Nargis Nigar, Xue Zheng, Asare Samuel, Bandi Priti, Jemal Ahmedin
American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA.
American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, USA.
Soc Sci Med. 2023 Jul;328:115982. doi: 10.1016/j.socscimed.2023.115982. Epub 2023 May 26.
The United States (U.S.) witnessed considerable reduction in cigarette smoking prevalence in the recent past. While the correlates of smoking prevalence and related disparities among U.S. adults are well documented, there is limited information on how this success was shared among different population sub-groups. Based on data from the National Health Interview Surveys, 2008 and 2018, representative of non-institutionalized U.S. adults (18 years and above), we applied the threefold Kitawaga-Oaxaca-Blinder linear decomposition analysis. We decomposed the trends in cigarette smoking prevalence, smoking initiation, and successful cessation into changes in population characteristics holding smoking propensities constant (compositional change), changes in smoking propensities by population characteristics holding population composition constant (structural change), and the unmeasured macro-level changes affecting smoking behavior in different population sub-groups at differential rates (residual change) to quantify the shares of population sub-groups by sex, age, race/ethnicity, education, marital status, employment status, health insurance coverage, family income, and region of residence in the overall change in smoking rates. The analysis shows that decreases in smoking propensities regardless of the changes in population composition accounted for 66.4% of the reduction in smoking prevalence and 88.7% of the reduction in smoking initiation. The major reductions in smoking propensity were among Medicaid recipients and young adults (ages 18-24 years). The 25-44-year-olds experienced moderate increase in successful smoking cessation, while the overall successful smoking cessation rate remained steady. Taken together, consistent reduction in smoking among U.S. adults by all major population characteristics, accompanied by disproportionately larger reduction in smoking propensities among the population sub-groups with initially higher smoking propensity compared to the national average, characterized the decline in overall cigarette smoking. Strengthening proven tobacco control measures with targeted interventions to reduce smoking propensities among underserved populations is key to continued success in reducing smoking overall and remedying inequities in smoking and population health.
美国近期吸烟率显著下降。虽然美国成年人吸烟率及其相关差异的影响因素已有充分记录，但关于不同人群亚组如何分享这一成功的信息有限。基于2008年和2018年全国健康访谈调查的数据（代表非机构化的美国成年人，年龄在18岁及以上），我们应用了三重北川-瓦哈卡-布林德线性分解分析。我们将吸烟率、开始吸烟率和成功戒烟率的趋势分解为：在吸烟倾向不变的情况下人口特征的变化（构成变化）、在人口构成不变的情况下按人口特征划分的吸烟倾向变化（结构变化），以及以不同速率影响不同人群亚组吸烟行为的未测量宏观层面变化（残差变化），以量化按性别、年龄、种族/族裔、教育程度、婚姻状况、就业状况、医疗保险覆盖范围、家庭收入和居住地区划分的人群亚组在吸烟率总体变化中所占的份额。分析表明，无论人口构成如何变化，吸烟倾向的降低占吸烟率降低的66.4%，占开始吸烟率降低的88.7%。吸烟倾向的主要降低发生在医疗补助接受者和年轻人（18-24岁）中。25-44岁人群的成功戒烟率适度上升，而总体成功戒烟率保持稳定。总体而言，所有主要人口特征的美国成年人吸烟率持续下降，与全国平均水平相比，最初吸烟倾向较高的人群亚组吸烟倾向下降幅度更大，这是总体吸烟率下降的特征。加强经过验证的烟草控制措施并采取针对性干预措施，以降低弱势群体的吸烟倾向，是在总体上持续成功减少吸烟以及纠正吸烟和人口健康方面不平等现象的关键。
