Feature

What’s the point in stopping?

What is it about being poor — and a young woman — that increases the likelihood of smoking, asks Patti White

On the face of it, it is strange that the poorest members of the community, whose health is already harmed by social and economic disadvantage and who have the most to gain by not smoking, are more likely to smoke than the better-off. A new report from ASH, Her Share of Misfortune: women, smoking and low income, examines what it is about living in constrained economic circumstances that shapes smoking behaviour. It tries to unpack some elements of people’s lives that determine their smoking habits.

Two clear trends emerge from the changing pattern of smoking in the UK. First, differences in the proportions of men and women who smoke have narrowed considerably. For most of this century, using tobacco has been a male habit, but by 1990 the gap between men’s and women’s cigarette smoking had almost disappeared, with about 31 per cent of men smoking compared with 29 per cent of women. This parity is most clear in younger age groups. Among adolescents and teenagers, girls are now more likely than boys to become regular smokers.

Smoking is also increasingly associated with living in the UK’s poorer communities and households. Thirty years ago smoking had no clear social class connotations. In 1958 a little over 40 per cent of women from all social classes were smokers, but by 1988 the proportion of women from manual-occupation households who smoked (34 per cent) was a third higher than those from non-manual households (25 per cent).

Where these two trends come together - among younger, relatively poorer women - there is evidence that smoking is much more prevalent than among women as a whole. Some small area studies, in regions of the UK where unemployment is high, have shown the proportion of women who smoke to be 70 per cent or greater.

What is it about being poor that increases the likelihood of smoking? While there has been a shocking lack of research into the relationship between social disadvantage and smoking, Hilary Graham has pioneered investigations into this area; it is largely upon her work that the ASH report is based. What Graham’s research indicates is that women’s smoking behaviour is determined not only by knowledge but also by the everyday circumstances of their lives. She says it is how women live, rather than what they know, that governs their smoking.

Life for women on low incomes can be characterised as a struggle to make ends meet. For those who rely on Income Support living standards are low. For example, in 1988 the Maternity Alliance estimated that an adequate diet for a pregnant woman would cost £14.06 a week - 54 per cent of the then total weekly Supplementary Benefit for a single woman aged between 18 and 24.

Having studied patterns of household expenditure among those on low income, Graham argues that smoking is the one exception to the rule by which poor women manage their family’s slender means. Priority is given to collective necessities such as rent, fuel and food. It is these obligations, and those of fixed costs, such as rates or debt repayments, that are met first.

In order to meet these demands, women will cut back in other areas. These are frequently those where mother and children are participating in the world outside the home, for example clothes and toys, public transport, outings or holidays and playgroups. For some women, cigarettes may be the only thing that they buy for themselves alone. In a life of relative poverty, smoking may represent both a necessity and the luxury of participating in the lifestyle of mainstream society.

Two lone mothers interviewed by Graham explained: ‘I try to cut down to save money but cigarettes are my one luxury and at the moment they feel a bit like a necessity.’

‘I think smoking stops me getting so irritable. I can cope with things better. If I was economising, I’d cut down on cigarettes but wouldn’t give up. I’d stop eating... Food isn’t that important to me but having a cigarette is the only thing I do just for myself.’

If smoking is part of the way some women cope with poverty, it is likely to be a habit that is deeply ingrained in the fabric of their lives. Clearly, the sorts of compensations that the better-off allow themselves for giving up smoking - spending the money they save on cigarettes on little luxuries, or saving for a holiday - are not really an option for the poor. Smoking plays a different, more central, role in their lives and the immediate benefits of giving it up are hard to see.

What can be done to create conditions that will make not smoking an easier option for poorer women? Current tobacco control policies and health education initiatives do not in themselves fully address this need. Policies that have helped to decrease smoking among the better-off have failed to take account of the needs of poorer women. Those who wish to promote better health for the whole population, not merely for the more fortunate, must radically rethink present policies and forge new alliances with those acting to combat poverty. We cannot be concerned about women’s smoking without being concerned about the women themselves. Their health and welfare are bound inextricably together.

Her Share of Misfortune is £3.95 and available from ASH, 109 Gloucester Place, London W1H 3PH.