Disparities In Smoking Research Articles

Widening disparities in cigarette smoking by race/ethnicity across education level in the United States

Reducing tobacco use is an important public health objective. It is the largest preventable cause of death and disease, yet inequalities remain. This study examines combined educational and racial/ethnic disparities in the United States related to cigarette smoking for the three largest racial/ethnic groups (African Americans, Hispanics/Latinos, and non-Hispanic Whites). Data included nine Tobacco Use Supplements to the Current Population Surveys (TUS-CPS) conducted in the United States from 1992/1993–2018 for four smoking metrics: ever smoking rates, current smoking rates, consumption (cigarettes per day), and quit ratios. Across all TUS-CPS samples, there were 9.5% African Americans, 8.8% Hispanics/Latinos, and 81.8% non-Hispanic Whites who completed surveys. Findings revealed that lower educational attainment was associated with increased ever and current smoking prevalence over time across all racial/ethnic groups, and education-level disparities within each race/ethnicity widened over time. Disparities in ever and current smoking rates between the lowest and highest categories of educational attainment (less than a high school education vs. completion of college) were larger for African Americans and non-Hispanic Whites than Hispanics/Latinos. Non-Hispanic Whites had the highest cigarette consumption across all education levels over time. College graduates had the highest quit ratios for all racial/ethnic groups from 1992 to 2018, with quit ratios significantly increasing for Hispanics/Latinos and non-Hispanic Whites, but not African Americans. In conclusion, educational disparities in smoking have worsened over time, especially among African Americans and Hispanics/Latinos. Targeted tobacco control efforts could help reduce these disparities to meet public health objectives, although racial/ethnic disparities may persist regardless of educational attainment.

Substance Use Disparities at the Intersection of Sexual Identity and Race/Ethnicity: Results from the 2015-2018 National Survey on Drug Use and Health.

Purpose: Lesbian, gay, and bisexual (LGB) racial/ethnic minority individuals experience minority stress due to both their sexual identity and race/ethnicity and may be at elevated substance use risk (relative to heterosexuals) compared with their White LGB peers. We examined differences in the presence and magnitude of substance use disparities among LGB adults across race/ethnicity. Methods: Using data on 168,560 adults (including 11,389 LGB adults) from the 2015-2018 National Survey on Drug Use and Health, we examined disparities in cigarette smoking, heavy episodic drinking (HED), and marijuana use by race/ethnicity (White, Black, Hispanic, and other race/multiracial). Analyses compared lesbian/gay and bisexual adults, respectively, with heterosexual adults of the same gender and race/ethnicity. We also tested the magnitude of racial/ethnic minority disparities relative to the corresponding White disparity. Results: Significant disparities in smoking, HED, and marijuana use were observed for lesbian/gay and bisexual women across nearly all racial/ethnic groups. Disparities were consistently greater in magnitude for Black and Hispanic LGB women compared with White LGB women. Few disparities were observed among men; the magnitude of observed disparities did not differ by race/ethnicity. Conclusion: Disparities were most pronounced among racial/ethnic minority LGB women, which may reflect their unique experiences of discrimination at the intersection of multiple minority idenities. However, racial/ethnic minority gay and bisexual men were not at elevated risk relative to their White counterparts. Future research on substance use disparities among LGB individuals using an intersectional framework is warranted to elucidate differential minority stress processes that contribute to the observed heterogeneity across race/ethnicity, sexual identity, and gender.

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis

BackgroundEducational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017.MethodsWe used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received.ResultsDaily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap.ConclusionsPrevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.

Disparities in current cigarette smoking among US adults, 2002–2016

BackgroundTo assess disparities in current (past 30 days) cigarette smoking among US adults aged ≥ 18 years during 2002–2016.MethodsNine indicators associated with social disadvantage were analysed from the 2002 to...

Smoking Behavior in Low- and High-Income Adults Immediately Following California Proposition 56 Tobacco Tax Increase.

