Friday, April 11, 2014

Cigarette Smoking as an Indicator of Poverty

I was an underage cigarette smoker. One had to be 19 to purchase cigarettes legally in the state of Alabama, but I found ways to circumvent the law. I was 15. If I couldn’t find them by less exhaustive means, there were always cigarette vending machines to target as inconspicuously as possible. The city council and the mayor’s office were aware of the activity of kids like me, and within two or three years they would ban vending machines for good. By then, I was able to legally purchase them myself.

The habit was picked up from my first job in a supermarket. A shy teenager, I’d never seen any reason to partake, though I'd been told numerous times that smoking would kill me. Applying for the job as grocery sacker and all-purpose laborer had been my father’s idea. In the blue collar, rural county where he grew up, a job at a grocery store was a coveted prize. Pitching the idea to me, Dad talked about how he’d badgered the general manager of a local store for a year before being given the job. The lesson taught was that of persistence, a sentiment admirable enough, but the context was totally wrong.

He didn’t realize that in a suburban setting, there were always low-paying jobs available. I was hired on the spot and promised minimum wage, which was then $4.75 an hour. The only thing I learned of value fell under the category of vice, not the value of hard work and self-sufficiency preached to me. I was taught how to steal behind the backs of my bosses, which was easy, though I never did. Part of my job responsibilities involved taking cartons of cigarettes and placing each pack one-by-one in racks. This was an excellent way to accidentally retain a pack or two for oneself.

I never stole, as I said, but other workers gave me a pack or two on occasion to share the wealth between us. A safer way was to bribe the butcher, who would buy a pack for you, provided you added an extra dollar or two to the total. These were, as has been noted by a clever writer, back in the days of Kurt Cobain and $2.50 per pack cigarettes. Alabama kept its sin taxes low out of deference to the tobacco lobby. I smoked for the next ten years, but quit several years ago and have never resumed the habit.

I write this lengthy introduction to speak to some new discouraging statistics. In some Alabama counties, cigarette smoking remains persistently high. I'm sure this is true throughout the entire country. Unsurprisingly, the poorest counties have the highest rates of tobacco usage. Statistically speaking, men smoke more than women, but when I was a smoker myself, the rates based on gender seemed to be equal. Male smokers have declined slightly over time, but curiously, more women have begun to use tobacco products.

For years, it was considered unladylike for women to smoke cigarettes. At the turn of the last century, an acceptable form of tobacco usage for women was to dip snuff. My great-grandmother was one of these. The flappers of the Twenties flaunted social conventions by smoking publicly. The increase among women may be another sign that gender equality is growing ever closer. I don’t champion this distinction for health reasons, obviously, but it is worth taking into account.

People in poverty often self-medicate. They may not be informed about healthier options. When I was a smoker, I found that nicotine provided a calming effect for my bipolar disorder and anxiety. When hospitalized for either depression or mania, nearly 100% of my fellow patients, myself included, lived for our hourly smoke breaks. Though these days I tend to judiciously avoid the smell of smoke when waiting at the bus stop, I’ll never come down harshly on anyone who keeps the habit.
In my father’s county of origin, smoking rates remain persistently high. According to recently released data from the University of Washington’s Institute for Health Metrics and Evaluation, Chambers County, Alabama, reflects the results of persistently stagnant wages and not much in the way of opportunity. In 2012, rates of total smoking, opposed to daily smoking, are at slightly over 28%. Sixteen years before, in 1996, these same rates were less than a percentage point higher. Stats like these reveal much, but poverty is the metric by which I choose to view these persistently unhealthy indicators.

In the cities and the more affluent areas, we continue to slowly move towards an eventual ban on tobacco products. We’ve banned smoking inside clubs, restricted where tobacco products can be sold, and expressed our societal disapproval. One might think that these efforts were enough, but even informed consumers can ignore how unhealthy cigarette smoking really is. I did, though my motives were mainly because of the ancient combination of peer pressure and teenage rebellion. I could take a paternalistic stance about this, but that would ignore the complexities.

I didn’t have much in common with those who put frozen food in its appropriate place or scanned groceries. Everyone I knew smoked. No one ever told me to stop or reminded me that I was still many years underage. They were more insistent that I learn to snuff out my cigarette butt in the ashtray the proper way, so that it wouldn’t continue to burn, flooding the breakroom with blueish smoke. Our gaze must focus beyond our righteous indignation before we can even begin to understand the problem.

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