Background:
The rising price of cigarettes has prompted many smokers to quit. Those who continue to smoke are now concentrated in lower income populations and an increasing amount of their income is dedicated to tobacco. This analysis looks at the percentage of annual income spent on tobacco by smokers in a multi-site research study.

Methods:
Subjects (n=605) screened for a study involving switching smokers to alternative nicotine products were asked demographics, annual income, purchase price per pack of cigarettes, and cigarettes smoked per day to estimate annual tobacco costs. Wilcoxon rank sum test compared the percent of income spent on cigarettes across several demographic variables.

Results:
Subjects were an average of 43.4 years old (SD=13.1), smoking 15.6 (7.4) cigarettes per day for 10 years; 56.3% were white, 35.2% black and 8.6% other; and mostly male (58%). Nearly a third of the subjects were unemployed (31.6%) and an additional 5.5% were disabled; 46.6% reported either full/part time or casual work. The average amount spent on tobacco was US$1,743 across all 3 sites or 10% of annual income. Percent of income spent across sites was 11.4 in Minnesota, 9.4 in Ohio, and 8.2 in New York. As expected, unemployed and disabled spent a significantly higher percent of their income compared to employed subjects (13.1 vs 8.0; p< 0.001). Gender or age were not related to cigarette spending. Over a quarter of the subjects reported an annual income of less than ,000 (28.6%). Those reporting annual incomes of < ,000, well below the poverty line compared to those above this line, spent a significantly higher percent on cigarettes (17.2 and 7.2 respectively; p< 0.001).

Conclusions:
Nicotine addiction is an economic burden for those smokers already living in poverty. Cessation treatment must be provided to this population especially when increased taxes are used for tobacco control.