Objectives. To compare the association of California Proposition 56 (Prop 56), which increased the cigarette tax by $2 per pack beginning on April 1, 2017, with smoking behavior among low- and high-income adults.Methods. Drawing on a sample of 17 206 low-income and 21 324 high-income adults aged 21 years or older from the 2012 to 2018 California Behavioral Risk Factor Surveillance System data, we explored 2 outcomes: current smoking prevalence and smoking intensity (average number of cigarettes per day among current smokers). For each income group, we estimated a multivariable logistic regression to analyze the association of Prop 56 with smoking prevalence and a multivariable linear regression to analyze the association of Prop 56 with smoking intensity.Results. Although we observed no association between smoking intensity and Prop 56, we found a statistically significant decline in smoking prevalence among low-income adults following Prop 56. No such association was found among the high-income group.Conclusions. Given that low-income Californians smoke cigarettes at greater rates than those with higher incomes, our results provide evidence that Prop 56 is likely to reduce income disparities in cigarette smoking in California.

Taxation reduces smoking but may not reduce smoking disparities in youth

ObjectiveThis study examines the extent to which cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity.MethodsWe used US nationally representative, repeated...

Simulating the Impact of a Cigarette Minimum Floor Price Law on Adult Smoking Prevalence in California.

Minimum floor price laws (MFPLs) are an emerging tobacco control policy that sets a minimum price below which a specific tobacco product cannot be sold. MFPLs target cheaper products and may disproportionately impact consumers choosing low price brands or using discounts to reduce prices. We developed a static microsimulation model for California, United States to project short-term effects of different MFPL options for a 20-stick pack of cigarettes on adult smoking behaviors. We simulated 300 000 individuals defined by race and ethnicity, sex, age, and poverty status. Smoking behaviors and cigarette prices were assigned based on demographic distributions in the 2014-2016 California Behavioral Risk Factor Surveillance System. We drew 100 random samples (n = 30 000), weighted to state-level California demographic characteristics. We simulated six MFPL options and modeled impacts on smoking prevalence and cigarette consumption, in general, and separately for those in households below or above 250% of the federal poverty level, assuming a price elasticity of -0.4. Predicted changes in prices, prevalence, and consumption increased exponentially as the floor price increased from $7.00 to $9.50. Assuming 15% policy avoidance, projected increases in average cigarette prices ranged from $0.19 to $1.61. Decreases in smoking prevalence ranged from 0.05 to 0.43 percentage points, and decreases in average monthly cigarette consumption ranged from 1.4 to 12.3 cigarettes. Projected prices increased, and prevalence and consumption decreased, more among individuals in households below 250% federal poverty level. MFPLs are a promising tobacco control strategy with the potential to reduce socioeconomic disparities in cigarette smoking prevalence and consumption. Despite reductions in adult smoking prevalence, significant socioeconomic disparities remain, with lower-income groups smoking at substantially higher levels than higher-income groups. Policies that set a floor price below which a tobacco product cannot be sold could reduce socioeconomic disparities in smoking, depending on variation in prices paid by smokers prepolicy. By using a microsimulation model to predict changes in smoking for different population groups in California under several floor price scenarios, this study demonstrates that MFPLs have the potential to reduce adult smoking prevalence overall, and especially for lower-income tobacco users.

Are state-level income-based disparities in adult smoking declining?

The United States (US) has identified income-based disparities in smoking as a critical public health issue, but the extent to which these disparities are changing over time within states is not well documented. This study examined recent trends in current cigarette smoking in each state and the District of Columbia by self-reported annual household income. Data came from the Behavioral Risk Factor Surveillance System, a state-representative survey of US adults. Sample sizes for each state and year ranged from 2914 to 36,955 participants. We fit logistic regression models to examine linear time trends in cigarette smoking status in each state between 2011 and 2017. In every state, the odds of smoking were 1.4 to 3.0 times greater in the lower-income group as compared to the higher-income group in 2017. Among 47 states, linear time trends in smoking did not significantly differ by income group, suggesting no change in income-based disparities. In three states (Florida, Maine, West Virginia) disparities widened, primarily because smoking prevalence only dropped among higher-income groups. Disparities declined in only one state. In New York, smoking prevalence declined more for lower-income groups compared to higher-income groups. Findings from this study suggest that little progress has been made toward reducing income-based differences in smoking and additional policy and tobacco control efforts may be required to meet national disparity reduction goals.

