Association of socioeconomic position with smoking and mortality: the contribution of early life circumstances in the 1946 birth cohort (original) (raw)
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Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study
BMJ, 2009
Objective To assess the impact of tobacco smoking on the survival of men and women in different social positions. Design A cohort observational study. Setting Renfrew and Paisley, two towns in west central Scotland. Participants 8353 women and 7049 men aged 45-64 years recruited in 1972-6 (almost 80% of the population in this age group). The cohort was divided into 24 groups by sex (male, female), smoking status (current, former, or never smokers), and social class (classes I + II, III non-manual, III manual, and IV + V) or deprivation category of place of residence. Main outcome measure Relative mortality (adjusted for age and other risk factors) in the different groups; Kaplan-Meier survival curves and survival rates at 28 years. Results Of those with complete data, 4387/7988 women and 4891/6967 men died over the 28 years. Compared with women in social classes I + II who had never smoked (the group with lowest mortality), the adjusted relative mortality of smoking groups ranged from 1.7 (95% confidence interval 1.3 to 2.3) to 4.2 (3.3 to 5.5). Former smokers' mortalities were closer to those of never smokers than those of smokers. By social class (highest first), age adjusted survival rates after 28 years were 65%, 57%, 53%, and 56% for female never smokers; 41%, 42%, 33%, and 35% for female current smokers; 53%, 47%, 38%, and 36% for male never smokers; and 24%, 24%, 19%, and 18% for male current smokers. Analysis by deprivation category gave similar results. Conclusions Among both women and men, never smokers had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women's survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations is limited unless many smokers in lower social positions stop smoking.
study and women by social position: a 28 year cohort Effect of tobacco smoking on survival of men
2009
Objective To assess the impact of tobacco smoking on the survival of men and women in different social positions. Design A cohort observational study. Setting Renfrew and Paisley, two towns in west central Scotland. Participants 8353 women and 7049 men aged 45-64 years recruited in 1972-6 (almost 80% of the population in this age group). The cohort was divided into 24 groups by sex (male, female), smoking status (current, former, or never smokers), and social class (classes I + II, III non-manual, III manual, and IV + V) or deprivation category of place of residence. Main outcome measure Relative mortality (adjusted for age and other risk factors) in the different groups; Kaplan-Meier survival curves and survival rates at 28 years. Results Of those with complete data, 4387/7988 women and 4891/6967 men died over the 28 years. Compared with women in social classes I + II who had never smoked (the group with lowest mortality), the adjusted relative mortality of smoking groups ranged from 1.7 (95% confidence interval 1.3 to 2.3) to 4.2 (3.3 to 5.5). Former smokers' mortalities were closer to those of never smokers than those of smokers. By social class (highest first), age adjusted survival rates after 28 years were 65%, 57%, 53%, and 56% for female never smokers; 41%, 42%, 33%, and 35% for female current smokers; 53%, 47%, 38%, and 36% for male never smokers; and 24%, 24%, 19%, and 18% for male current smokers. Analysis by deprivation category gave similar results. Conclusions Among both women and men, never smokers had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women's survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations is limited unless many smokers in lower social positions stop smoking.
2011
Changes in social inequality in smoking-attributable adult male mortality between 1986 and 2001 in four developed countries By Sonica Singhal Master of Science Institute of Medical Sciences University of Toronto 2011 Social inequalities exist in smoking-attributable mortality rates of males. Change in these social inequalities in the past two decades in developed countries remains uncertain. This study was conducted in Canada, France, Poland, and Switzerland to quantify differences in smoking-attributable mortality rates, at ages 35-69 years, among different social strata in recent years and to examine the changes in social inequalities in these rates between 1986 and 2001. Analyses included 377,878 deaths from a total population of 13,482,210 males of these four countries. Smoking-attributable mortality rates reduced in all strata over the comparative time periods, in all countries, except France. This work specifically focuses to fill the gap in knowledge about whether tobacco con...
