As smoking declines in wealthy places, it lingers more, or even rises, in poor, rural counties

Poor and working-class counties have increasingly high rates of smoking, while the smoking rates in wealthy counties continue to decline, according to a study by researchers at the University of Washington and in Germany, published in Population Health Metrics. In particularly poor places like Clay County, Kentucky, where only 7 percent of the population has a college degree, the smoking rate is 36.7 percent in 2012, the highest in any U.S. county with fewer than 15,000 people, Sabrina Tavernise and Robert Gebeloff report for The New York Times. (NYT map: Adult smoking rates for U.S. counties. To view the interactive version click here)

The study, which evaluated federal survey data from 1996 to 2012 "found that affluent counties across the nation have experienced the biggest, and fastest, declines in smoking rates, while progress in the poorest ones has stagnated," Tavernise and Gebeloff write. "The findings are particularly stark for women: About half of all high-income counties showed significant declines in the smoking rate for women, but only 4 percent of poor counties did, the analysis found."

Education also plays a role in smoking. "Americans with a high school education or less make up 40 percent of the population, but they account for 55 percent of the nation’s 42 million smokers," Tavernise and Gebeloff write. The smoking rate among adults has decreased 27 percent since 1997, but only 15 percent among poor people, and rates have not changed at all for adult smokers living in deep poverty in the South and Midwest.

“Smoking is leaving these fancy places, these big urban areas,” said Ali H. Mokdad, a researcher at the UW's Institute for Health Metrics and Evaluation and an author of the study. “But it has remained in these poor and rural areas. They are getting left behind.”(Read more)