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The income gap for smokers
There's a growing income gap between those who smoke, and those don't. - photo by JJ Feinauer
Just over 17 percent of all American adults smoke tobacco products, according to the Centers for Disease Control and Prevention.

While that might seem like a pretty large number (approximately 42 million people), it's one of the smallest percentages in the industrialized world. America, it appears, is making major strides to curb its smoking habit.

But that's not true across the board. According to Bloomberg View's Peter R. Orszag, there's an income gap developing when it comes to smokers vs non-smokers in the U.S.

"Over the past several decades, smoking rates have fallen sharply among high-income, highly educated Americans and not as much for less educated, low-income people," Orszag wrote Tuesday. "The result is that, in 2013, the smoking rate exceeded 20 percent for people with a high school degree or less while among those with a graduate degree it was just 5.6 percent."

According to Orszag, the best way to close this gap may be for employers to help their workers drop the vice through incentives. He cites a recent study published in the New England Journal of Medicine that found that employees who were rewarded with money actually showed positive signs of quitting.

The study compared "reward-based" incentives, in which participants were given money based on their ability to kick their smoking habit, and "deposit-based" incentives, in which participants paid a sum up front and were guaranteed a return on their deposit if they quit smoking. According to the research, reward based had substantive positive results, whereas deposit-based tests were less successful.

"The need for new approaches is clear because smoking remains the leading cause of preventable illness and death," the researchers concluded in the discussion portion of their paper. They also argued that "incentives that build on participants loss aversion may meaningfully change behavior."

According to the Centers for Disease Control and Prevention, 16 million Americans suffer from diseases related to smoking, and smoking remains the leading cause of preventable death in the United States.

And as Orszag pointed out, those numbers get even worse the smaller your income is.

"Reducing smoking among any group of employees is a good thing, and companies should act on this new research," he argued. "At the same time, it is reasonable to be concerned about the gap in smoking rates by socioeconomic status, which is one of the forces widening the gaps in life expectancy by education and income."

According to The Washington Post's Keith Humphreys, there's a whole swath of reasons why people in lower-income brackets tend to smoke at higher rates, including the social experience in the workplace.

"Because income tends to segregate where people work and live, poor smokers often have to make quit-attempts alongside people who are continuing to smoke," Humphreys explained in an article last year, "but wealthier smokers usually do not."

Another factor, according to pediatricians Megan Sandel and Rene Boynton-Jarrett, is that tobacco companies specifically target low-income neighborhoods.

"It is easy to blame people in poverty for making bad choices," they wrote at last year. "But it's more complicated than that. Tobacco companies target these communities to encourage the habit, and the stresses of living in poverty and sometimes hopelessness also cause people to turn to cigarettes."

That's why Orszag, Sandel and Boynton-Jarrett call for stronger efforts for structural changes to offset the vulnerabilities of those in poverty when it comes to smoking.

"To prevent smoking and keep young people from starting, it will take more than public health messages," they continued. "It will require changing our economic policies to improve our neighborhood living conditions. People need well-paying jobs and safe communities to reduce the stress that often underlies smoking."
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