Do socioeconomic differences in tobacco use exist also in developing countries? A study of Ghanaian adolescents

Abstract

BackgroundIn Western countries, tobacco use is most prevalent among adolescents in lower socioeconomic groups. The association between socioeconomic status (SES) and tobacco use among adolescents in developing countries is unexplored. Using multiple SES measures, we investigated this association among adolescents in Ghana.MethodA school-based survey of a representative sample of 13-18-year-old Ghanaians (N = 1,165, response rate = 89.7%) was conducted in three regions, in 2008. Logistic regression analysis was used to evaluate the relationship of smoking, tawa (smokeless tobacco) use with familial SES (parental occupation and education, material affluence scale, family structure), an adolescent's individual social position (school performance, plans after graduation) and inter-generational social mobility (predicted by the differences of familial and individual positions).ResultsSocioeconomic differences existed in tobacco use whether measured by familial SES or individual social position with higher prevalence in lower socioeconomic groups. Low father's education and living in a non-nuclear family were associated with both forms of tobacco use while low material affluence was associated with tawa use only; individual social position measured by plans after graduation was the strongest predictor of both smoking and tawa use. Inter-generational downward social mobility and particularly staying in low SES was related to both forms of tobacco use.ConclusionsSimilar to Western countries, lower SES is related to an adolescent's tobacco use also in developing countries. Cumulative socioeconomic disadvantage over generations increases the probability of tobacco use.

Educational Differences in Smoking among Adolescents in Germany: What is the Role of Parental and Adolescent Education Levels and Intergenerational Educational Mobility?

“…Our finding that intergenerational social mobility relates to smoking behaviour is also confirmed by the literature [15,26,35,38,39,40,41,42,43]. Lower smoking rates among young people with a stable high SES and those who experienced social upward mobility, and a higher inclination towards smoking in peers with a stable low SES and those who experienced social downward mobility, have been reported in studies from Scotland [15], France [38] and Ghana [40], among others. Already published KiGGS data have shown that intergenerational educational mobility also affects adolescents’ risk of obesity [50], multiple health behaviours [53,54], behavioural problems and their use of violence [55].…”

“…Other studies that directly compared the impact of various SES measures consistently report that indicators of adolescent SES are more relevant for adolescent smoking behaviour than parental SES indicators [15,24,25,26,28,29,31]. Our finding that intergenerational social mobility relates to smoking behaviour is also confirmed by the literature [15,26,35,38,39,40,41,42,43]. Lower smoking rates among young people with a stable high SES and those who experienced social upward mobility, and a higher inclination towards smoking in peers with a stable low SES and those who experienced social downward mobility, have been reported in studies from Scotland [15], France [38] and Ghana [40], among others.…”

“…Research on intergenerational social mobility has shown that upward mobility relates to an improvement in health and that downward social mobility is often accompanied by a worsening in health [34,35,36,37]. Most studies that analysed the association between intergenerational social mobility and smoking reported lower smoking rates for upwardly mobile groups and higher smoking rates for downwardly mobile groups compared with the stable SES groups of origin [15,26,35,38,39,40,41,42,43]. …”

Socioeconomic Status and Tobacco Consumption Among Adolescents: A Multilevel Analysis of Argentina's Global Youth Tobacco Survey

“…However , less is known about the strength of this relationship among adolescents. Although an inverse relationship between parent ' s SES and prevalence of smoking by adolescents has been reported in developed countries ( Blow, Leicester, & Windmeijer, 2005 ;Borland, 1975 ;Soteriades & DiFranza, 2003 ), we have found only one study of the association of SES with tobacco use in adolescents from developing nations ( Doku, Koivusilta, Raisamo, & Rimpela, 2010 ).…”

“…This is the fi rst study showing an association between tobacco consumption among youth and poverty in Latin America. Other studies have explored the relationship between tobacco and poverty, mainly in developed countries ( Blow et al, 2005 ;Borland, 1975 ;Doku et al, 2010 ;Harrell, Bangdiwala, Deng, Webb, & Bradley, 1998 ;Lowry, Kann, Collins, & Kolbe, 1996 ;Soteriades & DiFranza, 2003 ;Zhu, Liu, Shelton, Liu, & Giovino, 1996 ).This study has several limitations. First, an important limitation is that the GYTS does not include questions about individual-level SES , which prevented the investigation of individual-level SES as a confounder or effect modifi er.…”