9.7 Explanations of socioeconomic disparities in smoking

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9.0 Introduction

9.1 Socioeconomic position and disparities in tobacco exposure and use

9.2 Socioeconomic disparities in tobacco exposure and use: are the gaps widening?

9.3 Contribution of smoking to health inequality

9.4 The relationship between tobacco smoking and financial stress

9.5 Smoking and intergenerational poverty

9.6 Smoking, ill health, financial stress and smoking-related poverty among highly disadvantaged groups

9.7 Explanations of socioeconomic disparities in smoking

9.8 Are current strategies to discourage smoking in Australia inequitable?

9.9 Are there inequalities in access to and usage of treatment for dependence on tobacco-delivered nicotine?

9.10 Further initiatives to reduce tobacco-related disparities in Australia

Acknowledgments

References

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 2003260 p 807

Higher smoking rates among disadvantaged groups are associated with a web of interacting factors.261

No doubt different factors are more or less important in explaining socioeconomic disparities at different developmental stages262 and at different stages in the tobacco addiction cycle.260, 262 As with other aspects of social disadvantage, many factors driving tobacco-related disparities originate in childhood263, 264 and accumulate throughout the individual's life-course.250, 260, 265, 266

While a wealth of information is available and increasingly being collected on associations between various forms of social disadvantage and various aspects of tobacco use,13 understanding of the causal mechanisms underlying these associations remains elusive.267

One major strand of social epidemiology has used statistical analysis to try to tease out which factors most accurately predict relative rates and relative changes between groups.

An analysis of data from the 1995 Australian National Health Survey for instance used multiple logistic regression to examine the association of smoking status with various individual and geographic measures of disadvantage. Analyses showed that gender, age, marital status, country of birth and socioeconomic position were all significantly related to smoking status. The odds of being a smoker were largest for respondents who were 20?34 years old, were not married, had a low socioeconomic standing, and were born in the Middle East, southern and western Europe for men, and the United Kingdom/Ireland and western Europe for women. The area measure of socioeconomic status had a stronger association with smoking likelihood than the individual level indicators (education and income), suggesting a crucial role for the smoker's social environment.55

The Christchurch Health and Development Study, a longitudinal study of the health, development and adjustment of a cohort of New Zealand children born in mid-1977, has concluded that higher rates of cigarette smoking among young adults from socioeconomically disadvantaged backgrounds arise from an accumulation of conditions that were more common in children from disadvantaged backgrounds. The mediating factors that increase the likelihood of uptake of smoking include: lower measured intelligence and poorer school achievement (together estimated to account 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%). These conclusions did not depend on the choice of socio-economic indicators or the age at which smoking was assessed.268

Some researchers assert that it is important to tease out precise differences among different social and cultural groups at various stages in the addiction and life-cycle trajectories.262 Other commentators question the social value of more replication or demonstration of inequalities, and call for a much greater focus in research on the 'black box' of how to go about reducing them.267

Beyond social epidemiology, researchers from many other academic and professional disciplines have also explored physiological, psychological and sociological factors related to social disparities in tobacco use. Figures 9.20 and 9.21 attempt to sketch out how a variety of physiological, psychological and sociological factors may be working to maintain socioeconomic disparities in smoking uptake and smoking cessation.