Demography

, Volume 48, Issue 2, pp 653–674 | Cite as

Cross-National Sources of Health Inequality: Education and Tobacco Use in the World Health Survey

Article

Abstract

The spread of tobacco use from the West to other parts of the world, especially among disadvantaged socioeconomic groups, raises concerns not only about the indisputable harm to global health but also about worsening health inequality. Arguments relating to economic cost and diffusion posit that rising educational disparities in tobacco use—and associated disparities in health and premature mortality—are associated with higher national income and more advanced stages of cigarette diffusion, particularly among younger persons and males. To test these arguments, we use World Health Survey data for 99,661 men and 123,953 women from 50 low-income to upper-middle–income nations. Multilevel logistic regression models show that increases in national income and cigarette diffusion widen educational disparities in smoking among young persons and men but have weaker influences among older persons and women. The results suggest that the social and economic patterns of cigarette adoption across low- and middle-income nations foretell continuing, and perhaps widening, disparities in mortality.

Keywords

Health inequality SES Tobacco use Cross-national Education 

References

  1. Allison, P. D. (2002). Missing data. Thousand Oaks, CA: Sage.Google Scholar
  2. Barbeau, E. M., Krieger, N., & Soobader, M.-J. (2004). Working class matters: Socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. American Journal of Public Health, 94, 269–278.CrossRefGoogle Scholar
  3. Blakely, T., Hales, S., Kieft, C., Wilson, N., & Woodward, A. (2005). The global distribution of risk factors by poverty level. Bulletin of the World Health Organization, 83, 118–126.Google Scholar
  4. Bobak, M., Jha, P., Nguyen, S., & Jarvis, M. (2000). Poverty and smoking. In P. Jha & F. J. Chaloupka (Eds.), Tobacco control in developing countries (pp. 41–61). Oxford, UK: Oxford University Press.Google Scholar
  5. Cowell, A. J. (2006). The relationship between education and health behavior: Some empirical evidence. Health Economics, 15, 125–146.CrossRefGoogle Scholar
  6. Cutler, D. M., & Glaeser, E. L. (2006). Why do Europeans smoke more than Americans (NBER Working Paper No. 12124). Cambridge, MA: National Bureau of Economic Research. Available online at http://www.nber.org/papers/w12124
  7. Denney, J. T., Rogers, R. G., Hummer, R. A., & Pampel, F. C. (2010). Education inequality in mortality: The age and gender specific mediating effects of cigarette smoking. Social Science Research, 39, 662–673.CrossRefGoogle Scholar
  8. Department of Health and Human Services (DHHS). (2000). Reducing tobacco use: A report of the surgeon general. Washington, DC: DHHS, Public Health Service.Google Scholar
  9. Department of Health and Human Services (DHHS). (2004). The health consequences of smoking: A report of the surgeon general. Atlanta, GA: U.S. Public Health Service, National Center for Chronic Disease Prevention and Health Promotion.Google Scholar
  10. Ezzati, M., & Lopez, A. D. (2003a). Estimates of global mortality attributable to smoking in 2000. Lancet, 362, 847–852.CrossRefGoogle Scholar
  11. Ezzati, M., & Lopez, A. D. (2003b). Measuring the accumulated hazards of smoking: Global and regional estimates for 2000. Tobacco Control, 12, 79–85.CrossRefGoogle Scholar
  12. Ferrence, R. G. (1989). Deadly fashion: The rise and fall of cigarette smoking in North America. New York: Garland Publishing.Google Scholar
  13. Filmer, D., & Pritchett, L. H. (2001). Estimating wealth effects without expenditure data—or tears: An application to educational enrollments in states of India. Demography, 38, 115–132.Google Scholar
  14. Ganzeboom, H. B. G., De Graaf, P. M., & Treiman, D. J. (1992). A standard international socio-economic index of occupational status. Social Science Research, 21, 1–56.CrossRefGoogle Scholar
  15. Glied, S., & Lleras-Muney, A. (2008). Technological innovation and inequality in health. Demography, 45, 741–761.CrossRefGoogle Scholar
  16. Goel, R. K., & Nelson, M. A. (2004). International patterns of cigarette smoking and global anti-smoking policies. Journal of Economics and Finance, 28, 382–394.CrossRefGoogle Scholar
  17. Goel, R. K., & Nelson, M. A. (2008). Global efforts to combat smoking: An economic evaluation of smoking control policies. Aldershot, UK: Ashgate.Google Scholar
  18. Gwatkin, D. R. (2000). Health inequalities and the health of the poor: What do we know? What can we do? Bulletin of the World Health Organization, 78, 3–17.Google Scholar
  19. Huisman, M., Kunst, A. E., & Mackenbach, J. P. (2005). Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tobacco Control, 14, 106–113.CrossRefGoogle Scholar
  20. Jha, P., & Chaloupka, F. J. (Eds.). (2000). Tobacco control in developing countries. Oxford, UK: Oxford University Press.Google Scholar
  21. Jha, P., Ranson, M. K., Nguyen, S. N., & Yach, D. (2002). Estimates of global and regional smoking prevalence in 1995, by age and sex. American Journal of Public Health, 92, 1002–1006.CrossRefGoogle Scholar
