More than 50 years ago, the Surgeon General first reported that cigarette smoking was very bad for our health. At the time, 42% of Americans smoked. Even now that the percentage has dropped dramatically to less than 15%, smoking is still a deadly problem.
The deleterious effects of smoking are well known, including the increased risk for heart disease, stroke, and lung cancer. Smoking causes 480,000 deaths annually, which is more deaths each year than the following causes combined: HIV, illegal drug use, alcohol use, motor vehicle injuries, and firearm-related incidents.
While smoking impacts every socioeconomic group, it is most prevalent among low-income Americans. While high-earning Americans decreased smoking rates by more than 60% since 1964, low-income Americans have decreased only 9%. Today, nearly 30% of those enrolled in Medicaid smoke compared to only 11% of individuals covered by private insurance.
A number of reasons contribute to this widening gap, but mainly it comes down to the pressure to start and the challenge to stop among many low-income Americans.
Targeting a Vulnerable Population
Smoking ads were once as ubiquitous as the smoke cloud hanging over every office, restaurant and living room in America. However, slowly, the ads gave way to health reports and smoking cessation campaigns. As a result, cigarette manufacturers shifted their attention to new audiences.
As tobacco ads disappeared from TVs and billboards, “storefronts [became] some of the last bastions of tobacco marketing.” This move wasn’t an accident. Statistically, there are far higher concentrations of convenience stores in lower-income communities than wealthier ones, and tobacco companies are currently spending 40% of marketing dollars placing ads in windows, reserving prime shelf space, distributing coupons and discounting the prices per carton. These marketing tactics increase the uptake of smoking and trigger cravings.
Quitting is Not Just Difficult, It’s Expensive
The cost of smoking is a double-edged sword. It is expensive to smoke, but costly to quit. One-third of all smokers want to quit, but their nicotine addiction is too strong and smoking cessation methods are costly.
The most common and successful cessation methods are the use of either patches, gum or a combination of the two, and many individuals seek additional help from therapy or hypnosis. All of this comes with a cost. A 12-week supply of patches and gum could cost more than $400. And it’s not a sure thing. The average smoker attempts to quit 8 to 11 times before it is successful.
Challenging Big Tobacco Head-On
In 2010, health consequences from smoking alone were responsible for $40 billion in Medicaid funding, roughly 15% of the entire budget, and that number is only anticipated to grow.
With the implementation of the Affordable Care Act, Medicaid was expanded and state programs were required to cover a variety of tobacco cessation products and support systems with no cost-sharing. Cessation benefits have proven to deliver a meaningful ROI. Among the Medicaid population in Massachusetts, for example, every dollar spent on smoking cessation has resulted in an estimated $3.12 in medical savings.
Other policy initiatives are taking a different approach. In November, the U.S. imposed a nationwide ban on smoking in public housing. And, nationwide, the tax on cigarettes has been on the rise, best demonstrated in Chicago, where the combined federal, state, county, and city taxes are $7.17 a pack. Not so coincidentally, smoking among Chicago’s high school students dropped to its lowest rate ever a few months following the tax hike.
Both the “carrot” and “stick” approach can work to fight the addiction of smoking. But ultimately, it takes a coordinated effort with support from health providers and community groups to reduce smoking in all populations.
At Healthify, we are focused on coordinating services for low-income populations in order to better address the social determinants health. If you’re interested in learning how, please contact us below!