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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2003 Apr;57(4):270–276. doi: 10.1136/jech.57.4.270

Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk)

S Shohaimi 1, R Luben 1, N Wareham 1, N Day 1, S Bingham 1, A Welch 1, S Oakes 1, K Khaw 1
PMCID: PMC1732421  PMID: 12646543

Abstract

Objectives: To investigate the independent association between individual and area based measures of socioeconomic status and cigarette smoking habit.

Design and setting: Cross sectional, population based study.

Participants and methods: 12 579 men and 15 132 women aged 39–79 years living in the general community participating in the EPIC-Norfolk Study in 1993–1997. The association between social class, educational status, Townsend residential deprivation level, and cigarette smoking status was examined.

Main outcome measures: Cigarette smoking status at baseline survey.

Results: Social class, educational level, and residential deprivation level independently related to cigarette smoking habit in both men and women. Multivariate age adjusted odds ratios for current smoking in men were 1.62 (95% CI 1.45 to 1.81) for manual compared with non-manual social class, 1.32 (95% CI 1.17 to 1.48) for those with educational level less than O level compared with those with O level qualifications or higher and 1.84 (95% CI 1.62 to 2.08) for high versus low area deprivation level. For women, the odds ratios for current smoking for manual social class were 1.14 (95% CI 1.03 to 1.27); 1.31 (95% CI 1.18 to 1.46) for low educational level and 1.68 (95% CI 1.49 to 1.90) for high residential deprivation respectively.

Conclusions: Residential deprivation level using the Townsend score, individual social class, and educational level all independently predict smoking habit in both men and women. Efforts to reduce cigarette smoking need to tackle not just individual but also area based factors. Understanding the specific factors in deprived areas that influence smoking habit may help inform preventive efforts.

