Abstract
This study aimed to (a) describe the differences in the prevalence of alcohol use disorder (AUD), smoking, nicotine dependence (ND), and health conditions (physical and mental) across socioeconomic status (SES); (b) study the differences in alcohol-related characteristics (e.g., frequency, quantity); and (c) assess the association between SES with health behaviors (alcohol use, smoking) and health status. This cross-sectional study recruited participants (N = 6126) from a population registry through disproportionate stratified random sampling. Associations between SES with health behaviors and health status were examined using logistic or multinomial regressions adjusted for sociodemographic factors. Individuals in the low SES group had a higher prevalence of AUD than the high SES group (5.1% vs 4.6%). Low SES group had a higher proportion of current smokers (29.0% vs 15.2%) and those with ND (6.7% vs 3.0%). Those in the low SES group had higher prevalence of multi-morbidity (two or more chronic conditions) than the high SES group (46.8% vs 26.1%). Regression models showed that those in the low SES group had higher odds of AUD, smoking, and ND. Socio-environmental specific interventions should be strengthened in this group to promote health behaviors and early treatment entry to prevent potential health inequalities.
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References
Adams, S. (2017). Psychopharmacology of tobacco and alcohol comorbidity: A review of current evidence. Current Addiction Reports, 4, 25–34. https://doi.org/10.1007/s40429-017-0129-z
Allen, L. N., Townsend, N., Williams, J., Mikkelsen, B., Roberts, N., & Wickramasinghe, K. (2018). Socioeconomic status and alcohol use in low- and lower-middle income countries: A systematic review. Alcohol, 70, 23–31.
Amul, G. G. H., & Pang, T. (2018). Progress in tobacco control in Singapore: Lessons and challenges in the implementation of the framework convention on tobacco control. Asia Pac Policy Stud, 5(1), 102–121.
Asharani, P. V., Ling Seet, V. A., Abdin, E., et al. (2020). Smoking and mental illness: Prevalence, patterns and correlates of smoking and smoking cessation among psychiatric patients. International Journal of Environmental Research and Public Health, 17(15), 5571. https://doi.org/10.3390/ijerph17155571
Asharani, P. V., Lau, J. H., Roystonn, K., et al. (2021). Health literacy and diabetes knowledge: A nationwide survey in a multi-ethnic population. International Journal of Environmental Research and Public Health, 18(17), 9316. https://doi.org/10.3390/ijerph18179316
Baker, E. H. (2014). Socioeconomic status, definition. The Wiley Blackwell encyclopedia of health, illness, behavior, and society, pp. 2210–2214. https://doi.org/10.1002/9781118410868.wbehibs395
Batty, G. D., Bhaskar, A., Emslie, C., Benzeval, M., Der, G., Lewars, H., & Hunt, K. (2012). Association of life course socioeconomic disadvantage with future problem drinking and heavy drinking: Gender differentials in the west of Scotland. International Journal of Public Health, 57(1), 119–126. https://doi.org/10.1007/s00038-011-0270-8
Bauld, L., Judge, K., & Platt, S. (2007). Assessing the impact of smoking cessation services on reducing health inequalities in England: Observational study. Tobacco Control, 16(6), 400–404. https://doi.org/10.1136/tc.2007.021626
Bonevski, B., Regan, T., Paul, C., Baker, A. L., & Bisquera, A. (2014). Associations between alcohol, smoking, socioeconomic status and comorbidities: Evidence from the 45 and Up Study. Drug and Alcohol Review, 33(2), 169–176. https://doi.org/10.1111/dar.12104
Booranasuksakul, U., Singhato, A., Rueangsri, N., & Prasertsri, P. (2019). Association between alcohol consumption and body mass index in university students. Asian Pacific Island Nursing Journal, 4(1), 57–65. https://doi.org/10.31372/20190401.1035
Calling, S., Ohlsson, H., Sundquist, J., Sundquist, K., & Kendler, K. S. (2019). Socioeconomic status and alcohol use disorders across the lifespan: A co-relative control study. PLoS ONE, 14(10), e0224127. https://doi.org/10.1371/journal.pone.0224127
Castillo-Carniglia, A., Keyes, K. M., Hasin, D. S., & Cerdá, M. (2019). Psychiatric comorbidities in alcohol use disorder. The Lancet Psychiatry, 6(12), 1068–1080.
Chan, C. Q. H., Lee, K. H., & Low, L. L. (2018). A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore. International Journal for Equity in Health, 17(1), 39. https://doi.org/10.1186/s12939-018-0751-y
Chong, S. A., Vaingankar, J., Abdin, E., & Subramaniam, M. (2012). The prevalence and impact of major depressive disorder among Chinese, Malays and Indians in an Asian multi-racial population. Journal of Affective Disorders, 138(1–2), 128–136. https://doi.org/10.1016/j.jad.2011.11.038
Department of Statistics Singapore. (2020). Health facilities, Accessible from. https://www.tablebuilder.singstat.gov.sg/publicfacing/createDataTable.action?refId=15181. Accessed 20 November 2021.
