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    Lower-income, less-educated people lagging when it comes to quitting smoking

    Jessica Rinaldi/Globe Staff

    A new report from the American Cancer Society finds there’s been progress in reducing smoking but some groups in the American population, including lower-income and less-educated people, are lagging when it comes to quitting the deadly habit.

    The overall smoking rate in the United States has declined from 42 percent in 1965 to a little less than 16 percent in 2016, researchers for the ACS said, “but the high prevalence of cigarette smoking among vulnerable populations is one of the most pressing challenges facing the tobacco control community.”

    The researchers published their study in CA: a Cancer Journal for Clinicians.


    The study found that 6.5 percent of college-educated people continued to smoke, while 23.1 percent of those with a high school education or less smoked, the organization said in a statement.

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    The higher a person’s income the more likely they are not to smoke, the organization said. In 2015 and 2016, in households with incomes greater than 400 percent of the federal poverty level, only about 10 percent of adults smoked. The story was far different for those households below the poverty line, where about 25 percent smoked.

    People struggling with mental illness are more likely to smoke. The percentage of people who had a serious mental illness in the past year and reported they smoked was 27.9 percent, compared with 12.9 percent for those without a mental illness, the organization said.

    The researchers also found higher rates of smoking among lesbian, gay, bisexual, and transgender people. Studies have shown the social stress LGBT individuals endure contributes to more smoking. The group has also been targeted by the tobacco industry, which places advertisements in community media, sends representatives to pride festivals, and promotes their products in LGBT bars, the organization said.

    Individuals of American Indian or Alaskan Native descent have the highest smoking prevalence among racial and ethnic groups, 24.3 percent for men and 23.4 percent for women. And smoking among the women in the group recently turned upward after two decades of decline, the organization said.


    Smoking in the military has dropped from more than one-half in 1980 to 24 percent in 2011, the organization said. But the progress has been uneven. The researchers noted disparities by pay grade, with about 30 percent of the people in the lowest four pay grades smoking, compared with less than 5 percent smoking among the highest six pay grades of commissioned officers.

    The study also found disparities by geography, noting a range of smoking from 8.7 percent in Utah to 26.2 percent in Kentucky.

    “There is a smoking belt leading from Michigan to Mississippi, including several adjacent states in the Midwest and Appalachia, where smoking prevalence is substantially above the national average,” the organization said.

    The non-profit Truth Initiative calls this “Tobacco Nation,” and points to factors including the “policy, culture, and the strong and persistent influence of the tobacco industry in this region,” the organization said.

    “More attention to and support for promising novel interventions, in addition to new attempts at reaching these populations through conventional interventions that have proven to be effective, are crucial going forward to find new ways to address these disparities,” the study said.


    “How do we reach these populations better? How do we reach low-income people, low-education people, and folks with mental illness more effectively? It’s obviously something we here at the American Cancer Society think about a lot,” said researcher Jeffrey Drope.

    Smoking is the leading cause of premature, preventable death in America, causing about 480,000 premature deaths each year, according to the US government. It causes deaths from cancer, heart disease and stroke, and lung disease.