Commentary: Combating Tobacco Use Among Lower-Income Families

Tobacco doesn’t just affect smokers. In fact, 88 million non-smoking adults and children were exposed to secondhand smoke in the U.S. in 2007-08. Children who are exposed to secondhand smoke are at high risk for serious health consequences, such as low birth weight, Sudden Infant Death Syndrome, asthma, bronchitis, pneumonia, middle-ear infection and other diseases, affecting not only their health, but also school readiness.

The federal Head Start program was launched in the summer of 1965 as part of the “War on Poverty.” Head Start and Early Head Start (HS/EHS) have since served as models for high quality comprehensive service designed to nurture children and families of lower income levels intellectually, socially, emotionally and physically so that children are prepared to start school and reach their fullest potential.  Recognizing the benefit of partnering with Head Start to address the disparities in reaching individuals with low socioeconomic status (SES), Legacy, in partnership with Mailman School of Public Health at Columbia University, led and funded the Head Start Tobacco Cessation Initiative. The initiative was designed to work off of the overall mission of HS/EHS by enabling participating sites to incorporate cessation identification and referral protocols into their existing child development. The initiative seeks to increase awareness of the health consequences of tobacco use, reduce children’s exposure to secondhand smoke, and increase the capacity of Head Start programs to address tobacco cessation and secondhand smoke.

Legacy’s Head Start Initiative directly targets low income families since tobacco use can be directly tied to SES. The highest rates of tobacco use occur among people with the lowest levels of income, for in 2012, 27.9 percent of adults living below the Federal Poverty Line (FPL) smoked. High rates of tobacco use also goes hand in hand with low education levels, for 41.9 percent of adults with a GED smoke, as compared with just 5.9 percent of adults with a graduate level degree. Low SES and tobacco use is an issue for children as well as adults and according to a 2007 survey of children’s health, 26.2 percent of children nationwide live in households where someone smokes; in households below the poverty line, that percentage jumps to 36.9 percent. The cost of cigarettes also impacts families struggling to make ends meet as well. In 2014, the FPL for a family of four in the United States was $23,850. The average cost for a pack of cigarettes was approximately $6.01 varying widely by state.

The Head Start Tobacco Cessation Initiative was designed to prevent children and families from being exposed to secondhand smoke, as in 2007-08, 53.6 percent of children between 3-11 years old were exposed to secondhand smoke. Head Start wants children in their programs to live in healthy environments that include minimizing health care concerns like ear infections and asthma triggers, and work to link family members to the services they need. By helping participating HS/EHS sites to modify existing services to identify, refer, track and support family members who are tobacco users, staff will become more equipped to determine cessation services which are best suited for low-income families. Ultimately Legacy is working to integrate a performance standard that would require all Head Start programs to address tobacco use with the families they serve. This performance standard ensures that Head Start programs do this work for years to come – in other words, the policy supports sustainability and lasting change. Today, Legacy is working with Head Start in 14 states.

Listen to how Legacy works with Head Start.

Low-income families face health-related disparities on multiple levels. Compared to high-income families, they are less likely to have health-insurance coverage and access to medical care, including primary care. Access to primary care also varies depending on educational attainment, for in 2007, the percentage of people with primary care was significantly lower for those who earned a high school diploma, as compared to those with some college education. Therefore by staff linking families with existing services in the community, the Head Start Tobacco Initiative helps families take advantage of established social, health, and human service programs within their community. The staff are trained to talk with family members about quitting and referring them to services to establish an ideal partnership between tobacco control and prevention and Head Start. The initiative is based on education and skill building to build capacity which will lead to a change in organizational priorities.

Laura Hamasaka, Association Vice President for Priority Populations and Program Development at Legacy