Department of Health Promotion and Development, University of Bergen, Alrek helseklynge, Årstadveien 17, Bergen, 5009, Norway.
Department of Education and Childhood Studies, Swansea University, Singleton Campus, Swansea, Wales, SA2 8PP, UK.
BMC Public Health. 2023 Oct 17;23(1):2022. doi: 10.1186/s12889-023-16952-6.
Socioeconomic differences in the impact of alcohol consumption on health have been consistently reported in the so-called "alcohol harm paradox" (i.e., individuals from higher socioeconomic backgrounds (SES) drink more alcohol than individuals from lower SES, but the latter accrue more alcohol-related harm). Despite the severe health risks of smoking however, there is a scarcity of studies examining a possible "smoking harm paradox" (SHP). We aim to fill this gap.
We conducted a prospective cohort study with adolescents from the Norwegian Longitudinal Health Behaviour Study (NLHB). Our study used data from ages 13 to 30 years. To analyse our data, we used the random-intercept cross-lagged panel model (RI-CLPM) with smoking and self-reported health as mutual lagged predictors and outcomes as well as parental income and education as grouping variables. Parental income and education were used as proxies for adolescent socioeconomic status (SES). Smoking was examined through frequency of smoking (every day, every week, less than once a week, not at all). General health compared to others was measured by self-report.
Overall, we found inconclusive evidence of the smoking harm paradox, as not all effects from smoking to self-reported health were moderated by SES. Nevertheless, the findings do suggest that smoking predicted worse subjective health over time among individuals in the lower parental education group compared with those in the higher parental education group. This pattern was not found for parental income.
While our results suggest limited evidence for a smoking harm paradox (SHP), they also suggest that the impact of adolescent smoking on later subjective health is significant for individuals with low parental education but not individuals with high parental education. This effect was not found for parental income, highlighting the potential influence of parental education over income as a determinant of subjective health outcomes in relation to smoking.
在所谓的“酒精危害悖论”中，一直有报道称，酒精消费对健康的影响存在社会经济差异（即，来自较高社会经济背景（SES）的个体比来自较低 SES 的个体饮酒更多，但后者遭受更多与酒精相关的伤害）。然而，尽管吸烟存在严重的健康风险，但很少有研究探讨可能存在的“吸烟危害悖论”（SHP）。我们旨在填补这一空白。
我们对来自挪威纵向健康行为研究（NLHB）的青少年进行了一项前瞻性队列研究。我们的研究使用了从 13 岁到 30 岁的数据。为了分析我们的数据，我们使用了随机截距交叉滞后面板模型（RI-CLPM），将吸烟和自我报告的健康作为相互滞后的预测因子和结果，以及父母的收入和教育作为分组变量。父母的收入和教育被用作青少年社会经济地位（SES）的代理变量。吸烟通过吸烟频率（每天、每周、少于每周一次、从不吸烟）进行检查。与他人相比的一般健康状况通过自我报告进行衡量。
总体而言，我们发现吸烟危害悖论的证据不明确，因为并非所有吸烟对自我报告健康的影响都受到 SES 的调节。尽管如此，研究结果确实表明，与父母教育程度较高的个体相比，在父母教育程度较低的个体中，吸烟随着时间的推移预测到较差的主观健康状况。对于父母的收入，没有发现这种模式。
虽然我们的结果表明存在有限的吸烟危害悖论（SHP）的证据，但它们也表明，青少年吸烟对以后主观健康的影响对于父母教育程度较低的个体是显著的，但对于父母教育程度较高的个体则不然。对于父母的收入，没有发现这种影响，这突出了父母教育相对于收入作为与吸烟有关的主观健康结果的决定因素的潜在影响。
