Poor people are more likely to smoke cigarettes than rich ones. Maybe it's stress, maybe it's peer pressure, whatever, but they're hooked now.
Many of the poorest try to avoid vice taxes by buying tobacco and tubes, and making their own cigarettes -- which have a filter, but not always the highest quality tobacco. Or they will roll their own without using a tube with a filter -- which is even worse for them.
Chantix is contraindicated in many mental health patients, and psychiatrists have known for years that mental health patients are often heavier smokers. Nicotine binds to the niacin receptor in the brain -- niacin is "nicotinic acid" and it may be that these patients are self-medicating by finding something that binds to that receptor. There have been studies done about the role of B vitamins and their receptors in the brain in mental health, but unfortunately nice little chemicals that stimulate a receptor more are going to "work" better than the thing it's supposed to bind to normally -- as in, open the channel more.
In particular, psychiatrists have *always* had issues getting schizophrenic patients to quit, and apparently there may be some reason they don't. https://www.medicalnewstoday.com/articles/315446.php
The same "fake urine" products on the market to beat work pee tests are marketed towards employers that test for nicotine use, as nicotine is legal to use vs the other things most people are trying to keep from showing on their tox screen.
Then there's vaping, which is an option but my friends experiences have varied widely, the flavorings are untested on what they do to lungs even if the base carriers for the nicotine are safe, etc. Doctors can't in good conscience recommend it because it's untested, and the pharmaceutical alternative for people with the hand-to-mouth issue or who can't manage to absorb the right amount of nicotine to taper through gum or patches -- the Nicotrol inhaler -- is insanely expensive.
Yes, smoking is bad, so is drinking and other substance abuse. But testing and denying benefits to people who use them has not worked in the past, and cost more than it reduced people's eligibility for Food Stamps or unemployment.
Harm reduction and encouraging quitting should be the goal, not threatening denial of public benefits -- or people will lie to their doctors and use fake piss to keep their insurance. Just as women lied for decades about acne or heavy periods to get birth control covered under insurance, people will find a way, and any policy that makes a person not able to be honest with their physician is going to make whatever problems they have worse, not better.
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