Introduction
One of the public health problems the world has encountered is tobacco prevalence; in a year, more than 7 million people die because of it, 6 million people die because of direct tobacco consumption, while 890,000 deaths result from people being exposed to second-hand smoke despite not smoking themselves, i.e., involuntary inhalation of smoke from tobacco being smoked by others in places such as restaurants, offices, and other enclosed spaces.
Of 1.1 billion smokers worldwide, 80% live in low- and middle-income countries, where deaths and illnesses related to tobacco use are more numerous.
Families of those tobacco users who die too early are deprived of income. In addition to this, there is an increase in the cost of the healthcare system and a hindrance to the development of the economy.
In a few nations, children from poor families often work in tobacco farming to provide family income. Such children are particularly susceptible to green tobacco sickness, which is caused by transdermal absorption of nicotine from the surface of wet tobacco plants.
There is a global rise in the consumption of tobacco because the tobacco industry is mainly targeting young people along with women living in low and middle-income countries. Improving knowledge is an important step toward understanding the epidemiology and prevalence of smoking and toward designing, applying, and assessing interventions targeted at these at-risk populations. Smoking consumption is highest among people with low education levels and in low-income groups.
Rationale
Socioeconomic status refers to the position that an individual secures in society due to societal or economic factors. In this response paper, we aim to explore the relationship between socioeconomic status and smoking behavior and to discover how people from different socioeconomic backgrounds are affected by smoking, along with socioeconomic correlates such as smoking prevalence, uptake, tobacco consumption, smoking cessation, education levels, income, and tobacco-control interventions. To understand how socioeconomic factors are leading people to smoke (Hiscock et al., 2012).
Summary Of This Article
This article states that smoking prevalence is higher among disadvantaged groups, including people who have been unemployed for a long time, mentally ill people who are homeless, single guardians, criminals, groups of new migrants, and ethnic minorities; this review discusses socioeconomic-status differences in smoking prevalence, tobacco use and exposure, and how differences arise from smoking uptake and cessation. Evidence about mechanisms shows why it is difficult for people with low socioeconomic status to quit smoking, and tobacco-control interventions can reduce smoking among disadvantaged groups and reduce inequalities in smoking rates.
Since this article is a literature review on this topic, the authors used a variety of methods to review data and find studies; all authors involved were associates of the UK Center for Tobacco Control Studies. They used recent reviews of disadvantaged groups and smoking, evidence from the smoking toolkit study, and the PubMed database. Search terms used on PubMed included SES and smoking; 320 articles were initially found, 72 remained after the title search, and 28 remained after the abstract search. Google Scholar was also used to identify mechanisms underlying SES differences in smoking, and international comparisons were used to explore cigarette consumption and smoking prevalence.
Among people with low socioeconomic status, smoking rates are higher; among disadvantaged groups, this increase is associated with unemployment, disruption, and community cohesion. Socioeconomic differences in smoking prevalence have been found when analyzing variables such as education, salary, housing tenure, car access, financial status, single-parenting, and neighborhood deprivation.
When higher-income countries were compared with low-income countries, a greater increase in smoking prevalence was found in low-income countries than in upper-middle-income countries. Differences were found in smoking rates in middle-income countries compared with low-income countries, particularly among men and among both males and females under 40 years old. Variations will probably continue in the future as tobacco use becomes more widespread and low-income countries start to resemble middle-income countries.
Disadvantaged smokers may face greater exposure to tobacco’s harms; tobacco exposure has been estimated by the number of cigarettes smoked each day, which can lead to underestimation among groups with low socioeconomic status. Disadvantaged groups also have greater exposure to second-hand smoke because smoking bans are less common in the environments where they work and live.
There are two stages in life where differences in socioeconomic status related to smoking are prominent. First, during smoking uptake in adolescence and when attempts to quit are made, groups with low socioeconomic status have higher smoking rates because they are more likely to try smoking, become regular smokers, and be less inclined to quit.
An important determinant of smoking uptake among young people is socioeconomic status; parents’ smoking status is considered one indicator of youth smoking and involves parental role modeling, social norms, and the availability of and access to cigarettes and tobacco at home. Other factors include peer pressure, low awareness of tobacco harms, low education levels, and behavioral problems. Therefore, despite the difficulties in measuring SES in adolescent populations, where differences were found, higher smoking uptake appeared among disadvantaged groups and may differ by gender and form of tobacco use.
