The percentage of U.S. adults who smoke has fallen dramatically during the past 50 years, from 42 percent in 1965 to just 15 percent in 2015.1 Despite this decline, roughly one in five U.S. deaths is due to tobacco-related disease, making it the nation’s top cause of preventable disease and death.
While high rates of smoking decades ago contribute to tobacco-related deaths today, getting Americans to quit smoking and preventing them from starting in the first place remains a public health priority. To better design and target prevention efforts, researchers are examining genetics, stress, and neighborhood/family characteristics to identify who smokes and why.
Smokers born in the late 1940s and early 1950s (who reached their mid-20s after the U.S. Surgeon General’s 1964 report on the dangers of smoking) are more likely to have genes that raise a person’s risk for developing nicotine addiction compared with smokers born in the late 1930s and early 1940s (who reached their mid-20s before the report was issued), a team of researchers finds.2 Using genetic information from the nationally representative Health and Retirement Study data, Benjamin Domingue of Stanford University, Dalton Conley of New York University, Jason Fletcher of the University of Wisconsin-Madison, and Jason Boardman of the University of Colorado compared smokers and nonsmokers from various older age groups.
The population of U.S. smokers today is “fundamentally different,” they write. Those most able to quit smoking did so. Anti-smoking policies effective in the 1980s—such as taxes and bans on public smoking—may no longer induce smokers to stop or limit tobacco use because genes and biology now play an increasingly important role, they argue.
Others may smoke in response to stress. U.S. adults who involuntarily lost their jobs during the Great Recession (2007-2009) were more likely to start or resume smoking than those who did not experience unemployment during the period.3 Using data from the nationally representative Panel Survey of Income Dynamics (PSID), Shelley Golden and Krista Perreira of the University of North Carolina at Chapel Hill tracked 13,000 participants’ employment status, job loss, and smoking between 2001 and 2011.The researchers estimate that 165,000 people may have initiated or resumed smoking during the Great Recession. They document a link between job loss and smoking, and a link between psychological distress and smoking. While their analysis does not show that the psychological distress related to job loss caused people to smoke, they did find that those who reported an involuntary job loss were more likely to be psychologically distressed than their nondisplaced peers.
The researchers point out that the link between job loss and smoking was “strongest among those who were working within two years of losing work.” Losing a job might cause stress levels to spike and contribute to smoking, but then taper off over time with new employment—a dynamic that the every-two-years survey might not have been able to capture, they suggest.
They recommend targeting people immediately following job displacement with smoking prevention education, support, and other resources. They note that previous research shows that displaced workers are not well served by community- or health insurance-based smoking cessation programs. And due to the relationship between smoking and psychological distress, they recommend that mental health services be a component of smoking cessation programs.
Another team of researchers linked rises in state unemployment rates during the Great Recession to an increase in smoking and drug use, as well as poorer overall self-reported health, among urban mothers.4For the study, Janet Currie of Princeton University, and Valentina Duque and Irwin Garfinkel of Columbia University examined data from the Fragile Family and Child Wellbeing Study, which tracked a representative sample of urban parents over a nine-year period before and after the Great Recession.
The financial downturn appeared to take the heaviest toll on the health of disadvantaged mothers (those who were African-American, Latina, less educated, or unmarried): Disadvantaged mothers reported a greater deterioration in their overall health than advantaged mothers (those who were white, married, or college educated). But both advantaged and disadvantaged mothers started or resumed smoking in the wake of rising unemployment in their state: For every 1 percentage point increase in state unemployment rates, the researchers documented a roughly 5 percent increase in smoking among urban mothers.
The researchers suggest that smoking may be used as a stress reliever. “The Great Recession represented a huge financial and psychological shock for many households,” particularly for the most vulnerable, they write.
White youths and young adults who spent prolonged periods of their childhood living in high-poverty neighborhoods (poverty rate greater than 20 percent) were more likely to begin smoking before age 25 than their white peers who spent most of their childhood living in low-poverty neighborhoods (poverty rate less than 10 percent).5But, neighborhood poverty did not play the same role for racial/ethnic minorities (95 percent of the minorities in this study sample were African American), reports Nicole Kravitz-Wirtz who conducted the research at the University of Washington.
For this study, she paired census data on neighborhood poverty with PSID data from 1970 to 2011, accounting for differences in household characteristics such as income and education. Racial/ethnic minority youth and young adults were far more likely to continuously live in high-poverty neighborhoods than their white peers, but they tended to take up smoking at higher rates than whites only after age 21—a time when family influences may no longer protect against the consequences of long-term exposure to neighborhood poverty.
In low-income neighborhoods, youth and young adults may find making and maintaining healthy choices difficult because tobacco products tend to be more prominent, more heavily advertised, and more accessible compared with more affluent communities, Kravitz-Wirtz reports. In addition, residents of low-income neighborhoods may lack the capacity to enact smoking bans for public places or restrict tobacco sales.
Drawing on earlier research, she also suggests that African American youth may be “more likely to encounter religious and parental disapproval of smoking,” while white youth may be “more susceptible” to pressure from peers to smoke. Because those who begin smoking in youth face a greater risk of future dependence and ongoing health problems, Kravitz-Wirtz argues that prevention programs need a better understanding of the social conditions and family dynamics in low-income racial/ethnic minority communities that appear to buffer adverse neighborhood influences and keep teenagers from starting to smoke in the first place.
Another recent study shows that family environments continue to strongly influence smoking.6 Although a smaller share of young people now smoke than in their parents’ or grandparents’ generations, having a parent who smokes remains strongly linked to smoking among young adults, a team of researchers shows.
Elizabeth Vandewater, Seoung Eun Park, Felicia Carey, and Anna Wilkinson of the University of Texas at Austin, analyze PSID data for 1968 to 2011 and show that having a parent who smokes doubles the odds a young adult will also smoke. But they find that having a grandparent who smokes is not linked to a young adult smoking unless the parent also smokes.
They conclude that smoking is passed from one generation to their direct offspring, likely reflecting both exposure in the household and shared genetics. Prevention programs that target families may be able to address the environmental influences that lead young people to start smoking and provide some protection for those who are genetically predisposed to nicotine addiction, they suggest.
This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded population research centers was highlighted in this article: University of Wisconsin-Madison, University of North Carolina at Chapel Hill, Princeton University, Columbia University, University of Colorado, University of Washington, and University of Texas at Austin.