Smoking as a poor (and rural) people's problem

See Sabrina Tavernise and Robert Gebeloff's story in today's New York Times.  The dateline is Manchester, Kentucky, population 1,255, and the headline is, "Smoking Proves Hard to Shake Among the Poor."  While the headlines leads with "poor," the story also gives quite a bit of attention to the geography angle on the smoking problem.  Here's an excerpt reporting on this new study available on Population Health Metrics:  

The new study, which evaluated federal survey data from 1996 to 2012 to produce smoking rates by county, offered a rare glimpse beneath the surface of state-level data. It found that affluent counties across the nation have experienced the biggest, and fastest, declines in smoking rates, while progress in the poorest ones has stagnated. The findings are particularly stark for women: About half of all high-income counties showed significant declines in the smoking rate for women, but only 4 percent of poor counties did, the analysis found. 

This growing gap in smoking rates between rich and poor is helping drive inequality in health outcomes, experts say, with, for example, white women on the lowest rungs of the economic ladder now living shorter lives. 

“Smoking is leaving these fancy places, these big urban areas,” said Ali H. Mokdad, a researcher at the Institute for Health Metrics and Evaluation and an author of the study. “But it has remained in these poor and rural areas. They are getting left behind.”

The study found that among adults living in "deep poverty in the South and Midwest, the smoking rate has not changed" since 1977, even as it has fallen 27% on average for adults across the United States.

Manchester is the county seat of Clay County, Kentucky, where just 7% of residents have a college degree and the poverty rate is twice the national average.  Manchester banned smoking in restaurants, stores and bars in 2012.  The local hospital runs a smoking cessation program with free nicotine patches and so forth to low-income residents.