analyses of smoking-attributable mortality in middle age (defined as ages 35–69) in Canada, England and Wales, Poland, and the United States reveal that smoking is responsible for most of the excess mortality of poor men in these countries. For women, the situation is more variable, partly reflecting the more recent onset of mass smoking by women in certain parts of the world. Why poor people smoke more remains a complex question that requires further research.