  22. Larsen, K., & Merlo, J. (2005). Appropriate assessment of neighborhood effects on individual health: Integrating random and fixed effects in multilevel logistic regression. American Journal of Epidemiology, 161, 81–88.CrossRefGoogle Scholar
  23. Lawlor, D. A., Frankel, S., Shaw, M., Ebrahim, S., & Davey Smith, G. (2003). Smoking and ill health: Does lay epidemiology explain the failure of smoking cessation programs among deprived populations? American Journal of Public Health, 93, 266–270.CrossRefGoogle Scholar
  24. Lopez, A. D. (1995). The lung cancer epidemic in developed countries. In A. D. Lopez, G. Caselli, & T. Valkonen (Eds.), Adult mortality in developed countries: From description to explanation (pp. 111–143). Oxford, UK: Clarendon.Google Scholar
  25. Mackay, J. (1998). The global tobacco epidemic: The next 25 years. Public Health Reports, 113, 14–21.Google Scholar
  26. Mackay, J., Eriksen, M., & Shafey, O. 2006. The Tobacco Atlas. 2nd ed. Geneva: World Health Organization. Retrieved from http://ww2.cancer.org/docroot/AA/content/AA_2_5_9x_Tobacco_Atlas.asp
  27. Mackenbach, J. P., Stirbu, I., Roskam, A.-J. R., Schaap, M. M., Menvielle, G., Leinsalu, M., et al. (2008). Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, 358, 2468–2481.CrossRefGoogle Scholar
  28. Minujin, A., & Delamonica, E. (2004). Socio-economic inequalities in mortality and health in the developing world. Demographic Research, Special Collection 2, Article 13. doi:10.4054/DemRes.2004.S2.13
  29. Pampel, F. C. (2005). Diffusion, cohort change, and social patterns of smoking. Social Science Research, 34, 117–139.CrossRefGoogle Scholar
  30. Pampel, F. C. (2007). National income, inequality, and global patterns of cigarette use. Social Forces, 86, 455–466.Google Scholar
  31. Pampel, F. C. (2008). Tobacco use in sub-Sahara Africa: Estimates from the demographic health surveys. Social Science and Medicine, 66, 1772–1783.CrossRefGoogle Scholar
  32. Patrick, D. L., Cheadle, A., Thompson, D. C., Diehr, P., Koepsell, T., & Kinne, S. (1994). The validity of self-reported smoking: A review and meta-analysis. American Journal of Public Health, 84, 1086–1093.CrossRefGoogle Scholar
  33. Preston, S. H., & Wang, H. (2006). Sex mortality differences in the United States: The role of cohort smoking patterns. Demography, 43, 631–646.CrossRefGoogle Scholar
  34. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  35. Raudenbush, S. W., Bryk, A. S., Cheong, Y. F., & Congdon, R. T., Jr. (2004). HLM 6: Hierarchical linear and nonlinear modeling. Chicago, IL: Scientific Software International.Google Scholar
  36. Rock, V. J., Malarcher, A., Kahende, J. W., Asman, K., Husten, C., & Caraballo, R. (2007). Cigarette smoking among adults—United States, 2006. MMWR, 56, 1157–1161. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm Google Scholar
  37. Rogers, E. M. (2003). Diffusion of innovations. New York: Free Press.Google Scholar
  38. Sastry, N. (2004). Trends in socioeconomic inequalities in mortality in developing countries: The case of child survival in Sao Paulo, Brazil. Demography, 41, 443–464.CrossRefGoogle Scholar
  39. Shafey, O., Dolwick, S., & Guindon, G. E. (Eds.). (2003). Tobacco control country profiles (2nd ed.). Atlanta, GA: American Cancer Society. Retrieved from http://www.who.int/tobacco/statistics/country_profiles Google Scholar
  40. Soares, R. R. (2007). On the determinants of mortality reductions in the developing world. Population and Development Review, 33, 247–287.CrossRefGoogle Scholar
  41. Sorensen, G., Gupta, P. C., & Pednekar, M. S. (2005). Social disparities in tobacco use in Mumbai, India: The roles of occupation, education, and gender. American Journal of Public Health, 95, 1003–1008.CrossRefGoogle Scholar
  42. Üstün, T. B., Chatterji, S., Mechbal, A., & Murray, C. J. L. (2003). The world health surveys. In C. J. L. Murray & D. B. Evans (Eds.), Health systems performance assessment: Debates, methods and empiricism (pp. 797–808). Geneva, Switzerland: World Health Organization.Google Scholar
  43. Waldron, I., Bratelli, G., Carriker, L., Suno, W.-C., Vogeli, C., & Waldman, E. (1988). Gender differences in tobacco use in Africa, Asia, the Pacific, and Latin America. Social Science and Medicine, 27, 1269–1275.CrossRefGoogle Scholar
  44. World Bank. (1999). Curbing the epidemic: Governments and the economics of tobacco control. Washington, DC: World Bank.Google Scholar
  45. World Health Organization (WHO). (1997). Tobacco or health: A global status report. Geneva, Switzerland: World Health Organization.Google Scholar
  46. World Health Organization (WHO). (2008a). WHO report on the global tobacco epidemic, 2008: The MPOWER package. Geneva, Switzerland: World Health Organization.Google Scholar
  47. World Health Organization (WHO). (2008b). World health survey. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/healthinfo/survey/en/index.html Google Scholar
  48. Yach, D., & Bettcher, D. (2000). Globalization of tobacco industry influence and new global responses. Tobacco Control, 9, 206–216.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2011

Authors and Affiliations

  1. 1.Population ProgramUniversity of ColoradoBoulderUSA
  2. 2.Department of SociologyRice UniversityHoustonUSA

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