Image: Image: Leonard Perry smokes a cigarette.
Jim Seida  /  msnbc.com
Leonard Perry sometimes collects scrap metal and recycles it to support his pack-and-a-half a day smoking habit.
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msnbc.com
updated 6/30/2009 10:00:46 AM ET 2009-06-30T14:00:46

As household budgets shrink, some smokersare forced to choose: Pay the bills? Or buy cigarettes?

“We had a light bill that needed to be paid, so we paid a third of it so we could have cigarette money,” said Leonard Perry, a pack-a-day Doral smoker from Elkhart, Ind. “We’ve done that a couple times. It kind of works out but it makes it rough for the next week.”

Perry, 55, worked at American Hauler, a cargo trailer manufacturer, before being laid off two years ago. Sometimes he collects scrap metal for cigarette money. "My woman’s workin’, so that helps me out there," he said. But his wife has her own pack-a-day Marlboro habit to support.

He's tried repeatedly to quit, but said the habit's hold is too strong on him. "I've tried the patch, that don't work. I've tried the chewing gum, that don't work. I've tried to get away from it without doing anything and that don't work either," he said.

For the Perrys and other smokers, the incentive to kick the habit has perhaps never been stronger. The economic downturn continues to wear on, and this spring smokers were hit with the largest federal tax increase ever on cigarettes.

But reason doesn't always rule out, says Dr. David Abrams, a clinical psychologist and executive director of the Schroeder Institute for Tobacco Research and Policy, which is part of the anti-smoking nonprofit American Legacy Foundation. "If anybody looked at the pros and cons and weighed the evidence, frankly, we shouldn’t have a single smoker in the country. But the brain's reward centers are very powerful, and they avoid logical reasoning. Seeking immediate pleasure is sometimes something you can’t stop yourself from doing."

But while experts do say they're seeing more interest in quitting, the support system is collapsing, as some states have exhausted funds for smoking-cessation programs that many smokers, especially lower-income folks, depend on when they decide to quit.

An estimated 45 million Americans smoke, although the Centers for Disease Control and Prevention found last year that the U.S. smoking rate had dipped below 20 percent for the first time on record.

Cigarette sales have been steadily declining for about 10 years, according to The Tobacco Project, which is part of the National Association of Attorneys General. In 2006, about 380 billion cigarettes were sold. In 2007, that number dropped to 360.5 billion, and in 2008, cigarette sales dropped again to 344.8 billion.

In a survey done last November, the American Legacy Foundation found that economic stress was actually causing smokers to light up more.

“It may be sort of the less you have and the more out of control you are in a depressing economy, the more reasons you have to run for the cigarettes," Abrams says. "It’s in your control; you can enjoy your cigarettes while the world around you falls apart."

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In a survey of 2,375 adults, the nonprofit group found that one in four smokers said that the economy caused them to smoke more cigarettes. And the stress from the flailing economy seemed to hit women harder than men, as 31 percent of women said they were smoking more as a result of the stress caused by economy, compared to 17 percent of men.

Driven to downgrade
Less cash and more stress can also drive smokers to go downscale. When smokers are under financial duress, they often look for cheaper ways to feed their addiction, downgrading from premium to lower-tier brands of smokes.

“They go from Marlboro to Basic, from Basic to Doral, and now to the cheapest that they can find,” said Dusty Porch, a 36-year-old clerk at Low Bob’s Discount Tobacco in Elkhart, Ind.

Porch said traffic at the store hasn’t slowed at all in the eight months she’s worked there, but the way people are paying for their cigarettes has. "People are paying with a lot of change. … Pennies, nickels — that’s the worst.” 

The national average price for a pack of cigarettes is about $6, and the average state cigarette tax is $1.27 per pack. But some local governments also have their own cigarette tax, including Chicago, New York City and Anchorage, Alaska. For smokers in both New York City and Chicago, a pack of cigarettes costs close to $10.

That's why 25-year-old Lindsey Jaffe, a former pack-a-day smoker who lives in the New York City area, quit this spring — she took a look at her spending and realized she couldn't afford her habit.

"When you are looking at a monthly budget that includes everything from car payments to rent and there is nothing left to cut, and then you see $300 per month on cigarettes, there really aren't any options left," Jaffe says.

Her boyfriend quit at the same time after they realized they'd whittled their monthly grocery budget to just $150 a month for two people for three meals a day. When they realized they were spending twice that on cigarettes, they knew the smokes had to go. "Of all the times I have tried to quit, this was ... the easiest — I just didn't buy cigarettes," she says.

Hard times for smokers
Making hard times even harder for smokers, as the economic downturn dragged on into the spring, smokers were hit with the federal tax increase, which took effect on April 1. Both national and state-level quitlines saw huge surges in calls in April and May.

"One of the strongest motivators to get people to quit is an increase in the cost of cigarettes," says Michael Mark, the vice president of helpline services for the American Lung Association. Last year, the organization received 591,000 calls to its national quitline, 1-800-QuitNow. This year, the call center had already fielded 553,000 calls at the end of May.

In some states, quitlines were so overwhelmed with an increase of interest that they weren't able to give every caller the help they were seeking.

The state health department in Iowa had been giving a month's worth of free nicotine patches to anyone who called the state's free quitline, says Cathy Callaway, the senior representative for state and local campaigns with the American Cancer Society. At the end of March through April, calls to Iowa's quitline increased 300 percent, but the state program had already run out of funding. Unprepared for such a surge in interest, the quitline was unable to give away the nicotine patches to those folks that needed it.

“What’s tragic is, in an environment where you’ve got a higher tax, mass media campaigns and everything else lining up to push lifestyle change, it’s tragic that when we are having more people interested in quitting, we are withdrawing cessation resources," Abrams says.

Smoking is the cause of about one in every five deaths in the United States each year, and it is the leading preventable cause of death in the U.S., said the National Cancer Institute. Smoking also accounts for $96 billion in direct health care spending, about $97 billion in productivity losses and, in all, smoking costs the United States about $193 billion per year, according to the CDC.

“As Congress takes up health care reform and as states look to save money, we know that smoking cessation really gets you more bang for your buck — the more we’re going to save in health care costs and Medicare costs down the line,” says Erika Sward, the director of national advocacy for the American Lung Association.

Presidential struggle to quit
Last week, President Barack Obama said he still struggles with the urge to smoke as he signed a bill that granted the Food and Drug Administration regulatory authority over tobacco, which experts say focuses both on smoking cessation and the prevention of youth tobacco use.

"I would expect we’re going to see a continued interest in quitting," says Thomas Glynn, the director of cancer science and trends for the American Cancer Society.

But some smokers simply won't give the the habit up, no matter the cost. Porch, the clerk at the discount tobacco shop, smokes about a pack a day and has never tried to quit in her 24 years of smoking. “I’ve never even thought about it,” she said. “It’s my pastime. I can go six or seven hours without a cigarette, it doesn’t bother me. But there’s times where I’ve just gotta have one.” 

She said customers often tell her they’re going to quit. “They do the gum or the little pills the doctors give you, but they’re here the next day,” she said. “People are gonna smoke; you just can’t stop.”

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