Cigarette and E-Cigarette Retail Marketing on and Near California Tribal Lands.

Introduction. Retail settings are major channels for the tobacco industry to market commercial tobacco products. However, few studies have examined marketing strategies on Tribal lands. The resulting evidence is important, especially given that American Indian/Alaska Native (AI/AN) youth and adults have the highest smoking prevalence of any racial/ethnic group in the United States. In this study, we examined cigarette, e-cigarette, and vape/vaporizer availability, advertising, and price-reducing promotions in retail settings on and within a 1-mile radius of Tribal lands in California. Method. Trained AI/AN community health representatives (n = 8) conducted store observations (n = 96) using a checklist adapted from the Standardized Tobacco Assessment for Retail Settings observation tool. Chi-square analyses were performed to look for potential differences in availability, exterior advertising, and price promotions for cigarettes, e-cigarettes, and vapes between stores. Results. All stores sold cigarettes and over 95% sold menthol cigarettes. Nearly 25% of stores on Tribal lands were located inside a casino, and 40.4% of stores on Tribal lands offered a Tribal member discount. Stores within a 1-mile radius of Tribal lands sold significantly (p < .01) more e-cigarettes (69.8%), including flavored e-cigarettes (53.4%), compared to stores on Tribal lands (37.7% and 28.3%, respectively). Price promotions for cigarettes were significantly (p < .01) more common in stores located within a 1-mile radius of Tribal lands (46.5%) than stores on Tribal lands (22.6%). Discussion. To our knowledge, this study is the first to use store observations to examine cigarette and e-cigarette availability, advertising, and price promotions in retail settings on and near California Tribal lands. We recommend future studies build on our initial efforts to take an AI/AN Tribal community-engaged approach in assessing and documenting tobacco marketing practices on and near Tribal lands. Tribal governments can consider tobacco policies to help reduce smoking disparities and advance health equity for their communities.

Cigarette Prices in Rural and Urban Ohio: Effects of Census Tract Demographics.

The prevalence of smoking among rural Americans and Americans of lower socioeconomic status (SES) remains higher than among their urban and higher SES counterparts. Potential factors contributing to these disparities are area-based differences in the retail environment and tobacco control policies. We describe the association between neighborhood demographics and cigarette prices in rural and urban areas. Prices of one pack of Marlboro Reds, Newport menthols, and the cheapest cigarettes in the store were recorded from a stratified random sample of tobacco retailers in urban (N = 104) and rural (N = 109) Ohio in 2016. Associations between prices and census tract demographics (SES and race) were modeled separately in each region, controlling for store type. In the rural region, as the census tract income increased, the price of Marlboro and Newport cigarettes decreased, and the price of the cheapest pack of cigarettes increased. In the urban region, as the census tract income and percentage of White non-Hispanic people increased, the price of Marlboro decreased; there were no associations between census tract characteristics and the price of Newports or the cheapest cigarettes. Results describe a complex association between cigarette brand, prices, and area characteristics, where the cheapest brands of cigarettes can be obtained for the lowest prices in lower SES rural areas. Tobacco control policies that raise the price of cheap cigarettes, particularly minimum price laws, have the potential to reduce SES-related smoking disparities in both rural and urban populations.

Socioeconomic disparities in smoking are partially explained by chronic financial stress: marginal structural model of older US adults

BackgroundA persistent socioeconomic gradient in smoking has been observed in a variety of populations. While stress is hypothesised to play a mediating role, the extent of this mediation is unclear....

