Social determinants of smoking in women from low-income rural backgrounds: Findings from a photovoice study

Smoking is well recognized as one of the most preventable causes of death and disease in the United States (U.S.), accounting for approximately 480,000 deaths each year (Centers for Disease Control and Prevention [CDC], 2014). In addition, the American Academy of Addiction Psychiatry (AAAP, 2018) estimates that approximately 20–30% of individuals experimenting with cigarettes will meet criteria for tobacco use disorder within their lifetime while 60–80% of current cigarette smokers manifest classic drug dependence criteria. Associated annual healthcare cost of smoking are approximately133 billion dollars, with the additional cost in lost productivity estimated at 156 billion dollars annually (CDC, 2014; United States Department of Health and Human Services [USDHHS], 2014). Although recent national rates of cigarette smoking in adults have declined from 20.9% in 2005 to 13.7% in 2018, there remains significant disparity in smoking rates among rural populations (Creamer et al., 2019)