Women and Smoking: An Interdisciplinary Examination of Socioeconomic Influences

The dramatic decrease in smoking prevalence that has occurred over the past half century in the major industrialized countries has not been evenly distributed across all subgroups of smokers. In particular, young adults, disadvantaged individuals, and women have experienced proportionally smaller declines in smoking (e.g., Graham et al., 2007). Indeed, during this period of decline in overall smoking prevalence, disadvantaged women have come to make up an increasing proportion of the shrinking population of current smokers. While following a somewhat different pattern, overrepresentation of women and the socioeconomically disadvantaged is an emerging problem in less developed countries as well (Graham, 2009). The overarching aim of this Supplemental Issue of Drug and Alcohol Dependence is to increase scientific understanding of the extent to which socioeconomic disadvantage increases risk for smoking among women, elucidate potential processes involved in that relationship, and explore implications for improving the effectiveness of treatment and prevention interventions and tobacco-control policies. Cigarette smoking began as an activity of status among more affluent, culturally influential men, and later, women (e.g., Brandt, 2007). However, as the adverse effects of smoking came to be recognized, the more affluent largely quit or refrained from starting smoking; rather than denoting high social status, smoking has now come to represent socioeconomic disadvantage. This pattern is not unique to cigarette smoking or to women. For example, a similar pattern occurred in the most recent U.S. epidemic of cocaine use and dependence (e.g., Meich et al., 2005). There too drug use began among the more affluent social trend-setters, but as cocaine's considerable potential for producing dependence and other adverse effects came to be recognized, use among the more educated and affluent decreased. Similar to the trends observed with smoking, cocaine use in the U.S. is now a public health problem with greater concentration among the disadvantaged as a larger proportion of those with higher socioeconomic status have either quit using or refrain from ever initiating use (Harder and Chilcoat, 2007). Recognizing that any adequate scientific account of such a complex intertwining of socioeconomic status, gender, and substance use will almost surely have to be interdisciplinary in nature, we invited contributions from a range of different disciplines involved in the study of smoking and other substance use disorders (behavioral pharmacologists, epidemiologists, molecular geneticists, psychologists, sociologists, among other experts). By intensively examining smoking among disadvantaged women from an interdisciplinary perspective, we hope to advance scientific understanding of this specific public health problem but, to a more limited extent, socioeconomic disadvantage and risk for other substance use disorders as well. The major contribution of this interdisciplinary effort is the inclusion of more behavioral, biological, and individual-level science to go along with the population-based analyses that have largely defined the study of socioeconomic status and health. Indeed, it is this broader, interdisciplinary approach to the topic of smoking among disadvantaged women that distinguishes this Special Issue from earlier publications on this topic (e.g., Journal of Epidemiology and Community Health, 2007).