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Which literacy skills are associated with smoking?
  1. Laurie T Martin1,
  2. Ann Haas1,
  3. Matthias Schonlau1,
  4. Kathryn Pitkin Derose1,
  5. Lindsay Rosenfeld2,
  6. Rima Rudd3,
  7. Stephen L Buka4
  1. 1RAND Corporation, Arlington, Virginia, USA
  2. 2Institute on Urban Health Research, Northeastern University, Boston, MA, USA
  3. 3Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
  4. 4Community Health, Brown University School of Public Health, Providence, RI, USA
  1. Correspondence to Dr Laurie T Martin, RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA; lamartin{at}


Background Research has demonstrated associations between smoking and reading skills, but other literacy skills such as speaking, listening and numeracy are less studied despite our dependence on the use of numbers and the oral exchange to deliver information on the risks of smoking.

Methods The authors used multivariable logistic regression to examine the effects of reading, numeracy, speaking and listening skills on: (1) becoming a regular smoker and (2) smoking cessation. Further, multivariable linear regression was used to examine the relation between literacy skills and amount smoked among current smokers. Models controlled for education, gender, age, race/ethnicity, income and, when relevant, age at which they became a regular smoker.

Results For each grade equivalent increase in reading skills, the odds of quitting smoking increased by about 8% (OR=1.08, 95% CI 1.01 to 1.15). For every point increase in numeracy skills, the odds of quitting increased by about 24% (OR=1.24, 95% CI 1.06 to 1.46). No literacy skills were associated with becoming a regular smoker or current amount smoked.

Conclusion The ability to locate, understand and use information related to the risks of smoking may impact one's decision to quit. Messaging should be designed with the goal of being easily understood by all individuals regardless of literacy level.

  • Communication
  • health policy
  • public health epidemiology
  • public health policy
  • smoking

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Harvard School of Public Health. The RAND Corporation approved the use of the data for secondary analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.