Early Alcohol and Smoking Initiation: A Contributor to Sexual Minority Disparities in Adult Use

Lesbian, gay, and bisexual adults report higher rates of smoking and alcohol use than heterosexual peers. Prior studies have not examined whether potential disparities in early initiation among lesbian, gay, and bisexual youth may contribute to adult disparities. Data on 126,463 adults (including 8,241 lesbian, gay, and bisexual adults) were from the 2015-2017 National Survey on Drug Use and Health. Rates of reported early alcohol and smoking initiation (before age 15 years) among both lesbian/gay and bisexual adults were examined relative to same-gender heterosexual adults. Mediation analyses were used to assess whether early initiation differences contribute to disparities in adult heavy episodic drinking, alcohol use disorder, current smoking, and nicotine dependence for each subgroup. Analyses were conducted in 2018-2019. For both lesbian/gay and bisexual women, early alcohol initiation rates were elevated and explained 21%-38% of their observed disparities in adult heavy episodic drinking and alcohol use disorder. Similarly, early smoking initiation rates were elevated among both lesbian/gay and bisexual women and explained 22%-29% of their disparities in adult smoking and nicotine dependence. By contrast, no evidence was observed that early initiation mediated adult disparities for gay or bisexual men. A significant proportion of alcohol and smoking disparities among lesbian/gay and bisexual women in adulthood appear attributable to early initiation, indicating the need for enhanced early prevention efforts for these groups. Making routine adolescent screening for substance use, brief intervention, and referral to treatment more culturally sensitive to lesbian, gay, and bisexual youth may also be an important step in reducing adult disparities for lesbian, gay, and bisexual women.

Will Electronic Nicotine Delivery System (ENDS) use reduce smoking disparities? Prevalence of daily ENDS use among cigarette smokers.

Many smokers reported using Electronic Nicotine Delivery System (ENDS, e.g., electronic cigarettes or e-cigarettes) to quit cigarette smoking. Previous studies suggested that daily ENDS use may promote cigarette smoking cessation. We assessed variations in the prevalence of daily ENDS use among adult smokers by demographics and implications for cigarette smoking disparities. Data were from a nationally representative sample of US adults who participated in the 2014–2015 Tobacco Use Supplement to the Current Population Survey (n = 163,920). Participants reported socio-demographics, current cigarette smoking, current ENDS use, and past-year cigarette smoking cessation attempts. We estimated the prevalence of current cigarette smoking in the full sample by socio-demographics. We also estimated the prevalence of daily ENDS use among current smokers (n = 23,232) and those who attempted to quit smoking in the past year (n = 9,341) by socio-demographics. Multivariable logistic regression models were used to assess associations between daily ENDS use and socio-demographics. Prevalence of daily ENDS use was low: 1–6% among current smokers and 2–9% among those who made a past-year quit attempt, across socio-demographics. Hispanic (Adjusted odds ratio [AOR] = 0.45, 95% confidence interval [CI] = 0.29–0.69) and non-Hispanic black smokers (AOR = 0.38, 95% CI = 0.23–0.61) were less likely than non-Hispanic white smokers to use ENDS daily. Similar associations were observed among current smokers who made a past-year quit attempt (p < 0.05). Low prevalence of daily ENDS use suggests that ENDS may only promote smoking cessation in a small fraction of smokers. Lower prevalence of daily ENDS use among non-Hispanic black smokers may worsen race-related cigarette smoking disparities.

Changes in urban and rural cigarette smoking and cannabis use from 2007 to 2017 in adults in the United States

IntroductionRural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities. MethodsUrban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007–2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers. ResultsDespite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007. ConclusionsRurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use.

Text Message Support for Smoking Cessation During Ramadan: A Focus Group Study With Somali Immigrant Muslim Men.

Somali Muslim male immigrants in Minnesota have a high prevalence of smoking, estimated at 44%, compared with the average smoking rate for adults in the United States (14%). However, the literature has reported spontaneous reductions of smoking during Ramadan. This study sought to gather the views of Somali Muslim men on how faith impacts their smoking, and determine what messaging to incorporate into a tailored text messages intervention that draws on the Muslim faith beliefs and practices during Ramadan to promote smoking cessation. Thirty-seven Somali adult male smokers were recruited from community settings to participate in one of five focus groups in Minneapolis and Saint Paul, Minnesota. The research study team developed a semi-structured focus group guide that explored: (1) the experience of Muslim immigrants quitting smoking during Ramadan, (2) views on text messaging interventions to reduce smoking focusing on health and faith, and (3) views on the relationship between faith and smoking. A thematic analysis was conducted. Participants reported reductions in smoking during Ramadan, which was mostly achieved without formal treatment (ie, willpower). There was interest in text messaging interventions that incorporated faith and health-related messages, and that would be delivered around the time of Ramadan. Participants described concerns about the adverse health effects of smoking, including the risk of chronic health issues, cancer, and death. Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address smoking disparities in the Somali immigrant community. Ramadan offers a unique window of opportunity to intervene upon smoking for Somali Muslim immigrant men, for whom rates of smoking are high. Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address these serious smoking disparities.

