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 language | English (US) |
|---|---|
| Pages (from-to) | 615-624 |
| Number of pages | 10 |
| Journal | International Journal of Epidemiology |
| Volume | 37 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jun 2008 |
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Keywords
- Causality
- Disparities
- Education
- Smoking
ASJC Scopus subject areas
- Epidemiology
Cite this
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 journal › Article
}
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
C2 - 18180240
AN - SCOPUS:44949185358
VL - 37
SP - 615
EP - 624
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
SN - 0300-5771
IS - 3
ER -