The social work profession has a rich history of commitment to addressing the needs of women, people of color, children and adolescents, and other oppressed groups who are increasingly vulnerable to the harmful effects of tobacco use. Social work should consider smoking a substance abuse problem and respond to it as the addiction it is. Ironically, the profession continues to ignore a product that kills more people than any other addictive substance. Using key words such as cigarettes, nicotine, smoking, tobacco, drug abuse, and addiction, we reviewed the literature abstracted in Social Work Research & Abstracts from 1984 to 1994; remarkably, only two articles addressed the issue of smoking and its consequences (Bogolub, 1990; Valentich, 1994).
This article reviews the general literature on the health effects of tobacco, the impact of smoking on vulnerable populations, and the marketing practices of the tobacco industry. The underlying premise is that personal behavior is heavily influenced by the political and social environment and that from childhood on individuals are enticed to smoke. The article recommends a change in policy and practice - from viewing smoking not just as a public health concern that touches social work peripherally but also as a larger social problem affecting quality of life among disadvantaged populations. The authors call for political action by social workers, including coalition building, community organizing, and political advocacy.
SMOKING AND HEALTH
Tobacco use is responsible for more than 430,000 deaths annually in the United States, primarily from atherosclerotic disease, cancers, and chronic obstructive lung diseases (Brody, 1993; National Institute on Drug Abuse [NIDA], 1991). It is linked to more deaths than "alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fire, and AIDS combined" (Glynn, Greenwald, Mills, & Manley, 1993, p. 570). In the next 10 years, smoking-related diseases will kill approximately 4.5 million people in the United States. Also, about 50,000 nonsmokers die each year (Brody, 1993) and 150,000 to 300,000 infants contract pneumonia or bronchitis as the result of environmental or secondhand exposure to tobacco smoke (Axelrad, Bayard, & Jinot, 1994). The victims of smoking are not just elderly adults; one in three middle-aged men dies from tobacco use (McLellan, 1994b). Furthermore, roughly half of those who die from smoking-related conditions initiated tobacco use during their adolescent years (Darnton, 1994).
In the 1980s, both the surgeon general and the director of NIDA identified smoking as a form of drug dependence (Institute of Medicine [IOM], 1994) and nicotine as society's "most prevalent drug of abuse" (cited in White, 1991, p. 93). A recent report by IOM (1994) stated, "Tobacco use is not a choice like jogging or a habit like eating chocolate; it is an addiction that is fueled by nicotine" (p. 5). Not surprisingly, the etiology, progression, and treatment of nicotine addiction are similar to those o f other forms of addiction (Moncher, Schinke, & Holden, 1992).
According to Hilts (1994), nicotine use is more likely to lead to dependence (difficulty quitting, a high relapse rate, use in spite of risks) than is the use of heroin, cocaine, and other substances. Cigarette smoking is also associated with dependence on other drugs. Most alcoholics (92 percent) and heroin addicts (99 percent) smoke tobacco (Murray, 1991). There is a strong link between cigarette smoking and the use of alcohol and illicit drugs by women during pregnancy ("Survey," 1994). Furthermore, the earlier in life that a child tries cigarettes, the more likely it is that he or she will become a regular smoker as an adult (IOM, 1994) and hence dependent on nicotine (Breslau, Fenn, & Peterson, 1993).
The health consequences of tobacco use exact a hefty financial toll on society. The total cost of smoking in 1990 was an estimated $72 billion (Institute for Health Policy, 1993), including $20. …