J Epidemiol Community Health 57:802-808 doi:10.1136/jech.57.10.802
  • Research report

Socioeconomic status over the life course and stages of cigarette use: initiation, regular use, and cessation

  1. S E Gilman1,
  2. D B Abrams1,
  3. S L Buka2
  1. 1Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, USA
  2. 2Departments of Maternal and Child Health and Epidemiology, Harvard School of Public Health, Boston, USA
  1. Correspondence to:
 Stephen E Gilman
 Centers for Behavioral and Preventive Medicine, Brown Medical School and the Miriam Hospital, CORO Building, Suite 500, 1 Hoppin Street, Providence, Rhode Island 02903, USA;
  • Accepted 19 March 2003


Study objective: To investigate the association between multiple indicators of socioeconomic status (SES) over the life course and three stages of cigarette use: initiation, regular use, and cessation.

Design: Prospective birth cohort study.

Setting: Providence, Rhode Island.

Participants: Subjects (n=657) aged 30 to 39 were offspring of participants in the Brown University cohort of the United States National Collaborative Perinatal Project started in 1959.

Main results: A significantly increased risk of smoking initiation was observed among people from lower socioeconomic backgrounds. Low SES in childhood also increased the risk for progression to regular smoking, and was associated with a reduced likelihood of smoking cessation. Progression to regular smoking and smoking persistence were also associated with lower adult SES.

Conclusions: Socioeconomic conditions over the life course accumulate to produce increased rates of smoking uptake and reduced rates of cessation among lower SES people. Addressing SES gradients in smoking will require persistent and extended intervention over multiple life stages.


  • Funding: support for this research was received from the National Cancer Institute, Transdisciplinary Tobacco Use Research Center Grant P50 CA84719, and from the National Institute of Mental Health, Grant MH61953. Additional funding was provided by the National Institute on Drug Abuse and the Robert Wood Johnson Foundation.

  • Conflicts of interest: none declared.