Changing social circumstances influence smoking

Reducing people's deprivation through wider social policy should help reduce smoking rates significantly according to new research from the University of Otago, Wellington.

However findings that an improvement in social circumstances through increasing income among 15-24 year olds actually increased the chances of smoking suggests specific policy action is needed to help stop young adults from adopting smoking.

Professor Tony Blakely and his University of Otago, Wellington colleagues used data on the same people followed over several years to explore whether changes in social circumstances change smoking behaviour.

They found that increasing deprivation (be it your neighbourhood or your personal deprivation) increases your odds or chance of smoking. Moving from a neighbourhood in the least deprived fifth of New Zealand to the most deprived fifth increased someone's odds of smoking by a large 83 per cent.

This increase in your chances of being a smoker if you move to a more deprived neighbourhood is consistent with a 'social causation of disease' model," say Professor Blakely.

"That is, worsening social circumstances makes you more likely to smoke."

However, the study also found that an improvement in social circumstances through increasing income among 15-24 year olds increased the chances of smoking. Doubling personal income increased the odds of smoking by 28 per cent.

"We know that giving teenagers more pocket money increases their likelihood of smoking. We also know that increasing the price of tobacco through tax decreases smoking. So it is not surprising when you think about it that increasing incomes among young adults increases smoking risk. But, this runs counter to a simple 'social causation of disease' model that suggests improvement in social circumstances will always improve health – it doesn't."

The fact that increasing income among young adults increases smoking initiation requires more aggressive tobacco control policy at this age, Professor Blakely says.

"We want young adults to increase their incomes. But we do not want young adults to become addicted smokers as an unintended consequence."

Policy options include higher taxes on cigarettes as youth a more price-sensitive, lifting the minimum age to purchase tobacco, raising alcohol tax to help prevent both drinking and smoking as smoking is often a complementary activity to drinking, and adopting fully smokefree hospitality venues, similar to a 25-foot rule in force in some USA jurisdictions.

The study the researchers used was better able to tease out causation from correlation, because it tracked how the smoking behaviours of 11,000 Kiwis changed when their personal circumstances changed over a period of five years from 2004 to 2009.

The research was conducted with Survey of Family Income and Employment (SoFIE) data collected by Statistics New Zealand, with additional health data collected and analysed through funding by the Health Research Council of New Zealand.

The study has just been published in the international journal Tobacco Control.