Educational attainment and cigarette smoking

A causal association?

Stephen E. Gilman, Laurie T. Martin, David Abrams, Ichiro Kawachi, Laura Kubzansky, Eric B. Loucks, Richard Rende, Rima Rudd, Stephen L. Buka

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)615-624
Number of pages10
JournalInternational Journal of Epidemiology
Volume37
Issue number3
DOIs
StatePublished - Jun 2008

Fingerprint

Smoking
Education
Confidence Intervals
Siblings
Social Class
Odds Ratio
Regression Analysis
Parturition

Keywords

  • Causality
  • Disparities
  • Education
  • Smoking

ASJC Scopus subject areas

  • Epidemiology

Cite this

Gilman, S. E., Martin, L. T., Abrams, D., Kawachi, I., Kubzansky, L., Loucks, E. B., ... Buka, S. L. (2008). Educational attainment and cigarette smoking: A causal association? International Journal of Epidemiology, 37(3), 615-624. https://doi.org/10.1093/ije/dym250

Educational attainment and cigarette smoking : A causal association? / Gilman, Stephen E.; Martin, Laurie T.; Abrams, David; Kawachi, Ichiro; Kubzansky, Laura; Loucks, Eric B.; Rende, Richard; Rudd, Rima; Buka, Stephen L.

In: International Journal of Epidemiology, Vol. 37, No. 3, 06.2008, p. 615-624.

Research output: Contribution to journalArticle

Gilman, SE, Martin, LT, Abrams, D, Kawachi, I, Kubzansky, L, Loucks, EB, Rende, R, Rudd, R & Buka, SL 2008, 'Educational attainment and cigarette smoking: A causal association?', International Journal of Epidemiology, vol. 37, no. 3, pp. 615-624. https://doi.org/10.1093/ije/dym250
Gilman, Stephen E. ; Martin, Laurie T. ; Abrams, David ; Kawachi, Ichiro ; Kubzansky, Laura ; Loucks, Eric B. ; Rende, Richard ; Rudd, Rima ; Buka, Stephen L. / Educational attainment and cigarette smoking : A causal association?. In: International Journal of Epidemiology. 2008 ; Vol. 37, No. 3. pp. 615-624.
@article{16e8409a84d44e63898c8df84a6c7d49,
title = "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.",
keywords = "Causality, Disparities, Education, Smoking",
author = "Gilman, {Stephen E.} and Martin, {Laurie T.} and David Abrams and Ichiro Kawachi and Laura Kubzansky and Loucks, {Eric B.} and Richard Rende and Rima Rudd and Buka, {Stephen L.}",
year = "2008",
month = "6",
doi = "10.1093/ije/dym250",
language = "English (US)",
volume = "37",
pages = "615--624",
journal = "International Journal of Epidemiology",
issn = "0300-5771",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Educational attainment and cigarette smoking

T2 - A causal association?

AU - Gilman, Stephen E.

AU - Martin, Laurie T.

AU - Abrams, David

AU - Kawachi, Ichiro

AU - Kubzansky, Laura

AU - Loucks, Eric B.

AU - Rende, Richard

AU - Rudd, Rima

AU - Buka, Stephen L.

PY - 2008/6

Y1 - 2008/6

N2 - 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.

AB - 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.

KW - Causality

KW - Disparities

KW - Education

KW - Smoking

UR - http://www.scopus.com/inward/record.url?scp=44949185358&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=44949185358&partnerID=8YFLogxK

U2 - 10.1093/ije/dym250

DO - 10.1093/ije/dym250

M3 - Article

VL - 37

SP - 615

EP - 624

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

IS - 3

ER -