Abstract
IntroductionTo gain a better understanding of the complex and independent associations between different measures of socioeconomic position (SEP) and smoking in England.Aims and MethodsBetween March 2013 and January 2019 data were collected from 120 496 adults aged 16+ in England taking part in the Smoking Toolkit Study. Of these, 18.04% (n = 21 720) were current smokers. Six indicators of SEP were measured: social grade, employment status, educational qualifications, home and car ownership and income. Models were constructed using ridge regression to assess the contribution of each measure of SEP, taking account of high collinearity.ResultsThe strongest predictor of smoking status was housing tenure. Those who did not own their own home had twice the odds of smoking compared with homeowners (odds ratio [OR] = 2.01). Social grade, educational qualification, and income were also good predictors. Those in social grades C1 (OR = 1.04), C2 (OR = 1.29), D (OR = 1.39), and E (OR = 1.78) had higher odds of smoking than those in social grade AB. Similarly, those with A-level/equivalent (OR = 1.15), GCSE/vocational (OR = 1.48), other/still studying (OR = 1.12), and no post-16 qualifications (OR = 1.48) had higher odds of smoking than those with university qualifications, as did those who earned in the lowest (OR = 1.23), third (OR = 1.18), and second quartiles (OR = 1.06) compared with those earning in the highest. Associations between smoking and employment (OR = 1.03) and car ownership (OR = 1.05) were much smaller.ConclusionsOf a variety of socioeconomic measures, housing tenure appears to be the strongest independent predictor of smoking in England, followed by social grade, educational qualifications, and income. Employment status and car ownership have the lowest predictive power.ImplicationsThis study used ridge regression, a technique which takes into account high collinearity between variables, to gain a better understanding of the independent associations between different measures of SEP and smoking in England. The findings provide guidance as to which SEP measures one could use when trying to identifying individuals most at risk from smoking, with housing tenure identified as the strongest independent predictor.
Highlights
To gain a better understanding of the complex and independent associations between different measures of socioeconomic position (SEP) and smoking in England
Implications: This study used ridge regression, a technique which takes into account high collinearity between variables, to gain a better understanding of the independent associations between different measures of SEP and smoking in England.The findings provide guidance as to which SEP measures one could use when trying to identifying individuals most at risk from smoking, with housing tenure identified as the strongest independent predictor
All SEP measures were significantly associated with smoking status in the analysis adjusted for age, gender, and ethnicity
Summary
In England, only 15% of the adult population smoke but prevalence is substantially higher among those who are socially disadvantaged.[1]. There has been little attempt to compare and quantify the degree of independent association between a diverse range of measures relating to SEP or composite scores with smoking status We previously used this method to identify the best SEP predictors of alcohol intake.[12] This study found that social grade and educational attainment were the strongest SEP predictors of alcohol consumption indices in England, followed closely by housing tenure. It is hoped that these findings will help to inform population surveys by indicating which of SEP measures are key indices of smoking behavior This is important as logistical and financial constraints often mean it is not possible to include multiple measurements of SEP. If lower income is highly predictive of smoking status this may lend support to fiscal policies such as tax increases (which aim to increase the cost of tobacco) as they have been shown to be most effective among more disadvantages groups,[16] while a strong association with housing tenure would support the provision of localized anti‐smoking campaigns and neighborhood smoking cessation services in areas where social housing or renting is more common.[17]
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