Although most Americans finally may be breaking out of cigarette smoking’s killer grip, Big Tobacco keeps inflicting terrible harm on some of the nation’s most vulnerable—the poor, uneducated, and those who live in rural areas.

The federal Centers for Disease Control has just offered its annual assessment on Americans’ smoking habits, providing some rare good news about most of us and especially kids: Cigarette smoking among the nation’s youth is diving to new lows, and the use of smokeless or e-cigarettes for “vaping” showed its first declines.

Anti-smoking campaigns may be working, persuading teens and many adults to avoid smoking or to quit the bad habit that has been proven to cause cancers and to contribute to heart disease and other damaging conditions, the CDC says. The agency also notes that youth vaping and smoking may have declined due to new age-based restrictions on product sales and advertising.

The health agency previously has blamed 480,000 deaths per year in the United States on smoking, including more than 41,000 deaths from secondhand smoke exposure. That’s about 1 in 5 deaths annually, or 1,300 deaths every day. On average, smokers die 10 years earlier than nonsmokers.

Although such statistics, package warnings, and ad campaigns have slashed smoking to new lows, with just 15 percent of adults overall lighting up these days, the figures are far higher and dismal for rural, poor, and uneducated Americans.

The Washington Post, to its credit, has pulled together a depressing picture of how entrenched the killer habit has become in these groups, with more than 40 percent of those with a high school degree or less still puffing and lung cancer rates in rural areas as much as 20 percent higher than those in urban areas.

Smoking foes say they’re cautiously optimistic about getting Big Tobacco on the run with young people and most Americans. They continue to express worry about the Trump Administration’s announced delays in tougher anti-smoking steps.

But Big Tobacco’s opponents are less sanguine about getting the poor, poorly educated, and rural Americans unhooked from highly addictive nicotine, cigarette smoking, and vaping. These consumers are much harder to reach, and opponents can’t come close to matching Big Tobacco’s big hype budgets and advertising and marketing machinery.

Further, as the nationwide epidemic of opioid drug abuse has demonstrated, huge pockets of the country are struggling with not only poverty, downward economic mobility, unemployment, chronic illness, and physical pain, they’re also gripped by a disease of despair. Smoking, the Post reports, is just one more way for those without hope to self-medicate, in destructive fashion, to cope with their stress and unhappiness.

In my practice, I see the harms that patients can suffer while seeking medical services, including for treatment of the array of smoking-related diseases. Tobacco’s terrible toll on not only smokers but also the soaring costs of medical care in this country is unacceptable. And, while it’s good news that we’re making headway in combating this scourge, we can’t ease up in our anti-smoking fight, and we need to ensure it’s as inclusive as possible.

Simply put, we’re one nation and we cannot thrive as we have as Americans if we allow disparities in our medical care. Research (including insightful work by the Lancet medical journal, whose infographic accompanies this post) shows a chasm is opening in this critical area between rich and poor, urban and exurban residents, as well as for women and people of color. Doctors, hospitals, policy-makers, lawmakers, and regulators need to do more to overcome these and other medical inequities, including stomping out smoking and its harms to us all.