Unfair and Unjust Practices and Conditions Harm People with Low Socioeconomic Status and Drive Health Disparities

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Some policies and practices have led to mental and physical health risks and challenges, and related long-term health outcomes, for people with low socioeconomic status (SES). For example:

People with low SES have been harmed by unjust practices related to the sale of commercial tobacco*. Tobacco companies have a long history of using samples and giveaways to entice people with low SES to try and use their harmful products. For example, tobacco companies have handed out free cigarettes to children in public housing complexes, homeless shelters, and soup kitchens.8,9 They have also included coupons for cigarettes in mailings for government food stamps.10

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Other policies and practices related to the social environment also affect health and health outcomes of people with low SES. For example:

Overhead view of a rural area

Rural communities with low SES can lack resources needed for commercial tobacco control and prevention.

  • Lower quality education is associated with lower health literacy, fewer opportunities for employment, less ability to access enough healthy food, and less access to health care, all of which negatively impact health outcomes.11 People with low SES are more likely to live in neighborhoods where most people rent (versus own their own home) and K–12 schools, funded primarily through local property taxes, are subsequently under-funded.12
  • City, county, state, and federal courts can impose fines, fees, and other forms of legal financial obligations on people for traffic violations and other minor offenses. For people without the means to pay, these legal debts can trigger serious and escalating consequences – from the loss of a driver’s license to jail time. These court-imposed fines and fees can add stress and negatively affect health outcomes for people of low SES.13,14
  • Rural communities with low SES can lack resources (e.g. financial resources, access to services), which can serve as a barrier to support for tobacco education, prevention, and cessation.15

People with low SES have also been excluded from systems meant to protect and improve health and well-being, including health care and medical science.

  • People with lower incomes have less access to health care, including affordable health care needed to address smoking-related morbidities.16 People who have unmet needs (including economic or job instability, lack of housing) are more likely to go to the emergency room (ER), to miss medical appointments, and to have unmanaged medical conditions17,18 compared to those with met needs.
  • Being uninsured is related to health care disparities. People who are uninsured may decide not to get needed clinical screening (which could include for tobacco use or cancer) and routine or recommended care due to out-of-pocket cost.19
  • People with lower incomes are more likely to experience delayed access to health care20, which can result in adverse health outcomes.21
  • People with low incomes are less likely to be included in clinical trials for new cancer treatments.22 The lack of lower income populations included in clinical trials could potentially limit knowledge of the effectiveness of treatments across all populations.
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The tobacco industry targets low-income communities with marketing and advertising

Marketing plays a big role in whether people try or use commercial tobacco products. Being around commercial tobacco ads makes smoking appear more appealing and increases the chance that someone will try smoking for the first time or start using commercial tobacco products regularly.7,23,24,25

Billboard advertising tobacco products

Tobacco products are made cheap and easy to find in areas with low income.

  • Neighborhoods where people have lower incomes tend to have more stores selling and advertising commercial tobacco.26 In neighborhoods with a lower socioeconomic status, there is a significantly higher weekly unit sales of tobacco products per tobacco retail store.27 Schools that have a larger proportion of low-income students are also more likely to have stores selling commercial tobacco near those schools.28
  • More stores selling commercial tobacco means more advertisements for products like cigarettes, e-cigarettes, chewing tobacco, or other commercial tobacco products. People who see commercial tobacco promotions in places where these products are sold are more likely to smoke.29,30 Tobacco companies target in-store marketing campaigns toward neighborhoods where most residents have low income.10
  • Tobacco companies target communities with low incomes by using use price promotions to increase sales, such as discounts, coupons and special sales.31
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Tobacco companies promote flavored products—like menthol—in neighborhoods where people of low SES live.

Menthol has a minty flavor that masks the harsh taste of tobacco. Menthol makes cigarette smoke feel easier to inhale and can make it harder to quit smoking.32,33 To attract customers, tobacco companies target low-income communities with advertising and sales of flavored cigarettes and cigars—especially those with menthol. This can help explain why people with lower income and less education tend to smoke menthol cigarettes at a higher rate than groups with higher incomes and more education.34,35

States and communities can take action to make flavored tobacco products less available.

For example, states and communities can consider increasing prices, prohibiting price discounts, and either allowing fewer stores in a neighborhood to sell commercial tobacco products or prohibiting tobacco product sales altogether.36 Prohibiting the sale of all flavors in tobacco products, including cigarettes, e-cigarettes, cigars, and cigarillos, could also help to reduce the number of youth who use these products.37

Stress can increase commercial tobacco use, and can make health problems worse

When people face many forms of stress—like financial problems, discrimination, or unsafe neighborhoods—they can be more likely to smoke.46,47,48

The pressures of poverty help explain why the health problems caused by commercial tobacco tend to be worse for people with low SES. When people have severe or long-lasting stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems like high blood pressure and type 2 diabetes.49,50 Smoking cigarettes also leads to disease and disability and harms nearly every organ of the body.7

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*“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes.
Next Section: People with Low Socioeconomic Status Need More Protection from Secondhand Smoke Exposure >
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Page last reviewed: June 27, 2022
Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion