( CNN ) -- Crystal R. takes pictures of her neighborhood as part of Witnesses to Hunger . Among Crystal 's photos of piles of trash , abandoned lots and barbed wire fences is a striking picture : large advertisements for `` special prices '' of cigarettes promising `` Kool -- be true '' that greet her on her way to shop for food . A recent analysis of federal data by the Population Health Metrics found that as smoking declines at a fast rate in more affluent communities , the rates are staying the same among the poor and working class . More people are smoking in poorer communities . It is easy to blame people in poverty for making bad choices . But it 's more complicated than that . Tobacco companies target these communities to encourage the habit , and the stresses of living in poverty and sometimes hopelessness also cause people to turn to cigarettes . Witness to Hunger works with the real experts -- mothers and caregivers of young children who have gone hungry and live in poverty . Crystal , who chooses not to use her last name , talks openly about the stress of her environment : `` When I go to the supermarket , it 's uncomfortable . ... It 's embarrassing to pull my Access card out . I feel like the other people in the line are just looking and judging , saying things ... '' As pediatricians at Boston Medical Center , we know to define what is symptom of the disease , such as a cough , and what is the underlying disease to be treated , the pneumonia . We do n't just suppress the cough with syrups ; we treat the underlying infection with antibiotics . In this case , poverty may be as much the symptom as the disease , given how much the chronic stress of poverty drives unhealthy behaviors . There are underlying factors that must be addressed before tobacco use can be substantially reduced in all communities . First , tobacco companies target low-income neighborhoods with more cigarette advertising : larger signs , and three times as many brand ads . Tobacco manufacturers also specifically target young people in lower socioeconomic and minority neighborhoods and sell cheaper cigarettes in poor communities . This is an unconscionable strategy on the part of Big Tobacco . Another factor is that economic hardships , such as hunger , unstable housing and problems keeping the heat on are stressful and unhealthy for children . And childhood adversity is linked to unhealthy behaviors later , particularly to smoking . A Duke University study found that `` worries about paying bills or needing to sell possessions for cash independently erode a child 's self-control , regardless of strong parenting . '' That lack of self-control often leads to smoking . Women are quitting cigarettes at a lower rate than men . But women who are abused either physically or psychologically by their partners often smoke to cope with their tough lives . Strikingly , these connections between violence exposure and smoking can be seen in low-income women and in higher socioeconomic groups as well . Single mothers in poor neighborhoods are more likely to experience `` double jeopardy , '' with a high burden of childcare responsibilities coupled with social isolation and the chronic stress associated with neighborhood poverty . Smoking can be a reliable strategy to soften those burdens . The geography of opportunity and disadvantage is not equal across America . Clearly public health programs such as tobacco taxes and smoke-free public places and housing have worked in reducing smoking rates , but it seems poorer communities are being overlooked . Smoking is the top cause of preventable deaths in the United States . It causes lung cancer , heart disease , bronchitis , emphysema and more -- expensive health crises to add to the problems of the poor . To prevent smoking and keep young people from starting , it will take more than public health messages . It will require changing our economic policies to improve our neighborhood living conditions . People need well-paying jobs and safe communities to reduce the stress that often underlies smoking . Until we get real about the emotional toll of living in neighborhoods that offer little hope or help and stop the strong promotion of cigarettes , smoking will continue to be one strategy for coping among the most vulnerable members of our society . Note : An earlier version of this column did not make it clear that billboards advertising cigarettes are banned . The opinions expressed in this commentary are solely those of the writers .
Smoking is not declining in poor communities as it is in more affluent ones . Writers : Big Tobacco targets low - income neighborhoods , with cheap cigarettes . They say stresses of poverty and unemployment cause people to turn to smoking . Writers : Smoking should be coping , until social stresses of poverty are overcome .