Black Americans’ Diminished Return of Educational Attainment on Tobacco Use in Baltimore City

Abstract

Background Socioeconomic status (SES) indicators such as educational attainment are fundamental factors affecting health. One mechanism through which education affects health is by reducing the likelihood of engaging in high-risk behaviors such as smoking. However, according to the marginalization-related diminished returns (MDRs) theory, the association between education and health may be weaker for marginalized populations such as Black than White, primarily due to racism and discrimination. However, little is known about the racial variations in the differential associations between educational attainment and tobacco use in a local setting. Aim This study aimed to investigate the differential association between educational attainment and tobacco use among racial groups in a community sample in Baltimore City. Methods This cross-sectional study used data from a community survey conducted in 2012–2013 in Baltimore City among adults aged 18 years or older. The participants were 3501 adults. Univariate, bivariate, and logistic regression analyses were performed using Stata to investigate the racial difference in the association between education and two outcomes: current smoking status and menthol tobacco product use. Results The study found that adults with a graduate degree were less likely to be current smokers (adjusted odds ratio [AOR]: 0.10, 95% confidence interval [CI]: 0.08–0.13) and menthol tobacco users (AOR: 0.10, 95% CI: 0.07–0.14) compared to those with less than high school diploma. The inverse associations between educational attainment and current smoking (AOR: 1.83, 95% CI: 1.05–3.21) and menthol tobacco product use (AOR: 4.73, 95% CI: 2.07–10.80) were weaker for Back individuals than those who were White. Conclusion Due to MDRs of educational attainment, while highly educated White adults show a low risk of tobacco use, educated Black adults remain at a disproportionately increased risk. The study emphasizes the need for better policies and programs that address minorities’ diminished return of education for tobacco use.

What is Common Becomes Normal; Black-White Variation in the Effects of Adversities on Subsequent Initiation of Tobacco and Marijuana During Transitioning into Adolescence

“…Not only exposures to adversities are higher in minoritized populations 42 , minorities show diminished effects of various economic resources and adversities on behavioral and developmental outcomes 43,44 , such as tobacco 45 , marijuana 46 , and alcohol use 47,48 . African American youth and adults show diminished protective effects of certain family economic status on tangible health and developmental outcomes 49,50 , a pattern showed for various financial and economic indicators such as family income 48 , and parental SEP [51][52][53] . However, most of the weaker effects of economic status on behavioral outcomes are cross-sectional 43,44,50,54,55 .…”