Educational attainment and cigarette smoking: a causal association? - PubMed (original) (raw)
Educational attainment and cigarette smoking: a causal association?
Stephen E Gilman et al. Int J Epidemiol. 2008 Jun.
Abstract
Background: Despite abundant evidence that lower education is associated with a higher risk of smoking, whether the association is causal has not been convincingly established.
Methods: We investigated the association between education and lifetime smoking patterns in a birth cohort established in 1959 and followed through adulthood (n = 1311). We controlled for a wide range of potential confounders that were measured prior to school entry, and also estimated sibling fixed effects models to control for unmeasured familial vulnerability to smoking.
Results: In the full sample of participants, regression analyses adjusting for multiple childhood factors (including socioeconomic status, IQ, behavioural problems, and medical conditions) indicated that the number of pack-years smoked was higher among individuals with less than high school education [rate ratio (RR) = 1.58, confidence interval (CI) = 1.31, 1.91]. However, in the sibling fixed effects analysis the RR was 1.23 (CI = 0.80, 1.93). Similarly, adjusted models estimated in the full sample showed that individuals with less than high school education had fewer short-term (RR = 0.40; CI = 0.23, 0.69) and long-term (RR = 0.59; CI = 0.42, 0.83) quit attempts, and were less likely to quit smoking (odds ratio = 0.34; CI = 0.19, 0.62). The effects of education on quitting smoking were attenuated in the sibling fixed effects models that controlled for familial vulnerability to smoking.
Conclusions: A substantial portion of the education differential in smoking that has been repeatedly observed is attributable to factors shared by siblings that contribute to shortened educational careers and to lifetime smoking trajectories. Reducing disparities in cigarette smoking, including educational disparities, may therefore require approaches that focus on factors early in life that influence smoking risk over the adult life span.
Conflict of interest statement
Conflict of interest: None declared.
Comment in
- Commentary: Why are we biased against bias?
Kaufman JS. Kaufman JS. Int J Epidemiol. 2008 Jun;37(3):624-6. doi: 10.1093/ije/dyn035. Epub 2008 Mar 3. Int J Epidemiol. 2008. PMID: 18316349 No abstract available.
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References
- United States. Smoking and Health; Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington: U.S. Department of Health, Education, and Welfare, Public Health Service; 1964. Surgeon General’s Advisory Committee on Smoking and Health.
- Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM. Trends in cigarette smoking in the United States. Educational differences are increasing. JAMA. 1989;261:56–60. - PubMed
- Giovino GA, Henningfield JE, Tomar SL, Escobedo LG, Slade J. Epidemiology of tobacco use and dependence. Epidemiol Rev. 1995;17:48–65. - PubMed
- Iribarren C, Luepker RV, McGovern PG, Arnett DK, Blackburn H. Twelve-year trends in cardiovascular disease risk factors in the Minnesota Heart Survey. Are socio-economic differences widening? Arch Intern Med. 1997;157:873–881. - PubMed