In some of Milwaukee's poorest neighborhoods, nearly half of all adults are addicted to cigarettes, despite the fact that prices are nearing $9 a pack while many household incomes are below $15,000.
A Wisconsin research project has revealed some surprising misconceptions that may reinforce tobacco's hold on the poor.
Dr. Bruce Christiansen of the University of Wisconsin-Madison's Center for Tobacco Research and Intervention set out to discover attitudes about smoking among a group of low-income people in Milwaukee, Wisconsin's largest city.
The "ZIP Code" project is a community-based research project that includes the Salvation Army of Wisconsin and Upper Michigan and the Vincent Family Resource Center and is supported by the UW School of Medicine and Public Health's Wisconsin Partnership Program. Through a household survey, this project interviewed 654 randomly selected smokers in some of Milwaukee's poorest neighborhoods and found powerful misconceptions about smoking. Of those surveyed:
• Forty-two percent of adults smoke.
• Smokers perceive that most others smoke, as well. Neighborhood residents estimated that an average of 73 percent of adults smoke; in reality, the number nationwide is about 20 percent, and in the case of the college-educated, less than 15 percent.
• More than 60 percent generally approved of smoking as long as it didn't affect others (for example, if one smokes outside or away from children.)
• They also overwhelmingly thought that "willpower" was the best way to quit, and didn't know about the most effective aids to quitting.
• Many (48 percent) thought that medications to help people stop smoking are more dangerous than continued smoking. And 56 percent had not heard of the Wisconsin Tobacco Quit Line that provides free coaching and a free starter kit of medicines.
• Finally, almost 38 percent had never tried to quit — a large number compared to most groups of smokers.
Christianson says that because the survey was administered in homes during weekdays, those who took the survey represented "the poorest of the poor," with 68 percent reporting household incomes of less than $15,000 a year.
"There's an ugly truth behind the good news of dropping smoking rates – while smoking rates have dropped overall, we've left some populations behind,” said Dr. Christiansen, who manages the Milwaukee research office of CTRI.
What his research turned up in Milwaukee is true nationwide: the poor, the poorly educated, those with mental illness or other addictions all smoke at rates much higher than average.
But his studies among the poor in Wisconsin also point to some solutions. For one thing, because many have never tried to quit, their numbers are likely to include those who find treatment effective. "Personally, I'm encouraged by that,” Christiansen says. "If we can just get them to use evidence-based treatment, many of them will succeed."
Another reason for optimism is that a different Wisconsin CTRI study found smokers were receptive to smoking-cessation messages delivered along with other services at the Salvation Army.
So how best to reach this group of forgotten smokers? The Zip Code project followed up with billboards, quit-smoking classes at a community center, and a national speaker who talked about how the poor are targeted by the tobacco companies.
Christiansen and his group are also creating a "tool kit" for community organizations, so when smokers come to food pantries or shelters, for example, the staff can also provide a brief message on the best ways to quit. The 13-minute intervention addresses the best methods for quitting, explains coaching and medication options, introduces the "Quit Line," and tells smokers where to get help. Early outcomes indicate that those who receive the intervention express a greater intention to quit. This research was supported by the UW Institute for Clinical and Translational Research.
"We're trying to increase people's demand for evidence-based tobacco dependence treatment,” he said, "and it looks like it may be working."
While researchers worried that aid workers wouldn't like doing the intervention, or that it would drive clients away, the opposite turned out to be true.
"We found out that people really appreciated being asked, and that the staff liked making the inquiry and providing this essential help,” he said.