Smoking and (Not) Voting: The Negative Relationship Between a Health-Risk Behavior and Political Participation in Colorado

Nicotine Tob Res. 2016 Mar;18(3):371-6. doi: 10.1093/ntr/ntv098. Epub 2015 May 8.


Introduction: Considerable evidence suggests that cigarette smokers are an increasingly marginalized population, involved in fewer organizations and activities and with less interpersonal trust than their nonsmoking counterparts. However, only two previous studies, both among Swedish populations, have investigated smokers' attitudes toward political systems and institutions. The current, cross-sectional study examines smoking in relation to voting, a direct behavioral measure of civic and political engagement that at least partly reflects trust in formal political institutions.

Methods: Secondary analyses were conducted of interview data from 11 626 respondents in the Colorado Tobacco Attitudes and Behaviors Survey. Data were collected via telephone between October 2005 and mid-April 2006 and included respondents' reported voting behavior in the 2004 national election; the participation rate was 89.7%. Balanced multiple logistic regression was used to examine associations between smoking and voting while controlling for other covariates known to be associated with both variables.

Results: In the final model, daily smokers were less than half as likely as nonsmokers to report having voted in the election.

Conclusions: The results suggest possible consonance with previous work linking smoking with political mistrust. Possible causal mechanisms are discussed. This study is the first to link a health-risk behavior with electoral participation, and provides initial evidence that smoking is negatively associated with political participation. Future research should investigate how public health might enhance tobacco control efforts by taking nonvoting behavior into consideration, or creatively combining smoking cessation interventions with voter registration and other civic engagement work, particularly among socioeconomically disadvantaged populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Colorado / epidemiology
  • Cross-Sectional Studies
  • Female
  • Health Behavior*
  • Humans
  • Male
  • Politics*
  • Public Health / trends
  • Risk-Taking*
  • Smoking / epidemiology*
  • Smoking / psychology*
  • Surveys and Questionnaires