Income, occupation and education: Are they related to smoking behaviors in China?

Abstract

BackgroundThe association between socioeconomic status (SES) and smoking behaviors may differ across countries. This study aimed to estimate the association between socioeconomic status (income, occupation and education) and multiple measures of smoking behaviors among the Chinese elderly population.MethodsUsing data from the China Health and Retirement Longitudinal Study in 2013, we examined the relationship between socioeconomic status and smoking behaviors through multivariate regression analysis. Sample selection models were applied to correct for sample selection bias. Smoking behaviors were measured by four indicators: smoking status, cigarette consumption, health risks related to smoking, and smoking dependence. Analyses were stratified by gender and urban-rural residence.ResultsAmong Chinese people aged 45 years or older, smokers accounted for 40% of the population in 2013, smoking 19 cigarettes per day. It was also found that 79% of smokers were at an increased health risk. Overall, although the influence of income on smoking behaviors was small and even insignificant, occupation and education levels were significantly associated with smoking behaviors. Managers or professionals were more likely to smoke, however there was no significant relationship with smoking dependence. Individuals with higher educational attainment were less likely to be associated with smoking behaviors. In addition, gender and urban-rural differences existed in the relationship between SES and smoking behaviors.ConclusionsSmoking disparities among diverse levels of socioeconomic status existed but varied greatly by SES indicators and population characteristics. Tobacco control policies in China should be increasingly focused on populations with low socioeconomic status in order to break the link between socioeconomic disadvantage and smoking behaviors. Further actions should mitigate inequalities in education, improve the social culture of cigarette use, and tailor interventions based on characteristics of the population.

The Association Between Education and Smoking Prevalence, Independent of Occupation: A Nationally Representative Survey in Japan

“…Therefore, it is thought that education has a profound effect on smoking initiation on the younger population, while occupation can affect smoking cessation of the middle-age and older population. 19,36 With respect to the association between education and smoking, less educated persons are less likely to have the opportunity to acquire knowledge about smoking and its health effects than those having higher education, leading to a higher prevalence of current smoking in those individuals. 37 Additionally, living in a society that demands high academic qualifications seems to be one reason for increased difference in smoking prevalence between university-educated persons and junior high school graduates among young people.…”

“…41 For the association between occupation and smoking, many studies have reported a significant association between lower level occupations and a higher percentage of current smokers. 13,[19][20][21][22][23][24] It is well known that people with lower level occupations have more difficulties in successfully quitting smoking than those with higher level occupations because they are less likely to receive treatment and support to quit. 42 Another reason for a high rate of smoking in manual workers may be their hard physical tasks or a common practice of smoking at their workplace.…”

“…1 According to WHO reports, globally, 14% of all deaths from non-communicable diseases among adults aged 30 years or older are attributable to tobacco (eg, tobacco use is responsible for an estimated 71% of lung cancer deaths and 36% of deaths due to pulmonary problems), 2 and the estimated economic cost associated with smoking is 1.8% of global gross domestic product. 3 In Japan, smoking is the most attributable and preventable risk factor for non-communicable diseases 4,5 and the population attributable fraction of mortality associated with tobacco smoking is estimated to be 27.8% of all-causes, 38.6% of all cancers, 69.2% of lung cancers, and 60.3% of chronic obstructive pulmonary diseases for men (the corresponding values for women are 6.7%, 5.2%, 19.8%, and 15.6%, respectively). 6 Therefore, anti-smoking measures are part of a fundamental health promotion plan in all nations, including Japan.…”

“…Prior studies indicate that smoking status is associated with numerous factors. 7,8 Especially, regarding reports on socioeconomic differences in smoking, many studies have focused on education and occupation, reporting that smoking is more prevalent among persons with less education, [9][10][11][12][13][14][15][16][17][18][19] those with lower occupational status, 13,19,20 and among blue-collar workers. [21][22][23][24] However, prior studies have the following limitations:…”

“…(1) subjects were limited to working-class participants, 16,18,[20][21][22][23][24] so it is conceivable that prior studies' findings have healthy worker effects; (2) although there are differences in age and gender groups on academic background, work situation, and smoking habit, stratified analyses by both age and gender were not conducted 9,11,13,[17][18][19][20]22,23 ; and (3) although smoking behavior is affected by many factors, 7,8,11,18 such as marital status, financial situation, medical conditions, and mental health, prior studies did not have enough variable adjustment. 9,10,12,[14][15][16]22,24 In Japan, Tabuchi et al investigated smoking inequalities to education 25 ; they found differences in age-and gender-specific educational gradients in smoking among Japanese adults, but lacked adequate adjustments and occupational variables.…”