Pathways of disadvantage and smoking careers: evidence and policy implications

Graham, Hilary; Inskip, Hazel; Francis, Brian; Harman, Juliet

doi:10.1136/jech.2005.045583

Cited by 132 publications

(147 citation statements)

References 50 publications

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“…The final subsets significantly associated with current smoking included low adult SEP and depressive symptoms. Given the cycle of poverty described among women who smoke, 6,10 it is not surprising these nodes were identified. Depression is related to current smoking, 15 and using nicotine as a way to self-medicate for depression has been described.…”

Section: Discussionmentioning

confidence: 99%

“…5 Currently, 18% of adult American women are smokers, and there is compelling evidence to support a positive relationship between disadvantage and smoking. 6 U.S. women living below the poverty level are more likely to smoke (26.9%) compared to their advantaged counterparts (17.6%). 7 In concert with this disparity, less education and lower employment are related to decreased success in quitting smoking, especially among women.…”

Section: Introductionmentioning

confidence: 99%

“…9 Protecting children from passive smoke exposure while maintaining a smoking behavior may be a challenge in circumstances that involve child care responsibilities, for example, single motherhood. As scholars have noted, 6,10 the disproportionate prevalence in smoking among poorer women, with subsequent disparity in rates of morbidity and mortality, quitting success, and exposure to second-hand smoke, represents a critical topic of investigation in the field of women's health.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Smoking in Rural Women

Wewers

Salsberry

Ferketich

et al. 2012

Journal of Women's Health

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Background: This study examined the association between social, demographic, and psychologic factors and smoking status among Appalachian Ohio women. A secondary aim examined whether specific factors could be identified and segmented for future tailored treatment of tobacco dependence. Methods: A cross-sectional survey (n = 570) obtained information about social, demographic, and psychologic factors and smoking. Logistic regression described associations between these characteristics and smoking status. Chi-square automatic interaction detection (CHAID) analyses identified subgroups at risk for smoking. Results: Fifty-two percent never smoked, with 20.5% and 27.5% categorized as former and current smokers, respectively. Women with low adult socioeconomic position (SEP) were more likely to smoke (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.74-5.34) compared to high SEP women. Other factors associated with current smoking included age 31-50 (OR 2.30, 95% CI 1.22-4.33), age 18-30 (OR 3.29, 95% CI 1.72-5.34), Center for Epidemiologic Studies Depression scale (CES-D) score ‡ 16 (OR 1.99, 95% CI 1.31-3.05), and first pregnancy at age < 20 (OR 1.74, 95% CI 1.14-2.66). The prevalence of smoking was 50% among those with four or more risk factors compared to 10% for those reporting no risk factors. CHAID analyses identified low adult SEP and depressive symptoms as the combination of risk factors most strongly associated with smoking; 49.3% of women in this subgroup currently smoked. Conclusions: Low SEP in adulthood, maternal circumstances, and depressive symptoms are associated with current smoking. Tailored cessation interventions that address these risk factors should be developed and further evaluated in an attempt to reduce disparities in smoking prevalence among this vulnerable group of women.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Smoking in Rural Women

Wewers

Salsberry

Ferketich

et al. 2012

Journal of Women's Health

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“…We examine how 'biographies of disadvantage' (Graham et al, 2006) impact on experiences of time; how phenomenological dimensions of future time (fatalistic and often unimaginable) are discordant with the synoptic time of public health futures. It is not that people do not have hopes or aspirations for the future but rather that they are shaped by the reality of the present and may be limited and situational.…”

Section: Introductionmentioning

confidence: 99%

Short horizons and obesity futures: Disjunctures between public health interventions and everyday temporalities

Warin

Zivkovic

Moore

et al. 2015

Social Science & Medicine

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a b s t r a c tThis paper examines the spatio-temporal disjuncture between 'the future' in public health obesity initiatives and the embodied reality of eating. Drawing upon ethnographic fieldwork in a disadvantaged community in South Australia (August 2012eJuly 2014), we argue that the future oriented discourses of managing risk employed in obesity prevention programs have limited relevance to the immediacy of poverty, contingencies and survival that mark people's day to day lives. Extending Bourdieu's position that temporality is a central feature of practice, we develop the concept of short horizons to offer a theoretical framework to articulate the tensions between public health imperatives of healthy eating, and local 'tastes of necessity'. Research undertaken at the time of Australia's largest obesity prevention program (OPAL) demonstrates that pre-emptive and risk-based approaches to health can fail to resonate when the future is not within easy reach. Considering the lack of evidence for success of obesity prevention programs, over-reliance on appeals to 'the future' may be a major challenge to the design, operationalisation and success of interventions. Attention to local rather than future horizons reveals a range of innovative strategies around everyday food and eating practices, and these capabilities need to be understood and supported in the delivery of obesity interventions. We argue, therefore, that public health initiatives should be located in the dynamics of a living present, tailored to the particular, localised spatio-temporal perspectives and material circumstances in which people live.

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“…Many individuals cope with stress and adversity through use of cigarettes and other substances that harm fetal development (47,48), and women with fewer socioeconomic resources are more likely to smoke both before and during pregnancy (48,49).…”

Section: Causality and Its Discontentsmentioning

confidence: 99%

Rigor, vigor, and the study of health disparities

Adler

Bush²,

Pantell

2012

Proc. Natl. Acad. Sci. U.S.A.

104

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Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents' SES on their children's health provide evidence for a causal pathway from SES to health, but have limitations. Health disparities researchers face tradeoffs between "rigor" and "vigor" in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction. To achieve precision, many studies use a single SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, SES effects on overall health and functioning are likely to be greater than effects on any one disease. Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities.methodology | social determinants of health | cumulative risk G ood health and longevity are unequally distributed in populations. Although some unavoidable variations in health emanate from individual differences in vulnerability to disease, others are linked to membership in socially disadvantaged groups. The latter are unjust and have been the focus of considerable research and policy (1). Research on these health disparities has demonstrated consistent graded associations between various components of socioeconomic status (SES) and a wide range of health indicators; at each step up the social ladder, whether indexed by higher income, education, and/or occupational level, rates of morbidity and mortality decrease (2). The prevailing understanding of this relationship is that SES is a "fundamental cause" of health status (3), which operates through physical and/or psychosocial resources that are more readily available as SES increases, and hardships and adverse exposures that are more intense and frequent as SES decreases.Evidence for the SES-health gradient comes primarily from cross-sectional data linking contemporaneous measures of SES in adulthood with prevalence of disease, poor health, or mortality. Smaller literatures have established associations between socioeconomic conditions in childhood and childhood health, and betwe...

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Pathways of disadvantage and smoking careers: evidence and policy implications

Cited by 132 publications

References 50 publications

Risk Factors for Smoking in Rural Women

Risk Factors for Smoking in Rural Women

Short horizons and obesity futures: Disjunctures between public health interventions and everyday temporalities

Rigor, vigor, and the study of health disparities

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