摘要：The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts. Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved. SINCE THE 1970S, THE SMOKING prevalence rate among men residing in the United Kingdom has halved, 1 and the recently reported decrease in lung cancer among UK men has been attributed to the public health success of health promotion interventions designed to reduce smoking in the general population. 2 Similar reductions in smoking prevalence rates and tobacco-related diseases in the United States and other developed countries have also been related to the success of widespread health promotion initiatives, including individual-level approaches, such as advice and nicotine replacement, and social policy approaches, such as bans on smoking in public places. However, the decline in smoking prevalence rates has been least marked among the most deprived members of society, and over time this group has come to form an increasing proportion of those who remain smokers. 3, 4 Widening social class inequalities in terms of smoking prevalence rates are occurring between successive birth cohorts at the same age, and within cohorts at increasing ages, suggesting that members of lower social classes are increasingly more likely to take up smoking and less likely to quit. 4 There is no question that smoking is one of the most prominent causes of morbidity and premature mortality 5 and that the social class gradient in smoking prevalence rates contributes to the social class gradient in health outcomes. 6, 7 The resilience of deprived groups to smoking cessation programs is, however, remarkable. Here we pose the question of whether the poorer life chances of those who continue to smoke in effect constitute a rational disincentive to their avoidance or cessation of smoking. If this is the case, then smoking behaviors among members of deprived populations will continue to resist health promotion measures until their general health and well-being show improvements equivalent to those that preceded the earlier abandonment of smoking by more advantaged population groups.
