Pathways of disadvantage and smoking careers: Evidence and policy implications

Department of Health Sciences, University of York, UK.
Journal of Epidemiology & Community Health (Impact Factor: 3.5). 10/2006; 60 Suppl 2(Supplement 2):7-12. DOI: 10.1136/jech.2005.045583
Source: PubMed


To investigate in older industrialised societies (a) how social disadvantage contributes to smoking risk among women (b) the role of social and economic policies in reducing disadvantage and moderating wider inequalities in life chances and living standards.
Review and analysis of (a) the effects of disadvantage in childhood and into adulthood on women's smoking status in early adulthood (b) policy impacts on the social exposures associated with high smoking risk.
(a) Smoking status--ever smoking, current smoking, heavy smoking, and cessation--is influenced not only by current circumstances but by longer term biographies of disadvantage (b) social and economic policies shape key social predictors of women's smoking status, including childhood circumstances, educational levels and adult circumstances, and moderate inequalities in the distribution of these dimensions of life chances and living standards. Together, the two sets of findings argue for a policy toolkit that acts on the distal determinants of smoking, with interventions targeting the conditions in which future and current smokers live.
An approach to tobacco control is advocated that combines changing smoking habits with reducing inequalities in the social trajectories in which they are embedded. Policies to level up opportunities and living standards across the lifecourse should be championed as part of an equity oriented approach to reducing the disease burden of cigarette smoking.

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    • "Effective interventions in early childhood target a range of risks impacting on vulnerable children (Graham et al., 2006). For example, parenting support interventions and preschool programmes can improve children's cognitive and social–emotional development and school readiness , improve educational levels and enhance future employment prospects (Graham et al., 2006). The most disadvantaged and vulnerable children benefit most from these early childhood interventions (Engle et al., 2011). "
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    ABSTRACT: Despite Australia's success in reducing smoking rates, substantial inequities persist—with high smoking prevalence among disadvantaged groups. This article uses Fair Foundations: The VicHealth framework for health equity to identify promising strategies for promoting equity within tobacco control policies and programmes. A rapid review of the Australian and international literature was conducted in March 2014 using Pubmed, ISI web of Science and Scopus, Cochrane library and Google Scholar. A search of the grey literature was conducted to identify promising policy interventions. Population health surveys suggest that tobacco-related inequities in Victoria are beginning to decline. Data from the Victorian Smoking Survey shows that the inequity gap is narrowing, and in recent years, the prevalence of regular smoking declined fastest among disadvantaged smokers. Future approaches to accelerate reductions in tobacco-related inequities include: (i) continue proven population-based tobacco control policies—especially increasing the price of tobacco (while remaining cognisant of the increased economic burden for those smokers who do not quit), and continuing mass media campaigns; (ii) strengthening social policies to promote equity in early child development; educational experiences; quality of local environments; employment and working conditions; (iii) identifying and investing in targeted approaches to influence social norms and more effectively identify and support disadvantaged smokers to quit; (iv) within tobacco control programmes, give greatest priority to interventions focused on adult smokers (including pregnant women and their partners).
    Preview · Article · Sep 2015 · Health Promotion International
    • "The considerable inequality during adolescence results from a faster initiation among the least educated resulting in earlier peak prevalence compared to the highly educated, and confirms marked resistance of the highly educated to the initiation of regular smoking. The persistence of a high level of inequalities at younger ages can also be linked to low family socioeconomic status, personal and family difficulties , possibly explaining both smoking initiation and subsequent lower level of education (Graham et al. 2006; Etilé 2007; Cutler and Lleras-Muney 2010; Legleye et al. 2011a). These increases in prevalence compounded by social inequalities at these ages show the inefficiency of French public policies to prevent smoking initiation during adolescence (Lermenier-Jeannet 2014), while it has been presented as an important issue for public policies. "
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    ABSTRACT: Objectives The study investigates the life cycle patterns of educational inequalities in smoking according to gender over three successive generations. Methods Based on retrospective smoking histories collected by the nationwide French Health Barometer survey 2010, we explored educational inequalities in smoking at each age, using the relative index of inequality. Results Educational inequalities in smoking increase across cohorts for men and women, corresponding to a decline in smoking among the highly educated alongside progression among the lower educated. The analysis also shows a life cycle evolution: for all cohorts and for men and women, inequalities are considerable during adolescence, then start declining from 18 years until the age of peak prevalence (around 25), after which they remain stable throughout the life cycle, even tending to rise for the most recent cohort. Conclusions This analysis contributes to the description of the “smoking epidemic” and highlights adolescence and late adulthood as life cycle stages with greater inequalities.
    No preview · Article · Aug 2015 · International Journal of Public Health
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    • "The different-sex married also have greater access to health insurance than same-and different-sex cohabiters (Buchmueller and Carpenter 2010; although see Heck et al. 2006 for contrary evidence), in part because married people are more likely than the cohabiting to have adequate incomes to purchase insurance and are more likely to be employed full-time in occupations that include employer-and spousal-based health insurance programs (Cohen and Martinez 2012; Meyer and Pavalko 1996; Zuvekas and Taliaferro 2003). These interrelated and interdependent socioeconomic differences (i.e., employment status, income, and health insurance status) across union status groups may in turn relate to differences in smoking risk (Gilman et al. 2003; Graham et al. 2006; Huisman et al. 2005). Smoking initiation and continuance is more prevalent and cessation attempts are less successful among the un-or under-employed, those with lower incomes, and those with lower rates of health insurance in comparison to their more advantaged counterparts (Fagan et al. 2007a, b; Molarius et al. 2001; Stronks et al. 1997). "
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    ABSTRACT: Cigarette smoking has long been a target of public health intervention because it substantially contributes to morbidity and mortality. Individuals in different-sex marriages have lower smoking risk (i.e., prevalence and frequency) than different-sex cohabiters. However, little is known about the smoking risk of individuals in same-sex cohabiting unions. We compare the smoking risk of individuals in different-sex marriages, same-sex cohabiting unions, and different-sex cohabiting unions using pooled cross-sectional data from the 1997–2010 National Health Interview Surveys (N = 168,514). We further examine the role of socioeconomic status (SES) and psychological distress in the relationship between union status and smoking. Estimates from multinomial logistic regression models reveal that same-sex and different-sex cohabiters experience similar smoking risk when compared to one another, and higher smoking risk when compared to the different-sex married. Results suggest that SES and psychological distress factors cannot fully explain smoking differences between the different-sex married and same-sex and different-sex cohabiting groups. Moreover, without same-sex cohabiter’s education advantage, same-sex cohabiters would experience even greater smoking risk relative to the different-sex married. Policy recommendations to reduce smoking disparities among same-sex and different-sex cohabiters are discussed.
    Full-text · Article · Aug 2014 · Population Research and Policy Review
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