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7 Reasons Why So Many People Still Smoke

Poverty kills.

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With smoking banned in so many public spaces, it’s easy to think this unhealthy habit isn’t such a problem anymore.

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And you wouldn't be completely wrong. Only 17% of people in the United States reported being smokers in 2014, compared to 42% of people in 1965. It's even down among teens. According to a recent report, only 11% of high schoolers smoked cigarettes once in the past month, and just 2.3% said they smoke daily.

It's possible this dip can be attributed to more smoking bans, increased taxes on tobacco products, and a heightened awareness of the dangers of nicotine.

But just because it's less popular doesn't mean it isn't still a huge problem.

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It’s still considered the leading cause of preventable death in the US, responsible for 438,000 deaths each year, according to the American Lung Association. And while that's obviously one of the biggest reasons to quit, there are so many other reasons that people choose not to.

To understand what’s really motivating people to keep on smoking, BuzzFeed Health spoke to behavioral scientist Scott Leischow, PhD, professor of health services research at the Mayo Clinic, and smoking cessation researcher Dr. Diana Stewart Hoover, assistant professor in the Department of Health Disparities Research at the University of Texas MD Anderson Cancer Center. Here are the primary factors that contribute to smoking's hold on America.

1. Poverty is one of the biggest predictors of smoking.

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“When we look at the prevalence of smoking, the prevalence tends to be highest in the lowest income groups,” Leischow told BuzzFeed Health. “It’s really regressive in the sense that you've got people who can least afford to buy cigarettes having the highest prevalence.”

It’s true: 26% of people who live below the federal poverty level smoke cigarettes, compared to 15% who live above it, according to the Centers for Disease Control and Prevention (CDC). The confounding variable here is most likely stress, Hoover told BuzzFeed Health.

Tobacco companies are aware of this and often focus their marketing efforts on poorer neighborhoods, with price promotions and an abundance of stores that carry cigarettes, says Hoover.

2. Peer pressure — or societal pressure, at least — still exists.

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Smoking is simply more accepted in certain environments. While corporate companies and office buildings usually discourage smoking, that's not necessarily the case for people who work independently or outside, says Leischow. "That’s one of the challenges; how do we go about increasing the notion that smoking is not encouraged across all different strata of society?”

He pointed to the US Department of Housing and Urban Development, which has begun providing smoke-free multi-family housing to low-income families in hopes of reducing exposure to secondhand smoke — something that Leischow says may help to change the social norm for the next generation.

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3. A lack of education seems to play a big role.

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As education level rises, smoking rates drop; just 5% of people who have a post-doctorate degree smoke, compared to 43% of people with a GED. Again, socioeconomic factors could be at play here, but it's also possible that people with lower education levels are unaware of the risks of smoking, said Hoover. "They might think it’s associated with lung cancer, but not that it’s associated with the incidence of a lot of other types of cancers as well.”

Likewise, people who want to quit might not even know where to start, Hoover said. “In some of the work that we’ve done, we’ve found that even when they realize the risks associated with smoking, sometimes the barriers to quitting just seem to be so great. A lot of times, I don’t think people are generally aware of the smoking resources that do exist, and that’s something that I think there have been great efforts toward… but we still have a lot of work to do in that area.”

4. And so does insurance.

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In 2014, about twice as many people without health insurance or Medicaid were smoking, compared to those who had health coverage. These people are also more likely to have the lowest incomes, Leischow said, noting that if they were to come down with lung disease, heart disease, or some type of cancer, they’d be least able to afford it.

What’s worse is that “many times these individuals end up being diagnosed with smoking-related illnesses later down the line, when things have progressed more than they would” among people who are covered, Hoover said. In other words, it’s the goddamn apocalypse of situations.

Thankfully, Obamacare has given many of these people health coverage that includes programs for quitting smoking, Leischow said. “If they do get insurance, the law says that they have to be offered smoking cessation treatment at no cost… and that includes not just behavioral treatments but medications, too.”

5. Mental illness can lead many to self-medicate with cigarettes.

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The data shows that people who have a mental illness are more likely to smoke, says Leischow. “There’s speculation that some of them may be smoking to self-medicate. We know that when a person smokes, it has an impact on their brain. It makes people feel better. It calms them down a bit. It elevates mood.”

The temptation to self-medicate may also be stronger for people who lack access to health coverage.

6. Tax-free cigarettes are still available on Indian reservations in the United States.

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The price of cigarettes is typically lower on Indian reservations, since they are considered sovereign land, exempt from local and state taxes. And that's dangerous when it comes to cigarettes, which sell more when they’re taxed less, Leischow said, pointing to a University of North Carolina study. And it just so happens that American Indians and Alaska Natives smoke more cigarettes than any other ethnic group.

“You see that in [New York City], which significantly raised the price of cigarettes, that it contributed a great deal to a lot of people quitting smoking,” he said.

7. It's just hard AF to quit.

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“For many people who are smokers, quitting smoking will be the hardest thing they’ll ever do. Of course, the most meaningful thing they could do too...in terms of their health status and longevity,” Leischow said.

Part of that is because commercial tobacco has been processed to “increase the potential of rapid delivery of nicotine, [which] gives it a higher addiction potential," explained Leischow. And while everyone describes quitting differently, all of the stories typically include withdrawal symptoms (like “having an itch you can’t scratch because you don’t have hands”) and finding ways to rationalize smoking just one more cigarette.

But as hard as it is, both Leischow and Hoover agreed that it's possible with the right tools to help you both mentally and physically. So, if you’re dealing with addiction and want to quit, talk to your doctor or check out SmokeFree.gov, which has a bunch of resources including free apps and live help.