Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles.
Department of Psychology, University of Southern California, Los Angeles.
JAMA Intern Med. 2019 Jun 1;179(6):777-785. doi: 10.1001/jamainternmed.2019.0192.
Understanding emerging patterns of smoking disparities among disadvantaged populations can guide tobacco control policy.
To estimate disparities in smoking prevalence associated with the number of socioeconomic and health-related disadvantages faced by a population among US adults from 2008 to 2017.
DESIGN, SETTING, AND PARTICIPANTS: Nationally representative cross-sectional annual household-based probability sample of US noninstitutionalized residents. Polytomous regression estimated associations of disadvantage variables, survey year, and their interaction with the following 3 pairwise contrasts: current vs never smoking (estimate of overall disparities), current vs former smoking (unique contribution of disparities in smoking cessation), and former vs never smoking (unique contribution of disparities in smoking initiation). The setting was in-home face-to-face interviews. Participants were respondents in 2008 to 2017 survey years who were aged 25 years or older (N = 279 559).
Self-reported past-year unemployment, income below the federal poverty line, absence of high school diploma, disability/limitation interfering with daily functions, serious psychological distress on the Kessler 6-item screen, and at least 60 past-year heavy drinking days, each coded yes or no. These indicators were summed in a cumulative disadvantage index (0, 1, 2, 3, 4, or 5 or 6).
Self-reported current, former (ever smoked ≥100 cigarettes, had since quit, and not currently smoking), and never (<100 cigarettes) smoking.
Among 278 048 respondents (mean [SD] age, 51.9 [16.8] years; 55.7% female) with data on smoking history (99.5% of the sample), the mean current smoking prevalence across 2008 to 2017 compared with populations without disadvantages was successively higher among populations with 1 disadvantage (21.4% vs 13.8%; current vs never smoking adjusted odds ratio [OR], 2.34; 95% CI, 2.27-2.43), 2 disadvantages (26.6% vs 13.8%; OR, 3.55; 95% CI, 3.39-3.72), 3 disadvantages (35.1% vs 13.8%; OR, 5.35; 95% CI, 5.05-5.66), 4 disadvantages (45.7% vs 13.8%; OR, 8.59; 95% CI, 7.91-9.34), or 5 or 6 disadvantages (58.2% vs 13.8%; OR, 14.70; 95% CI, 12.30-17.50). In current vs former and former vs never smoking status contrasts, ORs were lower but also showed successively greater associations with increasing cumulative disadvantage. Current (vs never) smoking odds significantly declined each year among populations with 0 (OR, 0.95; 95% CI, 0.94-0.96), 1 (OR, 0.96; 95% CI, 0.95-0.97), or 2 (OR, 0.98; 95% CI, 0.97-0.99) disadvantages but did not change across 2008 to 2017 among those with 3 or more disadvantages.
Results of this study demonstrate that US disparities in smoking prevalence from 2008 to 2017 were successively larger with each additional disadvantage faced, were expressed in higher smoking initiation odds and lower smoking cessation odds, and widened over time.
重要性：了解弱势群体吸烟差距的新趋势可以为烟草控制政策提供指导。
目的：估计从 2008 年到 2017 年，美国成年人中与人口面临的社会经济和健康相关劣势数量相关的吸烟流行率的差异。
设计、地点和参与者：这是一项全国代表性的、每年进行的、基于家庭的、非机构化居民的概率抽样调查。采用多项回归估计劣势变量、调查年份及其与以下三个配对对比的相互作用：当前与从不吸烟（总体差异的估计）、当前与以前吸烟（戒烟差异的独特贡献）和以前与从不吸烟（吸烟开始差异的独特贡献）。研究地点是在家中进行面对面的访谈。参与者是在 2008 年至 2017 年调查年份中年龄在 25 岁或以上的受访者（N=279559）。
暴露因素：自我报告的过去一年失业、收入低于联邦贫困线、没有高中文凭、残疾/限制干扰日常功能、凯斯勒 6 项测试中存在严重心理困扰，以及过去一年至少有 60 天重度饮酒，每个指标均编码为是或否。这些指标在累积劣势指数（0、1、2、3、4 或 5 或 6）中进行了汇总。
主要结果和测量指标：自我报告的当前、以前（曾经吸烟≥100 支，已经戒烟，目前不吸烟）和从不吸烟（<100 支）。
结果：在 278048 名有吸烟史数据（样本的 99.5%）的应答者（平均[标准差]年龄，51.9[16.8]岁；55.7%为女性）中，与没有劣势的人群相比，2008 年至 2017 年期间，每增加一种劣势的人群中，当前吸烟的流行率依次更高：1 种劣势（21.4% vs 13.8%；当前 vs 从不吸烟调整后的优势比[OR]，2.34；95%CI，2.27-2.43）、2 种劣势（26.6% vs 13.8%；OR，3.55；95%CI，3.39-3.72）、3 种劣势（35.1% vs 13.8%；OR，5.35；95%CI，5.05-5.66）、4 种劣势（45.7% vs 13.8%；OR，8.59；95%CI，7.91-9.34）或 5 种或 6 种劣势（58.2% vs 13.8%；OR，14.70；95%CI，12.30-17.50）。在当前 vs 以前和以前 vs 从不吸烟状态的对比中，OR 较低，但也显示出与累积劣势的关系逐渐增强。在有 0（OR，0.95；95%CI，0.94-0.96）、1（OR，0.96；95%CI，0.95-0.97）或 2（OR，0.98；95%CI，0.97-0.99）种劣势的人群中，每年的当前（vs 从不）吸烟几率显著下降，但在有 3 种或更多劣势的人群中，2008 年至 2017 年期间并未发生变化。
结论和相关性：本研究结果表明，从 2008 年到 2017 年，美国吸烟流行率的差异与所面临的劣势数量成比例增加，表现为更高的吸烟起始几率和更低的戒烟几率，并随时间扩大。
