Monden Christiaan W S
Department of Sociology, Tilburg University, 5000 LE Tilburg, The Netherlands.
Prev Med. 2004 Jul;39(1):19-26. doi: 10.1016/j.ypmed.2004.02.016.
Studies explaining educational differences in health often employ current smoking as a mediator. To what extent does lifetime smoking mediate the association between education and self-reported health better than current smoking?
Analysis of cross-sectional data from a representative general population sample of Dutch men and women (n = 1,561) with complete retrospective smoking histories.
Educational differences in smoking over the life course are more pronounced than educational differences in current smoking, especially among men. The association between education and self-reported health is reduced when controlling for smoking for men. Among women, smoking is not such a mediator. The odds ratio for men with primary education to report less than good health is reduced from 2.94 (95% CI: 1.20-6.30) to 2.62 (95% CI: 1.13-6.05) when current smoking is taken into account and to 2.14 (95% CI: 0.90-5.04) when lifetime smoking is controlled for. This reduction in the difference between the highest and lowest educated is approximately 30% and statistically significant. For women, reductions are smaller and non-significant.
Educational differences in smoking among men are underestimated if current instead of lifetime smoking is studied. Consequently, the contribution of smoking to bringing about social inequalities in health is underestimated if current smoking is measured.
解释健康方面教育差异的研究通常将当前吸烟情况作为一个中介变量。终生吸烟情况在多大程度上比当前吸烟情况能更好地介导教育与自我报告健康之间的关联？
对来自具有完整回顾性吸烟史的荷兰男性和女性代表性普通人群样本（n = 1561）的横断面数据进行分析。
在整个生命历程中，吸烟方面的教育差异比当前吸烟方面的教育差异更为显著，尤其是在男性中。对于男性，在控制吸烟因素后，教育与自我报告健康之间的关联有所减弱。在女性中，吸烟并非如此明显的中介变量。考虑当前吸烟情况时，小学教育程度男性报告健康状况不佳的优势比从2.94（95%置信区间：1.20 - 6.30）降至2.62（95%置信区间：1.13 - 6.05），而控制终生吸烟情况时降至2.14（95%置信区间：0.90 - 5.04）。最高和最低教育程度之间差异的这种减少约为30%，且具有统计学意义。对于女性，减少幅度较小且无统计学意义。
如果研究的是当前吸烟而非终生吸烟情况，男性在吸烟方面的教育差异会被低估。因此，如果测量的是当前吸烟情况，吸烟对导致健康方面社会不平等的作用就会被低估。
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