Abstract
Educational attainment and income are among major socioeconomic status (SES) indicators that are inversely associated with cigarette smoking. Marginalization-related Diminished Returns (MDRs), however, are weaker protective effects of SES indicators for racial and ethnic minority groups compared to non-Hispanic White people. The aim is to test whether racial and ethnic differences exist in the effects of educational attainment and income on cigarette smoking of middle-aged and older American adults. This is a 26-year longitudinal study using data from the Health and Retirement Study (HRS), a nationally representative study of middle-aged and older adults in the US. A total number of 11,316 middle-aged and older adults (age ≥ 50) were followed for up to 26 years. The independent variables were educational attainment and income. The dependent variables were always smoking and being quitters over the follow-up time. Age, gender, self-rated health, and chronic medical conditions were the covariates. Race/ethnicity was the moderator. Logistic regressions were used to analyze the data. Most participants were never smokers (n = 7950), followed by quitters (n = 1765), always smokers (n = 1272), and initiators (n = 329). Overall, high educational attainment (OR = 0.92, 95% CI = 0.90 - 0.95) and income (OR = 0.99, 95% CI = 0.99 - 0.99) reduced the odds of being always smoker. High educational attainment (OR = 1.05, 95% CI = 1.02 - 1.08) was associated with higher odds of being a quitter. Ethnicity, however, showed significant interactions with education on both outcomes suggesting that the effects of educational attainment on reducing the odds of always being a smoker (OR = 1.24, 95% CI = 1.14 - 1.35) and increasing the odds of quitting (OR = 0.84, 95% CI = 0.75 - 0.93) were smaller for Hispanics than non-Hispanics. In the United States, middle-aged and older Hispanic adults remain at high risk of smoking cigarettes despite high educational attainment. That is, high educational attainment may better help non-Hispanic than Hispanic middle-aged and older adults to avoid cigarette smoking. As a result, we may observe a more than expected burden of tobacco use in middle class Hispanic middle-aged and older adults. Policymakers should not reduce racial and ethnic tobacco inequalities to SES gap, as ethnic tobacco disparities may persist in high SES levels as well.
Highlights
There has been some major decline in the prevalence of tobacco use in the US, cigarette smoking is still the leading preventable cause of morbidity and mortality in this country [1] [2] [3]
Educational attainment and income are among major socioeconomic status (SES) indicators that are inversely associated with cigarette smoking
About 480,000 Americans die from illnesses that are due to tobacco use
Summary
There has been some major decline in the prevalence of tobacco use in the US, cigarette smoking is still the leading preventable cause of morbidity and mortality in this country [1] [2] [3]. SES indicators do not protect various ethnic groups, and racial and ethnic minorities tend to remain at a higher risk of poor health outcomes [24] [25] This model proposes that: 1) racial/ethnic health inequalities in tobacco burden are not merely and exclusively due to SES gaps and due to smaller effects of SES indicators for minority populations, and 2) the racial and ethnic health disparities persist and may even widen at high SES levels. Research has shown that MDRs may apply to tobacco use of youth [26] and adults [27] [28] [29] According to this literature, at least some of the racial/ethnic tobacco use disparities are because of “weaker than expected” protective effects of SES indicators on tobacco use for racial, ethnic, and sexual minority populations [27] [28] [29]. MDRs are argued to be a side effect of the marginalization of racial and minority populations [34] [35]
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