Disparities in current cigarette smoking among US adults, 2002-2016.
Adolescent
Adult
Aged
Cigarette Smoking
/ epidemiology
Educational Status
Employment
Ethnicity
Female
Health Status Disparities
Humans
Income
Indians, North American
Male
Medicare
Middle Aged
Prevalence
Risk Factors
Smokers
Social Class
Stress, Psychological
United States
/ epidemiology
Vulnerable Populations
disparities
socioeconomic status
surveillance and monitoring
Journal
Tobacco control
ISSN: 1468-3318
Titre abrégé: Tob Control
Pays: England
ID NLM: 9209612
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
14
01
2019
revised:
13
03
2019
accepted:
19
03
2019
pubmed:
31
5
2019
medline:
29
5
2021
entrez:
1
6
2019
Statut:
ppublish
Résumé
To assess disparities in current (past 30 days) cigarette smoking among US adults aged ≥ 18 years during 2002-2016. Nine indicators associated with social disadvantage were analysed from the 2002 to 2016 National Survey on Drug Use and Health: education, annual family income, sex, race/ethnicity, urbanicity, serious psychological distress, health insurance, public assistance, and employment status. Using descriptive and multivariable analyses, we measured trends in smoking overall and within the assessed variables. We also evaluated effect of interactions on disparities and estimated the excess number of smokers attributable to disparities. During 2002-2016, current cigarette smoking prevalence declined overall (27.5%-20.7%; p trend < 0.01), and among all subgroups except Medicare insurees and American Indians/Alaska Natives (AI/ANs). Overall inequalities in cigarette smoking grew even wider or remained unchanged for several indicators during the study period. In 2016, comparing groups with the least versus the most social advantage, the single largest disparity in current smoking prevalence was seen by race/ethnicity (prevalence ratio = 5.1, AI/ANs vs Asians). Education differences alone explained 38.0% of the observed racial/ethnic disparity in smoking prevalence. Interactions were also present; compared with the population-averaged prevalence among all AI/AN individuals (34.0%), prevalence was much higher among AI/ANs with <high school diploma (53.0%), unemployed (58.0%), or with serious psychological distress (66.9%). The burden of smoking attributable to race/ethnic disparities in smoking prevalence was an estimated 27.6 million smokers. Overall smoking inequality increased or remained unchanged because of slower declines in smoking prevalence among disadvantaged groups. Targeted interventions among high-risk groups can narrow disparities.
Sections du résumé
BACKGROUND
To assess disparities in current (past 30 days) cigarette smoking among US adults aged ≥ 18 years during 2002-2016.
METHODS
Nine indicators associated with social disadvantage were analysed from the 2002 to 2016 National Survey on Drug Use and Health: education, annual family income, sex, race/ethnicity, urbanicity, serious psychological distress, health insurance, public assistance, and employment status. Using descriptive and multivariable analyses, we measured trends in smoking overall and within the assessed variables. We also evaluated effect of interactions on disparities and estimated the excess number of smokers attributable to disparities.
RESULTS
During 2002-2016, current cigarette smoking prevalence declined overall (27.5%-20.7%; p trend < 0.01), and among all subgroups except Medicare insurees and American Indians/Alaska Natives (AI/ANs). Overall inequalities in cigarette smoking grew even wider or remained unchanged for several indicators during the study period. In 2016, comparing groups with the least versus the most social advantage, the single largest disparity in current smoking prevalence was seen by race/ethnicity (prevalence ratio = 5.1, AI/ANs vs Asians). Education differences alone explained 38.0% of the observed racial/ethnic disparity in smoking prevalence. Interactions were also present; compared with the population-averaged prevalence among all AI/AN individuals (34.0%), prevalence was much higher among AI/ANs with <high school diploma (53.0%), unemployed (58.0%), or with serious psychological distress (66.9%). The burden of smoking attributable to race/ethnic disparities in smoking prevalence was an estimated 27.6 million smokers.
CONCLUSIONS
Overall smoking inequality increased or remained unchanged because of slower declines in smoking prevalence among disadvantaged groups. Targeted interventions among high-risk groups can narrow disparities.
Identifiants
pubmed: 31147473
pii: tobaccocontrol-2019-054948
doi: 10.1136/tobaccocontrol-2019-054948
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
269-276Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.