Lau Yan Kwan, Tam Jamie, Fleischer Nancy L, Meza Rafael
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, 1415 Washington Heights, United States of America.
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, 1415 Washington Heights, United States of America.
Prev Med Rep. 2018 Jul 4;11:202-208. doi: 10.1016/j.pmedr.2018.07.001. eCollection 2018 Sep.
Research on the role of neighbourhood-level deprivation in low- and middle-income countries with respect to tobacco use is relatively nascent. In South Africa, where race and deprivation are closely linked due to the history of apartheid, smoking disparities exist by individual risk factors such as gender, race, and socioeconomic status. However, less is known about how community-level factors affect smoking disparities in the country, or how the relationship between deprivation and smoking differs by race. We used data from the 2008 South African National Income Dynamics Study (NIDS) and Poisson generalised estimating equations to assess the relationship between neighbourhood deprivation and current smoking for individuals nested within neighbourhoods, while controlling for individual-level and household-level covariates. Subgroup analyses for racial categories Black and Coloured were performed. We found that the relationship between neighbourhood deprivation and smoking prevalence was non-linear: the smoking prevalence ratio was highest among those in the middle range for our deprivation index, and lower at extremely high and low levels of deprivation. Both Black and Coloured subsamples exhibited this inverted U-shape, although the relationship was weaker in the latter group. That the relationship between neighbourhood deprivation and smoking is non-linear contrasts with what has been found in high-income countries, where the relationship between neighbourhood deprivation and smoking is linear. Moreover, these findings are relevant to assess the potential differential impact of smoking interventions as a function of socioeconomic and environmental context.
关于邻里层面的贫困在低收入和中等收入国家烟草使用方面所起作用的研究相对较新。在南非，由于种族隔离的历史，种族与贫困紧密相连，吸烟差异因性别、种族和社会经济地位等个体风险因素而存在。然而，对于该国社区层面的因素如何影响吸烟差异，或者贫困与吸烟之间的关系如何因种族而异，我们了解得较少。我们使用了2008年南非国民收入动态研究（NIDS）的数据以及泊松广义估计方程，在控制个体层面和家庭层面协变量的同时，评估邻里贫困与邻里内个体当前吸烟之间的关系。对黑人与有色人种这两个种族类别进行了亚组分析。我们发现邻里贫困与吸烟流行率之间的关系是非线性的：在我们的贫困指数处于中等范围的人群中，吸烟流行率比值最高，而在贫困程度极高和极低的人群中则较低。黑人与有色人种这两个子样本均呈现出这种倒U形，尽管后一组中的这种关系较弱。邻里贫困与吸烟之间的关系是非线性的，这与在高收入国家所发现的情况形成对比，在高收入国家，邻里贫困与吸烟之间的关系是线性的。此外，这些发现对于评估吸烟干预措施作为社会经济和环境背景函数的潜在差异影响具有重要意义。
