Smoking and Ill Health: Does Lay Epidemiology Explain the Failure of Smoking Cessation Programs Among Deprived Populations?
The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts.
Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved.
The study (from 2003) confirmed the fairly obvious observation that those on the lowest incomes are most resistant to anti-smoking campaigns. There is a strong social gradient to smoking prevalence which didn't exist fifty years ago.
Although not explored in this study, one result is that taxing cigarette is about the most regressive form of taxation imaginable. Anti-smoking campaigners argue that those on low incomes benefit disproportionately from higher tobacco duty because, since they are least able to afford it, they will be most likely to quit smoking. They say that "a disproportionately number of lives of the poor are likely to be saved by a cigarette tax." It's a nice piece of rhetoric and for most products it would hold true (price relative to income affects consumption).
But tobacco is not most products and this simple economic formula does not take into account why people smoke. The proof of the pudding is in the eating and history is a better guide than economics on this issue. Decades of experience have shown that raising tobacco duty widens both health inequalities and financial inequalities. And while smoking is obviously linked to poor health, so is poverty.
Few politicians are eager to acknowledge, let alone address, this thorny issue. Tobacco duty raises around £13 billion a year in the UK.
7 comments:
"I'll be damned if I can find anything in the news to blog about today"
Well, here's something - the hype on smoking and cot death seems to be taking off again:
http://www.telegraph.co.uk/news/7932892/Smoking-in-front-of-youngsters-is-child-abuse.html
I've just read the paper, including your quote:
"Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology".
and my comment is, "No shit, Sherlock".
On the other hand, it has been shown that people in higher socio-economic groups on average drink *somewhat* more alcohol than those in lower groups, although the lower groups have a higher incidence of "problem drinking".
High taxation fails for two simple reasons.
1.People just buy tobacco abroad or from smugglers.
2.I may guess the loss in revenue from this is equatable to the revenue gained from a switch back to traditional sales that European levels of tobacco taxation would encourage.
But ..
That's simple logic and it does not apply to tobacco as it it an emotive issue with anti smoking nutjobs.
Hi Chris, I hope you are well. I also hope that you got my email which I hope proves the smoking ban is behind 70%-80% of pub closures.
It is even worse for the anti smokers, I am sure I have piste this ASH paper from Professor Jarvis before.
"Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study" We are characterised as being: "Hardcore smoking defined by four criteria (less than a day without cigarettes in the past five years; no attempt to quit in the past year; no desire to quit; no intention to quit), all of which had to be satisfied."
It is 16% of the population and includes me.
http://www.bmj.com/cgi/content/abstract/326/7398/1061?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=smoking&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Increased taxation will only result in the poor spending disproportionately more of their income on tobacco.
As to the wider point of why those on the lowest incomes resist quitting, John Reid expressed the reason of 'instant gratification'. The middle classes have traditionally prided themselves on preferring 'deferred gratification'. They can afford to but if you're poor and, more importantly, don't have any real hope of your circumstances changing, then you can only react to events, rather than plan, you want products that alleviate the low-level depression such as filling food, alcohol and tobacco and life doesn't seem so great that you want to prolong a it.
As someone once said, you don't find muesli-munchers among the working class.
Jay
I am surprised you have not realised yet that anti-tobacco are now well into one of their biggest campaigns to date, as anon 9/8/10 @ 1438 draws to your attention.
It was kicked off on Sunday by GP head, Dr Field
http://www.guardian.co.uk/commentisfree/2010/aug/08/steve-field-patient-responsibility-health
and has been followed with articles in many local media eg:
http://www.thenorthernecho.co.uk/news/8322244.Smokers_who_put_health_of_84_000_children_at_risk/
http://news.scotsman.com/health/Parents-39risking-children39s-health-with.6463450.jp
http://www.guardian.co.uk/society/2010/aug/08/public-health-attitudes-leading-gp
In fact Ben Goldacre (quoted by you) of ‘how to promote bad science’ fame is apparently in the loop too, only his approach is more subtle.(have you sussed him out yet?)
There is also to be a big media advertising campaign on TV radio etc.
This represents a major change of direction for anti-tobacco (who are clearly coordinating this)
They have been careful to only attack smokING in the past but NOW they are openly attacking SMOKERS in a coordinated attempt to promote negative stereotypes that smokers are child abusers and degenerates. (note some of the debase comments from GPs in the articles etc)
This is no different to the Nazi tactic of dehumanising jews. This needs to be taken very seriously AND requires a robust response to highlight their lies about harm to children etc together with their perverted mindset!!!
It has been clear for some time that anti-tobacco have slowly been losing ground to those who value freedom and tolerance and this I think, is a frantic effort to regain the initiative.
I hope you and every other person fighting these mentally depraved beings, will respond appropriately.
Kin_Free
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