Explaining socio-economic inequalities in daily smoking: a social-ecological approach
The European Journal of Public Health, 2012
This study assessed the contributions of individual, household and neighbourhood-level factors to socio-economic inequalities in smoking. Data came from 2706 participants of the 2004 wave of the Dutch GLOBE study. Participants were asked about several social and material characteristics of their households, neighbourhoods and smoking in their environment. Indicators of socio-economic position were education and income. Associations with daily smoking were examined using logistic regression analyses. Education and income were independently associated with daily smoking (mutually adjusted odds ratios for the lowest education and income groups: odds ratio (OR): 2.87, 95% confidence interval (95% CI): 1.78-4.62; OR: 1.55, 95% CI: 1.09-2.23, respectively). Individual beliefs about smoking contributed most to the association of education with daily smoking. Individual beliefs about smoking and household material adversity contributed most to the association of income with daily smoking. We found no evidence that negative perceptions of the neighbourhood contributed to smoking inequalities. In fully adjusted models, associations between income and smoking were fully attenuated, but an independent association between education and smoking remained. Education and income were related to smoking through partly different pathways. Reducing inequalities in smoking may require a multidimensional approach targeting material and social factors, with strategies targeted towards the individual and the household level.
Socioeconomic status and smoking: a review
Annals of the New York Academy of Sciences, 2012
Smoking prevalence is higher among disadvantaged groups, and disadvantaged smokers may face higher exposure to tobacco's harms. Uptake may also be higher among those with low socioeconomic status (SES), and quit attempts are less likely to be successful. Studies have suggested that this may be the result of reduced social support for quitting, low motivation to quit, stronger addiction to tobacco, increased likelihood of not completing courses of pharmacotherapy or behavioral support sessions, psychological differences such as lack of self-efficacy, and tobacco industry marketing. Evidence of interventions that work among lower socioeconomic groups is sparse. Raising the price of tobacco products appears to be the tobacco control intervention with the most potential to reduce health inequalities from tobacco. Targeted cessation programs and mass media interventions can also contribute to reducing inequalities. To tackle the high prevalence of smoking among disadvantaged groups, a combination of tobacco control measures is required, and these should be delivered in conjunction with wider attempts to address inequalities in health.
The Contribution of Smoking to Educational Gradients in U.S. Life Expectancy
Journal of health and social behavior, 2015
Researchers have documented widening educational gradients in mortality in the United States since the 1970s. While smoking has been proposed as a key explanation for this trend, no prior study has quantified the contribution of smoking to increasing education gaps in longevity. We estimate the contribution of smoking to educational gradients in life expectancy using data on white men and women ages 50 and older from the National Longitudinal Mortality Study (N = 283,430; 68,644 deaths) and the National Health Interview Survey (N = 584,811; 127,226 deaths) in five periods covering the 1980s to 2006. In each period, smoking makes an important contribution to education gaps in longevity for white men and women. Smoking accounts for half the increase in the gap for white women but does not explain the widening gap for white men in the most recent period. Addressing greater initiation and continued smoking among the less educated may reduce mortality inequalities.
Socioeconomic lifecourse influences on women's smoking status in early adulthood
Journal of Epidemiology & Community Health, 2006
Study objective: To incorporate women's domestic trajectories and circumstances into analyses of the socioeconomic influences on women's smoking status (current and former smoking) in early adulthood. Design: Cross sectional survey Setting: Southampton, UK. Participants: 8437 women aged 25-34 recruited from 1998-2002 via patient lists of general practices Main results: Domestic lifecourse factors contributed to the odds of being a current smoker and former smoker in models that included conventional measures of the socioeconomic lifecourse. Early motherhood, non-cohabitation, and lone motherhood increased the odds of smoking; early motherhood and noncohabitation reduced the odds of former smoking. For example, relative to childless women, odds ratios (OR) for women who had become mothers ,20 years were 1.71 for smoking and 0.76 for former smoking. The effects of education and current SEP remained strong with the inclusion of childbearing and cohabitation variables for both outcomes. For instance, compared with women in education to age >22, the odds ratio for smoking for those leaving school (16 was 3.37 and for former smoking was 0.42. Conclusions: Both the conventionally measured socioeconomic lifecourse and the domestic lifecourse contributed separately to the odds of smoking and former smoking, suggesting that lifecourse analyses should incorporate women's domestic circumstances as an important pathway of influence on their smoking status in early adulthood. 228 www.jech.com