9.7 Explanations of socio-economic disparities in smoking

Last updated: December 2016 

Suggested citation: Greenhalgh, EM, Scollo, MM, & Pearce, M. 9.7 Explanations of socio-economic disparities in smoking. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-9-disadvantage/9-7-explanations-of-socioeconomic-disparities-in-s

'The relation between SES and smoking patterns is complex involving cumulative and multiple effects across the human life course, possibly extending from one generation to the next.' Gilman et al 20031 p807

Higher smoking rates among disadvantaged groups are associated with a web of interacting physiological, psychological, social, economic, commercial, and cultural factors,2  including:

 

  • nicotine exposure in utero and during childhood3-6
  • parental and peer relationships and modelling7-15
  • poorer academic achievement and lower school satisfaction16
  • anxiety and depression17-20  
  • social isolation21
  • for minority groups, experiencing discrimination.22, 23
  • a lesser tendency to consider and value future outcomes24-27  
  • the endorsement of beliefs that minimise or discount the risks of smoking28
  • workplaces29 and social circles30 that normalise smoking
  • job loss31 and financial stress32
  • a lower likelihood of working indoors33-35  
  • representations of smoking in popular culture36-39 
  • a history of targeted and intensive marketing40-44 

 

The above factors vary in importance in explaining socio-economic disparities at different developmental stages45  and at different stages in the tobacco addiction cycle.145 As with other aspects of social disadvantage, many factors driving tobacco-related disparities originate in childhood46-51 and accumulate throughout the individual’s life.1485253   

While a wealth of information is available on associations between social disadvantage and tobacco use,54-56 understanding the causal mechanisms underlying these associations is more challenging.57

An analysis of data from the 1995 Australian National Health Survey showed that the odds of being a smoker were largest for respondents who were aged 20–34 years, were not married, had a low socio-economic standing, and were born in the Middle East, southern and western Europe for men, and the UK/Ireland and western Europe for women. Geographic socio-economic disadvantage had a stronger association with smoking than individual level factors (education and income), highlighting the importance of the person’s social environment to smoking behaviours.58   

A longitudinal study of the health, development and adjustment of a cohort of New Zealand children concluded that factors that increased the likelihood of uptake of smoking included: lower (conventionally) measured intelligence and poorer school achievement (which they estimated in combination accounted for 56% of the relationship between childhood social disadvantage and later smoking); higher rates of adolescent conduct problems (11%); and greater exposure to parental and peer smoking (26%).59

Figures 9.7.1 and 9.7.2 show how a variety of physiological, psychological and sociological factors may maintain socio-economic disparities in smoking uptake and smoking cessation. 

 

Figure 9.7.1

Figure 9.7.1
Factors driving socio-economic disparities in smoking uptake

 

Figure 9.7.2

Figure 9.7.2
Factors driving socio-economic disparities in smoking cessation

Source: Thank you to Dr Ron Borland for helping to simplify a previous version of these two diagrams.

Recent news and research

For recent news items and research on this topic, click here  (Last updated May 2017)   

References

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Recent references

Mental illness

Lawrence, D., J. Hafekost, P. Hull, F. Mitrou, and S. Zubrick, Smoking, mental illness and socioeconomic disadvantage: analysis of the Australian National Survey of Mental Health and Wellbeing. BMC Public Health, 2013. 13: p. 462. Available from: http://www.biomedcentral.com/1471-2458/13/462
http://www.ncbi.nlm.nih.gov/pubmed/23663362

Health literacy

Stewart, D., C. Adams, M. Cano, V. Correa-Fernandez, Y. Li, et al., Associations between health literacy and established predictors of smoking cessation. American Journal of Public Health, 2013. [Epub ahead of print]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23678912

Greater access to products

Wood, L., G. Pereira, N. Middleton, and S. Foster, Socioeconomic area disparities in tobacco retail outlet density: a Western Australian analysis. The Medical Journal of Australia, 2013. 198(9): p. 489-91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23682892

Other factors

Dorner, T., W. Stronegger, K. Hoffmann, K. Stein, and T. Niederkrotenthaler, Socio-economic determinants of health behaviours across age groups: results of a cross-sectional survey. Wiener Klinische Wochenschrift, 2013. [Epub ahead of print]. Available from: http://link.springer.com/article/10.1007%2Fs00508-013-0360-0
http://www.ncbi.nlm.nih.gov/pubmed/23579882

Green, M., A. Leyland, H. Sweeting, and M. Benzeval, Socioeconomic position and adolescent trajectories in smoking, drinking, and psychiatric distress. The Journal of Adolescent Health, 2013. [Epub ahead of print]. Available from: http://www.jahonline.org/article/S1054-139X%2813%2900146-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/23643540

 

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