You probably don’t think of smoking as an equity/social justice issue. But a quick glance at the map of where Orange County folks light up strongly suggests it is.
There are hardly any smokers in the wealthy ocean-view swaths of Huntington Beach, Newport Beach, Laguna Beach and Dana Point, or in highly educated Irvine, or in much of south O.C.
U.S. Centers for Disease Control
Instead, heavier smoking is concentrated in the less-wealthy central and northern reaches, including in Santa Ana, Orange, Garden Grove, Anaheim and Fullerton. In the heaviest central Santa Ana neighborhood, 17% of adults were lighting up, according to data from the U.S. Centers for Disease Control.
The higher smoking rates in cities like Garden Grove are driven by lower socioeconomic status and a largely Asian-immigrant population, said David Timberlake, associate professor of population health and disease prevention at UC Irvine.
“Residents originally from Vietnam, for example, have one of the highest smoking rates in California,” he said.
Even so, O.C.’s heaviest-smoking areas pale in comparison to swaths of the Inland Empire and Los Angeles counties. In several Long Beach and Los Angeles tracts, smokers comprised about one of five of every adults, and in slivers of San Bernardino, more than one of every three adults.
U.S. Centers for Disease Control
But step back to ponder the continental United States as a whole, and most of California’s heaviest smoking areas wash out. In most neighborhoods in the poorest states — Louisiana, Mississippi, Arkansas, Alabama, Tennessee, Missouri, West Virginia — at least one of every five adults is a smoker. (The darkest brown areas of the map mean at least 19.3% are smokers.)
The national average is 15.8%. Overall in Orange County, 9.2% are smokers; in Los Angeles County, it’s 11.2%; in Riverside County, 11.5%; and in San Bernardino County, 12.3%, according to the CDC data.
R.J. Renolds’s new, non-menthol Newport cigarettes are displayed for sale at a store in San Francisco’s Mission District on Jan. 7, 2023. Antismoking advocates criticized the marketing campaign as an attempt to circumvent the state’s ban on flavored tobacco products. (Aaron Wojack/The New York Times)
Though smoking has plummeted over recent decades — in 1965, 42% of adults smoked, including my parents — it remains the nation’s leading cause of preventable disease, disability and death, according to the CDC.
That’s some 3,000 deaths a year in Orange County, and some 40,000 statewide, attributed to smoking. It costs California some $15.4 billion a year, according to data crunched by the Campaign for Tobacco Free Kids.
Dr. Regina Chinsio-Kwong, county health officer with the Orange County Health Care Agency, said that the Tobacco Use Prevention Program has helped reduce use by focusing on youth prevention, expanding smoke‑free protections, limiting access to tobacco products, running media campaigns and providing cessation services.
Those moves, along with statewide measures — raising the tobacco sales age to 21, increasing tobacco prices, restricting flavored tobacco sales — has pushed tobacco use down across many cities throughout Orange County, she said. Some areas, however, continue to have higher rates, due to a complicated combination of factors.
Smoking, the U.S. National Cancer Institute and World Health Organization found, is responsible for a significant share of the health disparities between the rich and poor worldwide.
Big expense
The link between lower incomes and higher smoking poses quite a conundrum.
In addition to being deadly, tobacco is expensive. A single pack of cigarettes averages nearly $12 in California — far less than in New York, where a pack is $14.55, but far more than in North Carolina, where a pack is $7.95, according to Tobacco Insider.
The American Lung Association says the average daily smoker smokes 15 cigarettes a day.
Sforza’s mom, Marie, was a lifelong smoker. She died four days shy of her 69th birthday from lung cancer.
That’s 5,475 cigarettes a year.
With 20 cigs to a pack, that’s 273 packs.
And at nearly $12 a pop here in California, we’re talking some $3,200 a year, which approaches 10% of earnings for our region’s lower earners.
Smoking is heavily associated with poverty and less formal education, myriad studies have found.
Adults without high school degrees smoke at a rate of 18.3%, according to data from the American Lung Association. Adults with an undergraduate degree smoke at a rate of 4.4%.
Nearly 20% of people living in poverty smoke cigarettes, and they smoke more heavily, and for nearly twice as many years, as those with higher family incomes, the American Lung Association said.
Why do less wealthy people smoke more when they can least afford it?
Experts chalk it up to the burden of chronic financial and other stresses; cultural habits and histories; and, perhaps insidiously, targeted tobacco company advertising in poorer neighborhoods. Those neighborhoods have a higher density of tobacco retailers, many studies have found.
Nicotine is a highly addictive stimulant, and addiction is a messy business. On top of the other factors working against them, poor people also tend to have less access to programs and therapies to help them quit, researchers found.
Quitting
The overwhelming majority of smokers want to quit — nearly 68%, according to one recent survey — but a mere 8.8% were successful.
Register file photo
A person holds a cigarette in this file photo.
No wonder it’s hard: Nicotine triggers the release of endorphins and dopamine — the “feel-good” hormones. But smoking (and vaping) also involve thousands of other chemicals to boost flavor and nicotine absorption, according to the NIH.
“The impact of smoking on the body is almost all-encompassing. It damages blood vessels, increasing the risk for stroke, heart disease, and heart attack; it can reduce bone density and slow the healing of fractures; it impairs the immune system and increases inflammation; it increases the risk of gum disease; it can decrease fertility in men and women; it accelerates the aging process of the skin; it increases the risk for more than a dozen cancers; and it is the most common cause of lung diseases,” says the American Academy of Medical Colleges. 
No matter how long a person has smoked, quitting will improve health almost immediately. The FDA found that carbon monoxide levels, which can displace oxygen to vital organs, can drop back to normal in as soon as 12 hours after not smoking.
Nicotine replacement therapy appears to be essential in kicking the habit. It allows people to wean off the stimulant tolerably.
There are several FDA-approved over-the-counter and prescription therapies including a skin patch, gum, lozenges, nasal spray and an inhaler. They boost the chances of quitting by 50% to 60%. The GLP-1 drugs that are all the rage for weight loss show promise for quieting nicotine cravings as well, researchers are finding.
I so wish my mom had tried harder. She was a lifelong smoker who couldn’t stop — even after she coughed up blood and the doctor told her that she had precancerous nodules in her lungs. When I was a kid, she’d send me to the deli on my bike to buy her cigarettes. She gave me a few extra cents for Bazooka bubble gum, and I’d pop it all in the plastic-flower-strewn basket of my gold Stingray and pedal the booty home.
She was 68 when she died in 2001. She never got to meet her grandchildren. There are so many things I wish I could ask her.
Please folks, for your health and for your wallet, try to quit. Orange County’s TUPP provides free cessation services for adults and youth through contracted providers throughout the county. Call 1-866-NEW-LUNG and/or see https://bit.ly/4sAqDfz for more help and resources.
Think of the grandchildren you may actually live to see, and that great trip you can take every year with the $3,000 you’ll save!