Smoking is a leading cause of oral cancer as well as other complications in oral health. While tobacco control measures have reduced overall smoking rates in the United States from 42% in 1965 to 15% in 2015, according to the American Cancer Society (ACS), vulnerable subpopulations continue to smoke at high rates.
These populations include those with less education; lower socioeconomic groups; certain racial and ethnic groups; the lesbian, gay, bisexual, and transgendered (LGBT) community; those with mental illness; and active and veteran members of the military, particularly among those in the lowest pay grades.
The largest decrease in smoking rates over the past half-century has been among the college-educated. Fifty years ago, rates were clustered, with nearly 40% of the college-educated smoking compared to 45% among all other education groups. Now, 6.5% of college-educated individuals smoke, while 23.1% of those with a high school education or less smoke.
There also have been differences in decreases based on socioeconomic status. In 2015 and 2016, about 10% of those in households with higher incomes or greater than 400% of the federal poverty level smoked, compared to almost 25% among adults in households below the poverty line.
With a mostly downward trend among men and women of all racial and ethnic groups, those of American Indian or Alaskan Native descent exhibit the highest smoking prevalence, with 24.3% male and 23.4% female. Women in this group also experienced a recent upward trend after nearly two decades of decreasing prevalence. Individuals of Asian and Hispanic/Latino descent have the lowest prevalence, with 12.6% male and 3.5% female.
Rates of smoking in the past 30 days among people with a serious mental illness in the past year are more than double those who have not had a mental illness in the past year, at 27.9% versus 12.9%. Smoking prevalence was higher among those with schizophrenia, as individuals with such disorders may experience additional risk factors, such as the easy availability of tobacco in some treatment centers.
Also, individuals with a serious psychological distress accounted for two-thirds of the difference in life expectancy relative to nonsmokers without a serious psychiatric disorder. According to the ACS, evidence suggests that some individuals with a mental illness may have a genetic predisposition toward addiction and/or may self-medicate with nicotine.
Smoking rates are significantly higher among the LGBT community than among heterosexuals. The ACS notes that studies have shown that the stresses of living in a society that can be hostile to these individuals contribute to the greater smoking rates. Also, the tobacco industry has marketed to the LGBT community for many years via advertising in community media outlets, attending pride festivals to hand out coupons for discounted cigarettes, and promoting their products in LGBT bars.
In 1980, more than half of all military personnel reported smoking. By 2011, prevalence dropped to 24%, which is still higher than the general population. Service members in the lowest four pay grades of enlisted members saw smoking prevalence rates of approximately 30% in 2011, while less than 5% of those in the highest six pay grades of commissioned officers smoked.
Smoking varies from state to state as well, from 8.7% in Utah to 26.2% in Kentucky. There is a smoking belt from Michigan to Mississippi, including several adjacent states in the Midwest and Appalachia, where smoking prevalence is substantially above the national average. Policy, culture, and the strong, persistent influence of the tobacco industry in this region drive these rates.
Calling the high prevalence of cigarette smoking among these populations one of the most pressing challenges facing the tobacco control community, ACS is calling for more attention to and support for promising novel interventions and new attempts at reaching these populations through conventional interventions that have proven effective.
The study, “Who’s Still Smoking? Disparities in Adult Cigarette Smoking Prevalence in the United States,” was published by CA: A Cancer Journal for Clinicians.
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