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 childhood^3-6
• parental and peer relationships and modelling^7-15
• poorer academic achievement and lower school satisfaction¹⁶
• anxiety and depression^17-20  
• social isolation²¹
• for minority groups, experiencing discrimination.^{22, 23}
• a lesser tendency to consider and value future outcomes^24-27  
• 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 indoors^33-35  
• representations of smoking in popular culture^36-39 
• a history of targeted and intensive marketing^40-44 

 

The above factors vary in importance in explaining socio-economic disparities at different developmental stages⁴⁵  and at different stages in the tobacco addiction cycle.^1, 45 As with other aspects of social disadvantage, many factors driving tobacco-related disparities originate in childhood^46-51 and accumulate throughout the individual’s life.^{1, 48, 52, 53}   

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. 

 

 

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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