The reason that smokers of disadvantaged groups are less inclined towards quitting is that there is a lack of support; smokers with low socioeconomic status find quitting smoking very hard since there are few people who support their attempt to quit. If support is available, quit rates are more likely to improve among disadvantaged groups as well as among the general population of smokers. Peer pressure and tobacco addiction also contribute; even though smokers are aware of threats to their health, this may occur because low-SES smokers start smoking very early in life, smoke more cigarettes per day, and use cheap cigarette brands and hand-rolled tobacco with higher nicotine levels, which can increase addiction.
Motivation also plays a role in helping disadvantaged people quit smoking, but it is more effective when it is self-directed rather than directed by others; cost can affect low-SES smokers’ motivation, and increasing the price of tobacco can increase the likelihood of quit attempts.
In low SES, there is a high level of boredom and stress. People live more stressful lives inside the home and outside; smokers in such situations find their comfort in smoking. Low SES is also associated with work environments. Hence, smokers with low SES are more depressed and nervous, which contributes to relapse compared with people living with high SES.
Tobacco companies advertise and promote their brands to people with low education who have a low willingness to make choices for their future; such companies are well aware of people’s psychology related to SES and exploit such people through marketing campaigns. Anti-advertising campaigns, cigarette packs with graphic warnings, and bans on advertisements can increase the number of smokers who quit.
Treatment in a smoking-cessation program involves either taking pharmacotherapy or attending program sessions; nonadherence may be due to withdrawal symptoms, adverse reactions, lack of knowledge, negative behavior, cost, or relapse among patients with low SES. Patients with low income are less likely to complete the program. Adherence to the program is low in people living in low SES.
The model of mechanism and intervention mentioned in this article states that increasing the price of tobacco helps motivate people to quit. This is a more common assumption among people living with low SES because they have low income. Increased smoking rates are found among people who struggle even to afford food, since money spent on cigarettes cannot be used for other things such as health, education, or other purposes; poor people tend to become trapped in tobacco use. Quitting is found to be less frequent among a disadvantaged group of people. Cessation programs are capable of reducing inequalities; such programs report two problems related to the model: 1) stronger addiction requiring pharmacotherapy and 2) reduced self-efficacy addressed through counseling sessions. Mass media campaigns can help spread awareness regarding the harm associated with tobacco. Evaluations of smoke-free legislation showed decreased exposure to second-hand smoke but did not seem to show a reduction in smoking among people living with low SES (Centers for Disease Control and Prevention, n.d.).
Tobacco-control interventions can become more effective among low-SES groups by increasing cigarette prices, increasing tobacco taxes, though this is hard to achieve in low-income countries, and adapting campaigns and services for disadvantaged groups. Tobacco-control strategies that use different combinations of interventions are expected to be effective; disadvantaged smokers see smoking as a way of dealing with stressful lives.
Critique
In my opinion, more studies related to high- and middle-income groups should have been used since smoking prevalence, although common in low socioeconomic groups, is also found in high and middle socioeconomic groups.
In this article, the authors discuss how increased smoking rates among disadvantaged groups lead to increased exposure to second-hand smoke, but they mention only one way to measure tobacco exposure and do not explain how to measure second-hand smoke exposure, such as through hair and saliva biomonitoring.
Authors should have used a range of study designs to evaluate the effect of tobacco control strategies and interventions at the national and local levels.
The sample size is not mentioned.
The Relevance Of This Article With Socioeconomic And Determinants Of Health
This article is relevant to the socioeconomic-status-and-health aspect because, as the title suggests, it correlates socioeconomic status and smoking. All three components of SEDH are covered in this article: income, education, and occupation. People with low socioeconomic status may lack education, which can lead to poor job opportunities and, as a result, low income. Smoking is prevalent among such low-socioeconomic-status groups because of a lack of awareness about its harmful health effects and limited income resulting from inadequate employment. Whatever amount they earn, they may prefer spending it on cigarettes rather than on their health. These factors are among the main reasons smoking is prevalent among such groups because smoking serves as a coping mechanism for the stress they face in life.
References
Centers for Disease Control and Prevention. (n.d.). Cigarette smoking and tobacco use among people of low socioeconomic status. https://www.cdc.gov/tobacco-health-equity/collection/low-ses.html
Hiscock, R., Bauld, L., Amos, A., Fidler, J. A., & Munafò, M. (2012). Socioeconomic status and smoking: A review. Annals of the New York Academy of Sciences, 1248(1), 107–123. https://doi.org/10.1111/j.1749-6632.2011.06202.x
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