Why are people still smoking? Don’t they know it’s bad for their health?
I hadn’t thought about those questions for several years when the CDC recently published some statistics in its Morbidity and Mortality Weekly Report. In the report the CDC documents the extent of smoking in the United States. It was one of those “You’ve got to be kidding” moments.
Almost 20% of the people in the US smoke—one out of every five. That’s a slight decline from 2005. More shocking to me is the distribution of smokers by age. The highest percentage of smoking is going on among young adults, aged 18 to 24: almost 24% smoke—one out of four. The next age group, 25 to 34, smokes almost as much. The next two age groups, 35 to 44 and 45 to 64, were a little lower—but not by much: 21% and 20% respectively. Past 65 the percentage of smokers drops like a rock to 10%—half the national average.
This is an utter failure on the part of public health institutions.
I smoked for over ten years. I quit. I was so good at it that I quit several times. It’s not so easy. So I don’t tend to feel the righteous indignation exhibited by some toward smokers of “I quit. What’s wrong with you?” Tobacco companies… That’s another story.
But I want to lay aside the issue of quitting smoking and focus instead on what interests the tobacco companies: getting customers. That’s what I find so troubling about these statistics. The statistician in me says that, if public health institutions are doing their job, the number of new smokers—the adults younger than 35—should be smaller not larger than older smokers. Why? Because the public health apparatus should have had plenty of time to prevent young people from starting to smoke. But it hasn’t. So I say they failed.
Yes, it’s true that the number of smokers has declined since it became the official policy of the United States Surgeon General and government generally that cigarette smoking can be hazardous to your health. But again I ask, why are people still starting to smoke at all?
The simple answer is that they made a deliberate decision to fire up a cigarette for the first time. So why would a kid do that? Or an adult, for that matter?
I’ve been reading the work of a social psychologist on a process called story-editing. What this means is that we all have a story or narrative in terms of which we place our actions. To light the first cigarette and keep going, someone has, for example, “cool people smoke” in her story that makes sense from her perspective and in the context in which she acts out the story she has running in her head. That story can be edited, changed to read, for example, “I don’t have to smoke to be cool.” The important point isn’t the specific example of whether smoking is cool. The important point is that story-editing is something you do for yourself—possibly with help, something we can do for each other.
But, of course, there’s more. The context in which we act out the story that’s running in our head includes a political economy in which there are, for example, anti-smoking public service announcements countering marketing campaigns by tobacco companies. You will not be surprised to know that tobacco companies outspend anti-smoking public health programs by a factor of 25—that is, for every dollar spent on an anti-smoking campaign, $25 is spent by the tobacco industry to encourage someone to take that first hit and keep on going.
I could go on, but I think you get the idea: starting and continuing to smoke has less to do with health and addiction than it has to do with our social being, the school of fish in which we cavort and who controls the pond in which we fishies swim.
Some other statistics from the CDC are revealing.
White people have the highest percentage of smokers—20% more than African-Americans, 50% more than Hispanics. Despite, I might add, heavy expenditures by the tobacco industry in communities of color. However, people who are poor are more likely to smoke by 50%. People with less than a high school education are three times more likely to smoke than someone with a college degree. Getting some college improves that a little to two and a half instead of three times. In fact, having a college degree marks a sharp cutoff: someone with a college degree is dramatically less likely to be a smoker.
“Aha!” you might think. “All we need to do is get everyone through college in order to kick the habit.” A nice thought, but hopelessly muddled. Is the education what prevents smoking? Or is it socioeconomic advantages that lead to both the degree and rejection of smoking? Or is it the personal narrative that gets someone through college and stops them from lighting that first cigarette? And isn’t socioeconomic context what makes sense of the narrative in the first place? I’m telling you, it will give you a headache. In my opinion, the simple answer is that there’s no simple answer.
Why do people still light up that first cigarette? Or take that first drink? Or first try that wireless PDA that they now can’t live without?
Because they are in a story where doing those things makes sense in their socioeconomic context. That context is controlled by political economic forces that are unprincipled and devious and interested not one bit in anyone’s story. The hope lies is the capacity of each person to edit their story, help others in editing their story, and edit the context so that stories without smoking make sense.