A working paper released in June by the National Bureau of Economic Research suggested an interesting effect of pay raises for low-wages workers: a higher minimum wage is associated with healthier infants. The authors suggest part of the reason is that women with very low incomes are more likely to smoke during pregnancy.

Today, at least in North America, the poor are much more likely than the rich to smoke. Given that cigarettes are expensive as well as deadly, some commentators point to this as a sign of a character flaw shared by many people who live in poverty. But the NBER paper, along with two articles published by the Canadian Journal of Public Health, suggest a different way of looking at it.

In one of the papers, published in 1996, a team of researchers led by Miriam J. Stewart conducted focus groups and interviews with hundreds of smokers who were “priority women”—defined as those facing disadvantages like unemployment, poverty, or a lack of social support.

They found that the women were well aware of the health effects of smoking and recognized it as an addiction. But they often found it impossible to stop and, in many cases, didn’t see quitting as a priority. The reason, researchers found, was that smoking gave them something they needed: a way to cope with stress, fear, anxiety, and anger, and a tiny, pleasurable reward they could enjoy.

“Because of the pressing nature of priority women’s living circumstances… they were caught in a daily struggle for survival,” the authors write. “Consequently, the long-term benefits of quitting had little relevance from their perspective.”

The women were “either antagonistic or ambivalent toward tobacco control measures (e.g., increased taxes, smoking restrictions, anti-smoking messages) and believed that other issues such as poverty, abuse and alcoholism were more damaging to society than smoking,” they added.

The second paper, published by Kit-Ngan Young-Hoon in 2012, looked at poverty and smoking from a different angle, using a large national health survey to seek connections between income and smoking. They found that, overall, an increase in household income didn’t have an effect on smoking rates. What did make a difference was an increase that lifted smokers out of poverty. When a person’s household income rose from below the poverty line to above it, their chance of quitting rose 28 percent.

The new NBER paper points to the significant consequences of that kind of change, and suggests that if we want to help people stop smoking, and have healthier kids, the best way to do it might be simply to get more money into their pockets.

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Canadian Journal of Public Health / Revue Canadienne de Santé Publique, Vol. 103, No. 3 (May/June 2012), pp. 189-194
Canadian Public Health Association
Canadian Journal of Public Health / Revue Canadienne de Santé Publique, Vol. 87, No. 4 (JULY / AUGUST 1996), pp. 257-260
Canadian Public Health Association