Tobacco control policies need to explicitly protect the most vulnerable people, particularly children.
The tobacco epidemic’s impact is fundamentally unequal. To find more customers, the tobacco industry markets its products aggressively to women and children. Furthermore, in most countries, individuals with lower incomes and less education are far more likely to be tobacco users, and to pay a steep personal price for their addictions through poor health and the misallocation of precious resources to addictive tobacco products. In 24 countries, more girls than boys are now smoking tobacco, which foreshadows a major and ominous shift in who is using these deadly products.
Tobacco-related deaths are more common in people with lower socioeconomic status. In South Africa, mixed race men tend to be of lower socioeconomic status than white men.
Saulyte J, Regueira C, Montes-Martinez A, Khudyakov P, Takkouche B. Active or passive exposure to tobacco smoking and allergic rhinitis, allergic dermatitis, and food allergy in adults and children: a systematic review and meta-analysis. PLoS medicine. 2014;11(3):e1001611.
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 Atlanta, USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on SMoking and Health 2014.
Tobacco smoke can affect brain cells adversely. Several studies have shown atrophy of grey matter in smokers’ brains, which may make them more susceptible to dementia. Also, children born to mothers who smoked during pregnancy may have neural alterations similar to those in children with attention-deficit/hyperactivity disorder.
Fritz HC, Wittfeld K, Schmidt CO, Domin M, Grabe HJ, Hegenscheid K, et al. Current Smoking and Reduced Gray Matter Volume – a Voxel-Based Morphometry Study. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2014.
Holz NE, Boecker R, Baumeister S, Hohm E, Zohsel K, Buchmann AF, et al. Effect of Prenatal Exposure to Tobacco Smoke on Inhibitory Control: Neuroimaging Results From a 25-Year Prospective Study. JAMA psychiatry. 2014.
Families with low socioeconomic status may be more likely to be exposed to secondhand smoke at home.
Partial ban: smoking was allowed in certain areas and/or at certain times only.
Wei X, Zhang Z, Song X, Xu Y, Wu W, Lao X, et al. Household smoking restrictions related to secondhand smoke exposure in guangdong, china: a population representative survey. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2014;16(4):390-6.
In 2007, South Australia became the first Australian state to ban smoking in cars in which children were travelling. “While it is an adult’s right to choose to smoke and expose themselves to all the associated and well-known health risks, this ban aims to protect children who could not otherwise protect themselves.” –Katy Gallagher, Chief Minister of the Australian Capital Territory, 2012
While only one third of parents reported that their children were exposed to secondhand smoke, laboratory tests confirmed that, in reality, 80% of children brought to a hospital (Cincinnati Children’s Hospital Medical Center) in the United States for asthma or breathing problems were exposed to secondhand smoke. These findings indicate that many respiratory diseases that might not be linked to secondhand smoke based on self-reports may in fact be related to the exposure.
Suza in Kasungu district and Katalima in Dowa district of Malawi: 2008
63% of children of tobacco-growing families were involved in child labor.
10–14% of children from tobacco-growing families are out of school because of working in tobacco fields.
16% of parents said their children were out of school because of an inability to pay educational fees and buy uniforms and shoes.
Lack of education drives individuals further into poverty.
“…when child and maternal mortality are falling universally around the world, the threat of a rise in tobacco is heading in the wrong direction…The developing world is about to enter a phase of rapid growth in tobacco at a time when it can least afford it” –Keith Hansen, The World Bank Group, 2012
Hansen K. Remarks by Mr. Keith Hansen, Director of Human Development for Latin America and Caribbean – The World Bank Group: The Tobacco Atlas DC Launch. D.C., USA: The National Press Club; 2012.
“The yawning poverty gap in smoking exacerbates existing, and unconscionable, health disparities. Endgame strategies, therefore, must pay particular attention to the least advantaged, focusing on the equitable distribution of benefits. What justice requires is that the poor do not feel the blowback of the last blasts in the war against Big Tobacco” –Keith Hansen, The World Bank Group, 2012
“One [hypothesis] is the greater concern women have that if they stop smoking they will gain weight. THIS FEAR UNDOUBTEDLY PREVENTS MANY WOMEN from desiring to stop smoking.” –Lorillard 1973
Water pipe use is especially difficult to confront because it often happens in homes, away from where traditional social pressures and policy interventions like smoking bans can have an impact.
We calculated the proportion of all tobacco users who engaged in water pipe use. We want to emphasize that women in Middle Eastern countries who are frowned upon for using cigarettes, as they are a form of tobacco typically consumed in public, are more likely to pick up water pipe use. I’m showing that when women choose to smoke tobacco they often use water pipe at a higher rate than their male counterparts. This does not mean that women smoke more water pipe than men, but simply that among those women who smoke, water pipe is disproportionately popular.
Baheiraei A, Mirghafourvand M, Nedjat S, Mohammadi E, Mohammad-Alizadeh Charandabi S. Prevalence of Water Pipe Use and Its Correlates in Iranian Women of Reproductive Age in Tehran: A Population-Based Study. Med Princ Pract. 2012;21(4):340–4.
A U.S. study found that nearly three quarters of children aged 7-17 who were laboring in tobacco fields in the USA experienced symptoms of green tobacco sickness.
This is ironic as it is illegal for children under 18 to purchase cigarettes, yet they can be employed in tobacco fields and experience illness from their labors.
In 2013, Cancer Research UK (CR UK), the UK’s country’s largest health charity, produced shocking video clips of young schoolchildren examining various packets of cigarettes. Tellingly, a red pack reminded one boy of Ferrari (whose Formula One racing cars are sponsored by Marlboro); two boys likened a bright yellow pack to the sun, one adding, ‘it makes you almost happy just by looking at it.’ And a girl clearly loved a pink pack so much that she cuddled it, enthusing to her neighbour, ‘Pink, pink, pink!’
2013 US charitable contributions from the Altria Companies, in millions, USD
Tobacco company charitable giving is small compared to profits and creates a conflict of interest when donated to youth or healthcare organizations.
Donations from Philip Morris International (PMI); 2009 – 2013
Donations from Philip Morris International (PMI); 2009 – 2013