National studies have long pointed to Missouri as a problem state when it comes to smoking. A study by Washington University breaks down the high-risk groups and pushes for policy change.

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Sarah Shelton from the Center for Tobacco Policy Research at Washington University says more than 23 percent of Missourians smoke — among the highest in the nation. But looking at who those smokers are points out some demographics that are at higher risk. Shelton says people with fewer resources, i.e. less education and less money, are targeted by tobacco companies because they know they are more likely to gain lifetime customers.

Those statistics lead to a concentration of smokers in Southeast Missouri. Shelton says minority, gay and bisexual populations are also shown to have higher rates of smoking. She hopes the study will prompt policy change eventually making Missouri a smoke-free state.

The report, “Who is Most Affected? Tobacco-Related Disparities in Missouri,” identifies statewide differences related to who is smoking, who is exposed to secondhand smoke and who is quitting.

It’s based on the 2007 Missouri County-Level Study of Adult Tobacco Use and Related Chronic Conditions and Practices, a survey compiled by the Missouri Department of Health and Senior Services.

Some 50,000 Missouri adults were interviewed for the study, which was paid for by the Missouri Foundation for Health as part of its Tobacco Prevention & Cessation Initiative.

Among other findings, it was noted that Medicare recipients have the lowest level of confidence in their ability to quit smoking. More than 34 percent of the Medicare recipients who participated in the county-level study do not believe they can successfully stop smoking, a rate much higher than the state average of 20.7 percent.

Douglas Luke, director and professor at the George Warren Brown School of Social Work at Washington University, says the tobacco industry has a long history of targeting at-risk and vulnerable groups with its advertising.

“Addressing these groups as part of our comprehensive tobacco control efforts in Missouri will help reduce the overall burden from tobacco use, making Missouri a healthier place,” Luke says.

The groups involved in the study and report are recommending the following:

— Implement comprehensive, population-level tobacco control policies such as increasing the tobacco excise tax and mandating 100 percent clean indoor air policies.

— Address the need for affordable, accessible and relevant cessation services, particularly for those groups disproportionately affected by tobacco use.

— Tailor health messages to make sure they are culturally relevant and easily understood by targeted groups.

— Continue assessing tobacco-related behaviors across the state and make improvements to future statewide surveys as needed.

Nancy Mueller, board chair of the statewide Tobacco Free Missouri coalition, says communities across the state are acting to protect the health of their citizens.

“But we see from this report that unless our elected officials in Jefferson City take action, many populations will continue to face disparities in tobacco use and exposure,” Mueller says. “Comprehensive tobacco control policies at the state level ensure the inclusion of all Missourians.”