The Contribution of Smoking to Educational Gradients in U.S. Life Expectancy

Abstract

Researchers have documented widening educational gradients in mortality in the United States since the 1970s. While smoking has been proposed as a key explanation for this trend, no prior study has quantified the contribution of smoking to increasing education gaps in longevity. We estimate the contribution of smoking to educational gradients in life expectancy using data on white men and women aged 50 and above from the National Longitudinal Mortality Study (N=283,430; 68,644 deaths) and the National Health Interview Survey (N=584,811; 127,226 deaths) in five periods covering the 1980s to 2006. In each period, smoking makes an important contribution to education gaps in longevity for white men and women. Smoking accounts for half the increase in the gap for white women but does not explain the widening gap for white men in the most recent period. Addressing greater initiation and continued smoking among the less educated may reduce mortality inequalities.

Gender, education and Russia’s tobacco epidemic: A life-course approach

“…In the case of the US, Ho and Fenelon (2015) argued that the later uptake of smoking by women reflected shifts in the cultural meaning and social acceptability of female smoking, changing occupational affiliations during World War II, and the strategic targeting of certain sub-groups of women by tobacco manufacturers in the 1960s aiming deliberately at both gender-based and education-linked characteristics. During this period, smoking was promoted as fashionable, feminine and associated with weight control, but at the same time, information concerning the harmful effects of smoking for men dominated the public health narrative.…”

“…Correspondingly, the link of female smoking with an absence of respectability and sophistication was not reversed until the 1970s and 1980s when smoking among women was recast as fashionable, stylish and a marker of the newly emerging urbanism. It is no coincidence that this followed rapidly behind the 'secondary increase' in female smoking in the US (Ho & Fenelon, 2015) where smoking was also being rebranded as a fashion accessory for stylish females. Equally, what public health narrative there was, documented health risks to males even as the new 'healthier' form of cigarettes were becoming increasingly attractive to women, who perceived of them as natural accompaniments to their changing social and workplace contexts.…”

“You’ve Come a Long Way, Baby”: The Convergence in Age Patterns of Lung Cancer Mortality by Sex, United States, 1959–2013

“…The goal of this study is to do a descriptive analysis of lung cancer age-mortality patterns in the United States, net of changing composition of smokers and nonsmokers over time. This is not to deny, however, that microdata would permit a richer analysis (see, f.e., Ho and Fenelon 2015). Data by cohort would provide additional insights, subject, itself, to the limitation of much incomplete cohort data.…”

“…Death counts were converted to rates using person-years at risk (PYAR) from the Human Mortality Database (2015). Five-year groups (40-44,45-49,...,95-99) were used to smooth heaping on preferential digits of age, as is common practice (f.e., Ho and Fenelon 2015). The exposure (i.e., PYAR) data from the Human Mortality Database are an appropriate match for the MCD data, since the MCD data, collapsed to all causes, is the same as the HMD mortality count data (the HMD does not, as of this writing, include cause-specific data).…”

Educational differences in awareness and use of the outpatient smoking cessation services program in Taiwan

“…[7] Furthermore, smoking has even been found to be one of the main underlying mechanisms of educational disparities in health and mortality. [8][9][10][11][12][13][14] To mitigate these disparities, it is important that tobacco-control measures and cessation intervention services can reach vulnerable subpopulations. [1,15,16] Intuitively, more educated smokers should be more aware of and more likely to use cessation services because they are at better social positions with flexible resources like income and beneficial social connections to avoid risk factors and adopt new information or technology to improve their health.…”