Tobacco endgame: The poverty conundrum

There is no more striking public health triumph than the demise of the "brown plague." The cigarette was once the accoutrement of a good life, but smoking is now a tragic habit of the poor. By the mid-1960s, half of all men and a third of women in the United States smoked. Today the national prevalence is 18 percent, with rates in major cities below 15 percent. A suite of policies drove down smoking rates-antismoking campaigns, taxation, clean air laws, package labeling, and marketing curbs. These policies, and the resultant behavior changes, however, have diminishing returns. Is it possible that tobacco rates will remain relatively stagnant? If so, what "endgame" strategies might drive rates to negligible levels, say, lower than 5 percent? And if society does achieve such an audacious goal, how attentive should it be to the problems of social justice?