Durable Disparity: The Emergence and Entrenchment of the Great American Smoking Gap

This dissertation consists of three chapters that investigate how inequalities in health behaviors originate and how they are maintained, using cigarette smoking as a case. In Chapter II, I examine the associations between parental and adult child smoking and consider how they may be modified by the adult child’s socioeconomic attainment and social mobility. Using data collected by the Panel Study of Income Dynamics in 1968, 1986, and 2011, I find that having a smoking parent as a child is associated with a 9 percent to 10 percentage point increase in the probability of smoking as an adult in 1986 and 2011, respectively. However, the parental contribution to an adult child’s smoking likelihood decreased to 7 and 5 percentage point and is no longer statistically significant in 2011 after accounting for the adult child’s own socioeconomic attainment. Children of 1968 parents (themselves interviewed in 1986) are more likely to reproduce their parents’ smoking behavior if they maintain their parents’ economic position or are downwardly mobile than if they are upwardly mobile. For children of 1986 parents (interviewed in 2011), adult children who are downwardly mobile with respect to parental education show a larger effect of parental smoking on their own behavior than those who maintain their parents’ education or are upwardly mobile. In Chapter III, I evaluate the contribution of smoke-free laws to the socioeconomic inequality in smoking. Using a state-level dataset constructed from multiple sources, I show that states with lower smoking rates are more likely to adopt smoke-free laws. Lower unemployment rates and higher educational attainment in a state are positively associated with smoke-free workplace and bar laws, respectively. I then use a person-level survey dataset, the Behavioral Risk Factor Surveillance Survey, to estimate the effect of the laws’ implementation on individuals’ probability of smoking. Smoke-free laws are associated with a decline in smoking among women. The decline is concentrated among women who have high school diplomas or are college graduates. Taken together, the results suggest that smoke-free laws may contribute to between-state smoking inequalities and that they may contribute to gender disparities. In Chapter IV, I examine the associations between tobacco control policy change and smoking cessation and smoking intensity of older adults, and how they vary by education and race. I use geocoded longitudinal data from the 1992 to 2014 waves of the Health and Retirement Study including smokers 51 and older to assess the relationship between the implementation of 100 percent smoke-free nonhospitality and hospitality workplace laws at local and state levels, average cigarette pack price at the state level, and the likelihood of an individual’s smoking cessation or change in the number of cigarettes smoked daily. The implementation of a non-hospitality workplace law was associated with an increased likelihood of cessation among men, but not among women. Implementation of restaurant and bar smoke-free laws was not associated with increased cessation or lowered intensity. White men, nonwhite women, and high school graduates decreased their smoking intensity in response to cigarette price change more than others. These results suggest that the sensitivity of older U.S. adults to changes in smoke-free laws and cigarette prices is limited. I close the dissertation by discussing promising future research direction on health behavior disparities and smoking.PHDSoc&HlthSvcsOrgPlcy PhDUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/140926/1/luciekal_1.pd

Tobacco control policy and smoking cessation and intensity in a longitudinal sample of US older adults (1992 - 2014)

Background US Older adults have lower smoking rates than adults in other age groups; only about eight percent of people 65 and older smoke. These lower smoking rates have limited research into the effects of tobacco control policy on smoking cessation in later life, but the lack of attention is misguided. Quitting even relatively late in life confers health and life expectancy benefits. This study addresses two questions: were changes in average cigarette prices and smoke-free laws associated with an increased likelihood of cessation and/or decreased smoking intensity among older adults? Did the effects of tobacco control policies on the likelihood of cessation and/or decreased smoking intensity vary by education and/or race? Methods Geocoded longitudinal data from the 1992 to 2014 waves of the Health and Retirement Study including smokers 51 and older were used to assess the relationship between changes in 100% smoke-free laws and average cigarette pack price and the likelihood of smoking cessation or change in the number of cigarettes smoked daily. All analyses were stratified by gender. Results The enactment of a non-hospitality workplace law was associated with an increased likelihood of cessation among men, but not among women. Transition to other smoke-free laws was not associated with increased cessation or lowered intensity. High school graduates decreased their smoking intensity in response to cigarette price change more than those with less than high school. The most consistent predictor of increased probability of cessation and decreased smoking intensity among these older adults was a negative change in health. Conclusions These results suggest that older adults' smoking is less sensitive to changes in smoke-free policies or increased cigarette prices than that of younger adults

Smoke-Free Policies and Smoking Cessation in the United States, 2003-2015.

(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic characteristics. (2) Methods: We analyzed data from the Tobacco Use Supplement to the Current Population Survey, 2003-2015, to explore whether multiple measures of smoking restrictions were associated with cessation across population subgroups. We examined area-based measures of exposure to smoke-free laws, as well as self-reported exposure to workplace smoke-free policies. We used age-stratified, fixed effects logistic regression models to assess the impact of each smoke-free measure on 90-day cessation. Effect modification by gender, education, family income, and race/ethnicity was examined using interaction terms. (3) Results: Coverage by workplace smoke-free laws and self-reported workplace smoke-free policies was associated with higher odds of cessation among respondents ages 40-54. Family income modified the association between smoke-free workplace laws and cessation for women ages 25-39 (the change in the probability of cessation associated with coverage was most pronounced among lower-income women). (4) Conclusions: Heterogeneous associations between policies and cessation suggest that smoke-free policies may have important implications for health equity