Educational attainment and cigarette smoking: a causal association?

Abstract:

BACKGROUND:Despite abundant evidence that lower education is associated with a higher risk of smoking, whether the association is causal has not been convincingly established. METHODS:We investigated the association between education and lifetime smoking patterns in a birth cohort established in 1959 and followed through adulthood (n = 1311). We controlled for a wide range of potential confounders that were measured prior to school entry, and also estimated sibling fixed effects models to control for unmeasured familial vulnerability to smoking. RESULTS:In the full sample of participants, regression analyses adjusting for multiple childhood factors (including socioeconomic status, IQ, behavioural problems, and medical conditions) indicated that the number of pack-years smoked was higher among individuals with less than high school education [rate ratio (RR) = 1.58, confidence interval (CI) = 1.31, 1.91]. However, in the sibling fixed effects analysis the RR was 1.23 (CI = 0.80, 1.93). Similarly, adjusted models estimated in the full sample showed that individuals with less than high school education had fewer short-term (RR = 0.40; CI = 0.23, 0.69) and long-term (RR = 0.59; CI = 0.42, 0.83) quit attempts, and were less likely to quit smoking (odds ratio = 0.34; CI = 0.19, 0.62). The effects of education on quitting smoking were attenuated in the sibling fixed effects models that controlled for familial vulnerability to smoking. CONCLUSIONS:A substantial portion of the education differential in smoking that has been repeatedly observed is attributable to factors shared by siblings that contribute to shortened educational careers and to lifetime smoking trajectories. Reducing disparities in cigarette smoking, including educational disparities, may therefore require approaches that focus on factors early in life that influence smoking risk over the adult life span.

journal_name

Int J Epidemiol

authors

Gilman SE,Martin LT,Abrams DB,Kawachi I,Kubzansky L,Loucks EB,Rende R,Rudd R,Buka SL

doi

10.1093/ije/dym250

subject

Has Abstract

pub_date

2008-06-01 00:00:00

pages

615-24

issue

3

eissn

0300-5771

issn

1464-3685

pii

dym250

journal_volume

37

pub_type

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