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Selected References

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  1. Barnett J. R. Does place of residence matter? Contextual effects and smoking in Christchurch. N Z Med J. 2000 Oct 27;113(1120):433–435. [PubMed] [Google Scholar]
  2. Beer V., Bisig B., Gutzwiller F. Social class gradients in years of potential life lost in Switzerland. Soc Sci Med. 1993 Oct;37(8):1011–1018. doi: 10.1016/0277-9536(93)90436-8. [DOI] [PubMed] [Google Scholar]
  3. Blane D., Hart C. L., Smith G. D., Gillis C. R., Hole D. J., Hawthorne V. M. Association of cardiovascular disease risk factors with socioeconomic position during childhood and during adulthood. BMJ. 1996 Dec 7;313(7070):1434–1438. doi: 10.1136/bmj.313.7070.1434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Davey Smith G., Hart C., Hole D., MacKinnon P., Gillis C., Watt G., Blane D., Hawthorne V. Education and occupational social class: which is the more important indicator of mortality risk? J Epidemiol Community Health. 1998 Mar;52(3):153–160. doi: 10.1136/jech.52.3.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Day N., Oakes S., Luben R., Khaw K. T., Bingham S., Welch A., Wareham N. EPIC-Norfolk: study design and characteristics of the cohort. European Prospective Investigation of Cancer. Br J Cancer. 1999 Jul;80 (Suppl 1):95–103. [PubMed] [Google Scholar]
  6. Ellaway A., Macintyre S. Does housing tenure predict health in the UK because it exposes people to different levels of housing related hazards in the home or its surroundings? Health Place. 1998 Jun;4(2):141–150. doi: 10.1016/s1353-8292(98)00006-9. [DOI] [PubMed] [Google Scholar]
  7. Graham H., Der G. Patterns and predictors of tobacco consumption among women. Health Educ Res. 1999 Oct;14(5):611–618. doi: 10.1093/her/14.5.611. [DOI] [PubMed] [Google Scholar]
  8. Gregorio D. I., Walsh S. J., Paturzo D. The effects of occupation-based social position on mortality in a large American cohort. Am J Public Health. 1997 Sep;87(9):1472–1475. doi: 10.2105/ajph.87.9.1472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kleinschmidt I., Hills M., Elliott P. Smoking behaviour can be predicted by neighbourhood deprivation measures. J Epidemiol Community Health. 1995 Dec;49 (Suppl 2):S72–S77. doi: 10.1136/jech.49.suppl_2.s72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Krieger N., Chen J. T., Selby J. V. Comparing individual-based and household-based measures of social class to assess class inequalities in women's health: a methodological study of 684 US women. J Epidemiol Community Health. 1999 Oct;53(10):612–623. doi: 10.1136/jech.53.10.612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kunst A. E., Groenhof F., Mackenbach J. P., Health E. W. Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population based studies. EU Working Group on Socioeconomic Inequalities in Health. BMJ. 1998 May 30;316(7145):1636–1642. doi: 10.1136/bmj.316.7145.1636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Laaksonen M., Rahkonen O., Prättälä R. Smoking status and relative weight by educational level in Finland, 1978-1995. Prev Med. 1998 May-Jun;27(3):431–437. doi: 10.1006/pmed.1998.0288. [DOI] [PubMed] [Google Scholar]
  13. Leclerc A., Pietri F., Boitel L., Chastang J. F., Carval P., Blondet M. Level of education, lifestyle, and morbidity in two groups of white collar workers. J Epidemiol Community Health. 1992 Aug;46(4):403–408. doi: 10.1136/jech.46.4.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Marang-van de Mheen P. J., Davey Smith G., Hart C. L., Gunning-Schepers L. J. Socioeconomic differentials in mortality among men within Great Britain: time trends and contributory causes. J Epidemiol Community Health. 1998 Apr;52(4):214–218. doi: 10.1136/jech.52.4.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Martikainen P., Lahelma E., Ripatti S., Albanes D., Virtamo J. Educational differences in lung cancer mortality in male smokers. Int J Epidemiol. 2001 Apr;30(2):264–267. doi: 10.1093/ije/30.2.264. [DOI] [PubMed] [Google Scholar]
  16. Osler M., Holstein B., Avlund K., Damsgaard M. T., Rasmussen N. K. Socioeconomic position and smoking behaviour in Danish adults. Scand J Public Health. 2001 Mar;29(1):32–39. [PubMed] [Google Scholar]
  17. Pearl M., Braveman P., Abrams B. The relationship of neighborhood socioeconomic characteristics to birthweight among 5 ethnic groups in California. Am J Public Health. 2001 Nov;91(11):1808–1814. doi: 10.2105/ajph.91.11.1808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Reijneveld S. A. The impact of individual and area characteristics on urban socioeconomic differences in health and smoking. Int J Epidemiol. 1998 Feb;27(1):33–40. doi: 10.1093/ije/27.1.33. [DOI] [PubMed] [Google Scholar]
  19. Robert S. A. Community-level socioeconomic status effects on adult health. J Health Soc Behav. 1998 Mar;39(1):18–37. [PubMed] [Google Scholar]
  20. Ross C. E., Mirowsky J. Neighborhood disadvantage, disorder, and health. J Health Soc Behav. 2001 Sep;42(3):258–276. [PubMed] [Google Scholar]
  21. Ross N. A., Taylor S. M. Geographical variation in attitudes towards smoking: findings from the COMMIT communities. Soc Sci Med. 1998 Mar;46(6):703–717. doi: 10.1016/s0277-9536(97)00175-5. [DOI] [PubMed] [Google Scholar]
  22. Schrijvers C. T., Stronks K., van de Mheen H. D., Mackenbach J. P. Explaining educational differences in mortality: the role of behavioral and material factors. Am J Public Health. 1999 Apr;89(4):535–540. doi: 10.2105/ajph.89.4.535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Sloggett A., Joshi H. Higher mortality in deprived areas: community or personal disadvantage? BMJ. 1994 Dec 3;309(6967):1470–1474. doi: 10.1136/bmj.309.6967.1470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Smith G. D., Hart C., Blane D., Gillis C., Hawthorne V. Lifetime socioeconomic position and mortality: prospective observational study. BMJ. 1997 Feb 22;314(7080):547–552. doi: 10.1136/bmj.314.7080.547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Smith G. D., Hart C., Watt G., Hole D., Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health. 1998 Jun;52(6):399–405. doi: 10.1136/jech.52.6.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stewart M. J., Brosky G., Gillis A., Jackson S., Johnston G., Kirkland S., Leigh G., Pawliw-Fry B. A., Persaud V., Rootman I. Disadvantaged women and smoking. Can J Public Health. 1996 Jul-Aug;87(4):257–260. [PubMed] [Google Scholar]
  27. Sundquist J., Malmström M., Johansson S. E. Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Int J Epidemiol. 1999 Oct;28(5):841–845. doi: 10.1093/ije/28.5.841. [DOI] [PubMed] [Google Scholar]
  28. Townsend J., Roderick P., Cooper J. Cigarette smoking by socioeconomic group, sex, and age: effects of price, income, and health publicity. BMJ. 1994 Oct 8;309(6959):923–927. doi: 10.1136/bmj.309.6959.923. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tseng M., Yeatts K., Millikan R., Newman B. Area-level characteristics and smoking in women. Am J Public Health. 2001 Nov;91(11):1847–1850. doi: 10.2105/ajph.91.11.1847. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Wang M. Q. Social environmental influences on adolescents' smoking progression. Am J Health Behav. 2001 Jul-Aug;25(4):418–425. doi: 10.5993/ajhb.25.4.7. [DOI] [PubMed] [Google Scholar]
  31. White I. R., Blane D., Morris J. N., Mourouga P. Educational attainment, deprivation-affluence and self reported health in Britain: a cross sectional study. J Epidemiol Community Health. 1999 Sep;53(9):535–541. doi: 10.1136/jech.53.9.535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Yen I. H., Kaplan G. A. Poverty area residence and changes in physical activity level: evidence from the Alameda County Study. Am J Public Health. 1998 Nov;88(11):1709–1712. doi: 10.2105/ajph.88.11.1709. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. de Vries H. Socio-economic differences in smoking: Dutch adolescents' beliefs and behaviour. Soc Sci Med. 1995 Aug;41(3):419–424. doi: 10.1016/0277-9536(94)00330-v. [DOI] [PubMed] [Google Scholar]

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