Abstract
BackgroundSocioeconomic status (SES) is a major determinant of tobacco use but little is known whether SES affects nicotine exposure and the degree of nicotine dependence.MethodsThe Pennsylvania Adult Smoking Study is a cross-sectional study of smoke exposure and nicotine dependence among adults conducted in central Pennsylvania between June 2012 and April 2014. The study included several measures of SES, including assessments of education and household income, as well as occupation, home ownership, health insurance, household density and savings accounts. Measurements included saliva for the nicotine metabolites cotinine (COT), 3-‘hydroxycotinine (3HC) and total metabolites (COT +3HC). Puffing behavior was determined using portable smoking topography devices.ResultsThe income levels of lighter smokers (< 20 cigarettes per day) was $10,000 more than heavier smokers. Higher Fagerström Test for Nicotine Dependence scores were associated with lower income and job status, scores ranged from 5.4 in unemployed, 4.4 in blue-collar, and 3.8 in white-collar workers. In principal components analysis used to derive SES indicators, household income, number in household, and type of dwelling were the major SES correlates of the primary component. Job category was the major correlate of the second component. Lower SES predicted significantly higher adjusted total nicotine metabolite levels in the unemployed group. Job category was significantly associated with total daily puffs, with the highest level in the unemployed, followed by blue-collar workers, after adjustment for income.ConclusionsAmong smokers, there was a relationship between lower SES and increased nicotine dependence, cigarettes per day and nicotine exposure, which varied by job type.
Highlights
Socioeconomic status (SES) is a major determinant of tobacco use but little is known whether SES affects nicotine exposure and the degree of nicotine dependence
Household income adjusted for household size was associated with job type, with the highest levels found in white collar subjects and the lowest in unemployed subjects
The mean household income was about $61,500 in participants who smoked less than one pack per day, compared to Overall Mean SD
Summary
Socioeconomic status (SES) is a major determinant of tobacco use but little is known whether SES affects nicotine exposure and the degree of nicotine dependence. In the recent National Cancer Institute Monograph 22 “A Socioecological Approach to Addressing Tobacco-Related Health Disparities,” it was noted that historically, individuals with higher incomes and levels of education were more likely to be smokers [1]. This has changed dramatically in the past few decades where smoking is a habit that occurs predominantly in persons. While the need for smoking cessation in these individuals is a major public health goal, it has been argued that decreasing smoking prevalence in these smokers should be considered as a poverty reduction strategy [19, 20]
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