Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA.
Department of Psychiatry, Virginia Commonwealth University, Richmond VA.
Nicotine Tob Res. 2021 Jan 22;23(2):334-340. doi: 10.1093/ntr/ntaa161.
Academic achievement (AA) is associated with smoking rates. Can we determine the degree to which this relationship is likely a causal one?
We predict smoking in male conscripts (mean age 18.2) assessed from 1984 to 1991 (N = 233 248) and pregnant females (mean age 27.7) receiving prenatal care 1972-1990 (N = 494 995) from AA assessed in all students at 16. Instrumental variable (IV) analyses used the instrument month-of-birth as in each school year, older children have high AA. Co-relative analyses used AA-smoking associations in the population, cousins and siblings to predict the AA-smoking relationship in MZ twins, thereby controlling for familial confounding.
In males, higher AA was associated with a substantial decrease in risk for smoking (odds ratio [OR] [95% confidence intervals [CIs]] per standard deviation [SD] = 0.41 [0.40-0.41]) while the parallel figures obtain from our IV and co-relative analyses were 0.47 (0.39-0.57) and 0.51 (0.43-0.60), respectively. In females, these figures for pre-pregnancy smoking were, respectively, 0.39 (0.39-0.39), 0.50 (0.46-0.54) and 0.54 (0.51-0.58). Results for heavy versus light smoking suggested a causal effect but were inconsistent across methods. However, among females smoking prior to pregnancy, AA predicted a reduced risk for continued smoking with ORs for uncontrolled, IV, and co-relative analyses equaling, respectively, were 0.54 (0.53-0.55) 0.68 (0.56-0.82) and 0.78 (0.66-0.91), respectively.
Two different methods produced consistent evidence that higher AA has a causal effect on reducing smoking rates and increasing cessation rates in smoking pregnant females. Improving AA may result in meaningful gains in population health through reduced smoking.
This study provides consistent evidence across two different methods that high AA is causally related to reduced rates of smoking and increasing rates of smoking cessation among pregnant women. Our results suggest that interventions that improve educational achievement in adolescence would reduce tobacco consumption, thereby improving public health.
学业成绩（AA）与吸烟率有关。我们能否确定这种关系在多大程度上可能是因果关系？
我们预测了从 1984 年至 1991 年接受评估的男性应征者（平均年龄 18.2 岁）和从 1972 年至 1990 年接受产前护理的孕妇（平均年龄 27.7 岁）的吸烟情况（N=233248），这些人在 16 岁时接受了所有学生的学业成绩评估。使用工具变量（IV）分析了月份出生作为每学年的指标，因为年长的孩子学业成绩更高。相对分析使用了人群中的 AA-吸烟关联、表亲和兄弟姐妹来预测 MZ 双胞胎中的 AA-吸烟关系，从而控制了家族混杂因素。
在男性中，较高的 AA 与吸烟风险的显著降低相关（每标准差[SD]的优势比[OR]（95%置信区间[CI]）=0.41[0.40-0.41]），而我们的 IV 和相对分析得到的平行数字分别为 0.47（0.39-0.57）和 0.51（0.43-0.60）。对于怀孕前的吸烟情况，女性的这些数字分别为 0.39（0.39-0.39）、0.50（0.46-0.54）和 0.54（0.51-0.58）。对于重度与轻度吸烟的结果表明存在因果效应，但在方法之间不一致。然而，对于怀孕前吸烟的女性，AA 预测继续吸烟的风险降低，未控制、IV 和相对分析的 OR 分别为 0.54（0.53-0.55）、0.68（0.56-0.82）和 0.78（0.66-0.91）。
两种不同的方法都提供了一致的证据，表明较高的 AA 对降低吸烟率和增加吸烟孕妇的戒烟率有因果影响。提高 AA 可能会通过减少吸烟来提高人群健康水平，从而带来有意义的收益。
这项研究通过两种不同的方法提供了一致的证据，表明高 AA 与孕妇吸烟率降低和戒烟率增加有因果关系。我们的结果表明，改善青春期教育成就的干预措施将减少烟草消费，从而改善公共卫生。
