TITLE:
Social Determinants of Change in Smoking Status over a 26-Year Follow up Period among Middle-Aged and Older Americans
AUTHORS:
Shervin Assari
KEYWORDS:
Smoking, Tobacco Use, Population Groups, Ethnic Groups, Race, Socioeconomic Position, Socioeconomic Status
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.9 No.4,
April
15,
2021
ABSTRACT: Educational
attainment and income are among major socioeconomic status (SES) indicators
that are inversely associated with cigarette smoking. Marginalization-related
Diminished Returns (MDRs), however, are weaker protective effects of
SES indicators for racial and ethnic minority groups compared to non-Hispanic
White people. The aim is to test whether racial and ethnic differences exist in
the effects of educational attainment and income on cigarette smoking of
middle-aged and older American adults. This is a 26-year longitudinal study
using data from the Health and Retirement Study (HRS), a nationally
representative study of middle-aged and older adults in the US. A total number
of 11,316 middle-aged and older adults (age ≥ 50) were followed for up to 26 years. The
independent variables were educational attainment and income. The dependent
variables were always smoking and being quitters over the follow-up time. Age,
gender, self-rated health, and chronic medical conditions were the covariates.
Race/ethnicity was the moderator. Logistic regressions were used to analyze the
data. Most participants were never smokers (n = 7950), followed by quitters (n
= 1765), always smokers (n = 1272), and initiators (n = 329). Overall, high
educational attainment (OR = 0.92, 95% CI = 0.90 - 0.95) and income (OR = 0.99,
95% CI = 0.99 - 0.99) reduced the odds of being always smoker. High educational
attainment (OR = 1.05, 95% CI = 1.02 - 1.08) was associated with higher odds of
being a quitter. Ethnicity, however, showed significant interactions with
education on both outcomes suggesting that the effects of educational
attainment on reducing the odds of always being a smoker (OR = 1.24, 95% CI =
1.14 - 1.35) and increasing the odds of quitting (OR = 0.84, 95% CI = 0.75 - 0.93)
were smaller for Hispanics than non-Hispanics. In the United States,
middle-aged and older Hispanic adults remain at high risk of smoking cigarettes
despite high educational attainment. That is, high educational attainment may
better help non-Hispanic than Hispanic middle-aged and older adults to avoid
cigarette smoking. As a result, we may observe a more than expected burden of
tobacco use in middle class Hispanic middle-aged and older adults. Policymakers
should not reduce racial and ethnic tobacco inequalities to SES gap, as ethnic
tobacco disparities may persist in high SES levels as well.