Smoking and socioeconomic status in a population-based inner city sample of African-Americans, Latinos and whites.

OBJECTIVE

To examine patterns of cigarette smoking among individuals of different socioeconomic status (SES) and ethnicity.

DESIGN

A cross-sectional and longitudinal community-based random household sample.

METHODS

Unmarried African-American, Latino and while men and women, aged 20-44 years, living in San Francisco in 1988-9 and in 1989-90, were surveyed regarding prior and current smoking. Evaluation of behaviors was based on responses to an interviewer reading questions related to the variables of interest. SES was primarily based on educational attainment.

RESULTS

Overall, 40% of respondents smoked, with an inverse association in univariate analysis between smoking and educational attainment in each gender/ethnic subgroup, except for Latino men. After controlling for other variables, ethnicity and education predicted smoking: with Latinos as referent, whites [odds ratio (OR) = 3.2] and African-Americans (OR = 2.7) were more likely to stroke, and there was a consistent graded inverse association between educational attainment and smoking (P < 0.0001). Of smokers, after controlling for other variables, heavy smokers (> or = 1 pack/day compared with < 1 pack/day) were more likely to be older (P < 0.0001) and white (OR = 7.1) than African-American (OR = 1.8) or Latino (OR = 1.0), and there was trend toward heavy smokers being less educated (P = 0.06). One year later, 1422 (80%) of the original participants were resurveyed. Of 563 baseline smokers, 96 (17%) reported having quit, with African-Americans less likely to quit than whites or Latinos (P < 0.05). Of 859 baseline nonsmokers, 34 (4%) had started to smoke 1 year later.

CONCLUSIONS

In a population-based inner city sample, the prevalence of smoking was considerable and there was a strong inverse association between smoking and educational attainment in almost all ethnic and gender subgroups. Further studies are needed to explore the possible reasons for these differences so that culturally sensitive risk factor interventions may be developed and tested.