Lower levels of occupation, income and education are strongly associated with a longer smoking duration: Multivariate results from the 2001 Australian National Drug Strategy Survey
Introduction
While duration of smoking from onset to cessation has a strong positive association with morbidity and mortality,1, 2, 3, 4 cessation reverses most adverse effects of smoking.1, 3 People who quit before 50 years of age have half the risk of dying in the next 15 years compared with those who continue to smoke.4 Life expectancy among smokers who quit at 35 years of age exceeds that of continuing smokers by at least 6.9 years for men and 6.1 years for women. Even men and women who quit at 65 years of age expect to live at least 1.4 and 2.7 years longer, respectively.5 The gain in life expectancy is because cessation reduces the risk of such conditions as lung and coronary heart disease.6, 7
The link between lower socio-economic status (SES) and higher prevalence of smoking is well established.8, 9, 10 Similarly, there are marked SES differentials in quit ratios (also referred to as cessation rates), defined as the ratio of ex-smokers to ever smokers in the population at a given point in time.9, 11, 12 The quit ratio does not take into account the duration of smoking from onset to cessation. Studies that investigate the link between social disadvantage and duration of smoking are scant. Gilman et al.13 used a sample of 657 respondents aged 30–39 years who were the offspring of participants in the Brown University cohort of the United States National Collaborative Perinatal Project. They employed survival analysis and reported that lower education and poverty during the first 7 years of life were associated with a reduced likelihood of cessation. Similarly, in a prospective study of 1007 participants aged 21–31 years from a health maintenance organization in south–east Michigan, Breslau and Peterson14 found that the potential for quitting was markedly higher in smokers with a college education than in smokers with no college education.
Subgroups within the smoking population that are prone to smoke for longer are at a greater risk of ill health. The objective of this study was to investigate variation in duration of smoking among socio-economic groups, using the 2001 Australian National Drug Strategy Household Survey.
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Sample and measurement
Data came from the 2001 National Drug Strategy Household Survey, which involved a multistage area sample and mainly self-administered questionnaires.15 Two small subsamples using face-to-face and telephone interviews were also used, which were excluded from the present analysis. The response rate was 68%. We used the subsample of adult (18+ years) ever smokers, i.e. respondents who stated that they either ‘smoke daily now’ or ‘used to smoke daily’ (n=9973). The outcome was time from smoking
Results
The average age of blue-collar, white-collar and professional respondents were 45.5, 41.6 and 47.2 years, respectively. The average age of respondents with weekly income less than $300, $300–799 and $800+ were 54.3, 45 and 41.2 years, respectively. The average age of respondents with an education level of year 9 or less, years 10 and 11, and year 12 and beyond were 55, 43.5 and 42.8 years, respectively. Sample characteristics, median duration of smoking and log-rank tests are given in Table 1.
Discussion
This was one of the first studies to examine the association of several predictors of SES with duration of smoking from onset to cessation. Our finding revealed that lower levels of occupation, income and education were independently associated with longer duration of smoking in Australia. Our findings were consistent with Gilman et al.'s analysis described above.13 They employed education and occupation as indicators of current SES and found that only education was associated with cessation.
Acknowledgements
We wish to thank Karen Burns for her research assistance. This research was supported by a grant from the Victorian Health Promotion Foundation (VicHealth). Those who carried out the original analysis and collection of the data no responsibility for the analyses and interpretations presented in this article.
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