Disparities in adult cigarette smoking and smokeless tobacco use by sexual identity

BackgroundWhile there have been reductions in rates of tobacco use in the general population in recent years, rates remain high among sexual minority populations (SMP). Prior studies often group SMP as one category due to limited data. This study examined the association between sexual identity status and tobacco use (cigarette and smokeless tobacco use) among U.S. adults. MethodsData from the 2014–2017 Behavioral Risk Factor Surveillance System were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, other, not sure, and heterosexual or straight) and tobacco use. A propensity score analysis was conducted to address potential imbalance among group characteristics. ResultsLesbian/gay and bisexual groups had significantly higher odds of being an every day smoker (OR = 1.83, 95 % Confidence Interval (CI) 1.59–2.10; OR = 1.36, 95 % CI 1.19–1.55, respectively) and current smoker (every day or some days) (OR = 1.71, 95 % CI 1.52–1.93; OR = 1.44, 95 % CI 1.29–1.62, respectively) compared to straight adults. In terms of smokeless tobacco products, lesbian and gay adults had lower odds of every day and current use. However, significant differences were found in the separate analysis conducted for males and females. While gay and bisexual males had lower odds of smokeless tobacco use, lesbians had significantly higher odds when compared to the straight population. Bisexual females were also more likely to be current users of smokeless tobacco. ConclusionsSignificant heterogeneity in tobacco use was found among sexual minority subgroups. Findings demonstrate the importance of subgroup analysis of SMP. These results have implications for prevention and cessation targeting.

Daily stress as link between disadvantage and smoking: an ecological momentary assessment study

BackgroundThere is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. Here, we take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior.MethodA sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether socioeconomic disadvantage (indicated by educational attainment, income and race) exerts indirect effects on smoking (cigarettes per day) via daily stress. Stress experience was assessed at the end of each day using Ecological Momentary Assessment methods. Data were analyzed using random effects regression with a lower-level (2-1-1) mediation model.ResultsOn the within-person level lower educated and African American smokers reported significantly more daily stress across the monitoring period, which in turn was associated with more smoking. This resulted in a small significant indirect effect of daily stress experience on social disadvantage and smoking when using education and race as indicator for social disadvantage. No such effects were found when for income as indicator for social disadvantage.ConclusionThese findings highlight the potential for future studies investigating behavioral mechanisms underlying smoking disparities. Such information would aid in the development and improvement of interventions to reduce social inequality in smoking rates and smoking rates in general.

25 FUNCTIONAL ANNOTATION OF RARE STRUCTURAL VARIATION IN THE HUMAN BRAIN

Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities.Urban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007–2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers.Despite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007.Rurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use.

Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys.

IntroductionTobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs.MethodsData among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008–2011) and the International Tobacco Control Surveys (2009–2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country.ResultsEstimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10).ConclusionLack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

The educational gap in tar and nicotine content in purchases of cigarettes: An observational study using large-scale representative survey data from Japan

The intensity of tobacco use is commonly measured by the number of cigarettes, which is inaccurate because it masks the heterogeneity and substances contained in tobacco. Unlike existing studies, this study adopted the tar and nicotine content of purchased cigarettes as proxies for smoking intensity and elicited socioeconomic disparities from the participants regarding tobacco use. Using a nationally representative consumer panel survey of Japan from 2010 to 2014, we found that socioeconomic disparities in smoking are more pronounced when tar and nicotine content in cigarettes is considered. University graduates purchased 26% fewer cigarettes, and 40% less tar or nicotine than their secondary school-educated counterparts. Low education groups purchased more tar-rich cigarettes, which cost less than low-tar cigarettes. The public health recommendations for reducing socioeconomic health inequalities might be understated because they are drawn from evidence based on the number of cigarettes smoked.