Risk Factors for Smoking in Rural Women

Abstract

Background: This study examined the association between social, demographic, and psychologic factors and smoking status among Appalachian Ohio women. A secondary aim examined whether specific factors could be identified and segmented for future tailored treatment of tobacco dependence. Methods: A cross-sectional survey (n = 570) obtained information about social, demographic, and psychologic factors and smoking. Logistic regression described associations between these characteristics and smoking status. Chi-square automatic interaction detection (CHAID) analyses identified subgroups at risk for smoking. Results: Fifty-two percent never smoked, with 20.5% and 27.5% categorized as former and current smokers, respectively. Women with low adult socioeconomic position (SEP) were more likely to smoke (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.74-5.34) compared to high SEP women. Other factors associated with current smoking included age 31-50 (OR 2.30, 95% CI 1.22-4.33), age 18-30 (OR 3.29, 95% CI 1.72-5.34), Center for Epidemiologic Studies Depression scale (CES-D) score ‡ 16 (OR 1.99, 95% CI 1.31-3.05), and first pregnancy at age < 20 (OR 1.74, 95% CI 1.14-2.66). The prevalence of smoking was 50% among those with four or more risk factors compared to 10% for those reporting no risk factors. CHAID analyses identified low adult SEP and depressive symptoms as the combination of risk factors most strongly associated with smoking; 49.3% of women in this subgroup currently smoked. Conclusions: Low SEP in adulthood, maternal circumstances, and depressive symptoms are associated with current smoking. Tailored cessation interventions that address these risk factors should be developed and further evaluated in an attempt to reduce disparities in smoking prevalence among this vulnerable group of women.

Risk Factors for Smoking in Rural Women: The Role of Gender-Based Sexual and Intimate Partner Violence

“…To answer research question 3, and mirroring the modeling for smoking status on the published risk factor for smoking paper among this population, 16 a multivariable logistic regression model was fit with the binary outcome of smoking status (1 = current smoker, 0 = former, and never smoker). Univariate analysis with binary smoking status was performed for all known risk factors for smoking among this population 16 contained in the dataset and all abuse exposure variables, using LOGISTIC procedure in SAS.…”

“…Univariate analysis with binary smoking status was performed for all known risk factors for smoking among this population 16 contained in the dataset and all abuse exposure variables, using LOGISTIC procedure in SAS. All univariate terms found to have significant associations ( p = .05) were then added to a multivariable logistic regression model to allow for the independent effect of each variable, controlling for other known risk factors.…”

“…Otherwise, adult SEP was defined as low. 16 Depressive symptomology as measured by the center for epidemiologic studies depression scale 52 . The center for epidemiologic studies depression scale (CES-D) is a 20-item instrument, range score 0-60, intended for use in the general population to assess frequency of past week feelings and behaviors associated with depression.…”

“…[6][7][8][9][10] Its use is concentrated among populations marginalized due to education, poverty, substance abuse, disability, and geography. [11][12][13][14][15][16] For instance, regional differences in smoking prevalence persist for women Ohio Appalachian residents, and smoking is an established risk factor linked to elevated cervical cancer incidence and mortality in the region. 1,3 In Ohio Appalachia, in 2012, 32.1% of women aged 19 and older smoked every day or some days-compared with 22.7% in metropolitan regions, 24.4% in rural non-Appalachian regions, and 23.3% in suburban regions of the state.…”

“…17 Among Ohio Appalachian women, risk factors for smoking include low socioeconomic position in adulthood, depressive symptoms, first pregnancy before age 20, and younger age. 16 In addition to smoking, a recently identified risk factor for cervical cancer is exposure to gender-based violence (GBV) against women, defined to include intimate partner violence, child sexual abuse, and forced sex in adulthood. 18 A crosssectional analysis of the 2006-2007 Kentucky Women's Health Registry demonstrated after controlling for other risk factors, women with exposure to any GBV had 2.6 times the odds of ever having cervical cancer compared to women with no exposure; whereas the odds of ever having cervical cancer increased to 6.4 among women with exposure to all three types of abuse compared to those never exposed.…”