Abstract
Associations of educational attainment with improved health outcomes have been found to be weaker among racial/ethnic minority groups compared with those among the racial/ethnic majority group. Recent research has also documented higher than expected prevalence of smoking in highly educated African American and Hispanic adults. To compare the association of educational attainment with exposure to tobacco advertisements among racial/ethnic groups of US young adults. This cross-sectional study included data from 6700 young adults who participated in wave 1 of the Population Assessment of Tobacco and Health Study, a nationally representative survey of US adults in 2013. Educational attainment was classified as less than high school diploma, high school graduate, or college graduate. Analysis was conducted between September 20 and October 4, 2019. The independent variable was educational attainment (less than high school diploma, high school graduate, and college graduate). The dependent variable was any exposure to tobacco advertisements in the past 12 months. Race/ethnicity, age, sex, poverty status, unemployment, and region were the covariates. Binary logistic and Poisson regression were used to analyze the data. The study included 6700 participants (3366 [50.2%] men) between ages 18 and 24 years. Most participants were non-Hispanic (5257 participants [78.9%]) and white (5394 participants [80.5%]), while 1443 participants (21.5%) were Hispanic. Educational levels included 1167 participants (17.4%) with less than a high school diploma, 4812 participants (71.8%) who were high school graduates, and 4812 participants (10.8%) who were college graduates. A total of 4728 participants (70.6%) reported exposure to tobacco advertisements in the past 12 months. Exposure to tobacco advertising was reported by 383 participants (53.1%) who were college graduates, 3453 participants (71.8%) who were high school graduates, and 892 participants (76.4%) with less than high school educational attainment. In regression analysis, high school graduation (odds ratio, 0.79; 95% CI, 0.68-0.92) and college graduation (odds ratio, 0.46; 95% CI, 0.39-0.54) were associated with lower odds of exposure to tobacco advertisements compared with young adults with lower educational attainment. Compared with non-Hispanic participants, high school education had a weaker protective association for tobacco advertisement exposure among Hispanic participants (odds ratio, 1.44; 95% CI, 1.03-2.01; P = .03), suggesting that the association of high school graduation with lower exposure to tobacco advertisement is weaker among Hispanic young adults than non-Hispanic young adults. This study found that high school graduation had a weaker inverse association with tobacco advertisement exposure among Hispanic than non-Hispanic young adults. Future research should explore the role of targeted marketing strategies of the tobacco industry that largely advertise tobacco in areas with high concentrations of racial/ethnic minority groups. Future research should also evaluate the efficacy of more restrictive marketing policies on racial/ethnic disparities in tobacco use.
Highlights
High school graduation and college graduation were associated with lower odds of exposure to tobacco advertisements compared with young adults with lower educational attainment
Compared with non-Hispanic participants, high school education had a weaker protective association for tobacco advertisement exposure among Hispanic participants, suggesting that the association of high school graduation with lower exposure to tobacco advertisement is weaker among Hispanic young adults than non-Hispanic young adults
This study found that high school graduation had a weaker inverse association with tobacco advertisement exposure among Hispanic than non-Hispanic young
Summary
In the United States, considerable racial/ethnic disparities exist in the burden of tobacco use.[1,2,3,4,5] Despite some racial/ethnic minority groups, such as Hispanic and African American people, having a lower prevalence of tobacco use compared with non-Hispanic white people, racial/ethnic minority groups continue to have higher rates of adverse tobacco outcomes—a paradox well known to tobacco researchers.[3,6,7] Owing to low access to tobacco cessation programs[3,6,7] combined with low acceptability and trust in the health care system overall and tobacco cessation services in particular, African American and Hispanic young adults remain at an increased risk of adverse tobacco-related outcomes, such a cancer, respiratory conditions, and heart disease.[8]Traditionally, some of the racial/ethnic differences in tobacco use have been associated with lower socioeconomic status of racial/ethnic minority groups.[9,10,11,12] The role of socioeconomic status as a social determinant of tobacco disparities has recently increased in the United States, which can be seen as a challenge to the success of US policies in reducing tobacco use prevalence.[12,13,14] From 1966 to 2015, cigarette smoking declined by 83% among people in the United States with college degrees. The same decline was less than half as strong (40%) among individuals who did not have a high school diploma.[15] If the socioeconomic gap was solely responsible for racial/ethnic disparities in tobacco use, policies aimed at the elimination of economic inequalities would have had some success in narrowing the tobacco gap across racial/ethnic and socioeconomic groups, which is clearly not the case.[12,13,14] socioeconomic status does not seem to be the sole mediator of the racial/ ethnic gap in tobacco burden. To eliminate racial/ethnic and socioeconomic gaps, noneconomic interventions, such as restricting tobacco marketing, may be required
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