MANCHESTER, Ky. — When smoking first swept the United States in the early decades of the 20th century, it took hold among the well-to-do. Cigarettes were high-society symbols of elegance and class, puffed by doctors and movie stars. By the 1960s, smoking had exploded, helped by the distribution of cigarettes to soldiers in World War II. Half of all men and a third of women smoked.
But as evidence of smoking’s deadly consequences has accumulated, the broad patterns of use by class have shifted: Smoking, the leading cause of preventable death in the country, is now increasingly a habit of the poor and the working class.