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Debbie A Lawlor, MPH, MB, ChB, Stephen Frankel, DM, PhD, Mary Shaw, PhD, MA, Shah Ebrahim, DM, MSc and George Davey Smith, DSc, MD

The authors are with the Department of Social Medicine, University of Bristol, Bristol, England.

Correspondence: Requests for reprints should be sent to Debbie A. Lawlor, MPH, MB, ChB, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, England (e-mail: d.a.lawlor{at}bristol.ac.uk).

The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts.

Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved.

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