Department of Statistics Singapore. (2020). Health facilities, Accessible from. https://www.tablebuilder.singstat.gov.sg/publicfacing/createDataTable.action?refId=15181. Accessed 20 November 2021.
Department of Statistics (2021a). Population and population structure, 2021a, https://www.singstat.gov.sg. Accessed 18 May 2022.
Department of Statistics. (2021b). Key Household income Trends, https://www.singstat.gov.sg/-/media/files/visualising_data/infographics/households/key-household-income-trends-2021b.ashx. Accessed 18 May 2022.
Department of Statistics Singapore. (2021c). GINI, https://www.singstat.gov.sg/-/media/files/visualising_data/infographics/households/key-household-income-trends-2021c.ashx. Accessed 18 May 2022.
Department of Statistics. (2021d). Households and Housing. Accessible from https://www.singstat.gov.sg/-/media/files/publications/cop2020/sr2/findings2.pdf. Accessed 18 May 2022.
Department of Statistics. (2022). Education, Language Spoken and Literacy. https://www.singstat.gov.sg/whats-new/latest-data#Education-Language-Spoken-and-Literacy_6be32ecbfecf49619be303f7b692d5c5. Accessed 18 May 2022.
Earnest, A., Ong, M. E., Shahidah, N., Chan, A., Wah, W., & Thumboo, J. (2015). Derivation of indices of socioeconomic status for health services research in Asia. Preventive Medicine Reports, 2, 326–332.
Fagerström, K. (2002). The epidemiology of smoking: Health consequences and benefits of cessation. Drugs, 62(2), 1–9. https://doi.org/10.2165/00003495-200262002-00001
Fuller, E. (2013). Alcohol consumption. Health Survey for England 2012. Leeds, The Health and Social Care Information Centre. http://healthsurvey.hscic.gov.uk/media/1025/chpt-6_alcohol.pdf. Accessed 20 November 2021.
Grucza, R. A., & Bierut, L. J. (2006). Co-occurring risk factors for alcohol dependence and habitual smoking: Update on findings from the Collaborative Study on the Genetics of Alcoholism. Alcohol Research & Health, 29(3), 172–178.
Hahn, L., Rigby, A., & Galletly, C. (2014). Determinants of high rates of smoking among people with psychosis living in a socially disadvantaged region in South Australia. In Australian and New Zealand Journal of Psychiatry, 48(1), 70–79. https://doi.org/10.1177/0004867413491158
Hall, W. (2017). Socioeconomic status and susceptibility to alcohol-related harm. Lancet. Public Health, 2(6), e250–e251. https://doi.org/10.1016/S2468-2667(17)30089-0
Harwood, G. A., Salsberry, P., Ferketich, A. K., & Wewers, M. E. (2007). Cigarette smoking, socioeconomic status, and psychosocial factors: Examining a conceptual framework. Public Health Nursing, 24(4), 361–371. https://doi.org/10.1111/j.1525-1446.2007.00645.x
Healton, C., & Nelson, K. (2004). Reversal of misfortune: Viewing tobacco as a social justice issue. American Journal of Public Health, 94(2), 186–191. https://doi.org/10.2105/ajph.94.2.186
Hiscock, R., Bauld, L., Amos, A., Fidler, J. A., & Munafò, M. (2012). Socioeconomic status and smoking: A review. Annals of the New York Academy of Sciences, 1248(1), 107–123. https://doi.org/10.1111/j.1749-6632.2011.06202.x
Hosseinpoor, A. R., Bergen, N., Mendis, S., Harper, S., Verdes, E., Kunst, A., & Chatterji, S. (2012). Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: Results from the World Health Survey. BMC Public Health, 12, 474. https://doi.org/10.1186/1471-2458-12-474
Housing Development Board. (2021). Public Housing – A Singapore Icon https://www.hdb.gov.sg/about-us/our-role/public-housing-a-singapore-icon
Institute of Medicine, Board on Population Health and Public Health Practice, & Roundtable on Health Literacy. (2013) Health Literacy: Improving Health, Health Systems, and Health Policy Around the World: Workshop Summary. National Academies Press.
Intarut, N., & Pukdeesamai, P. (2017). Socioeconomic inequality in concurrent tobacco and alcohol consumption. Asian Pacific Journal of Cancer Prevention, 18(7), 1913–1917.
Jones, L., Bates, G., McCoy, E., & Bellis, M. A. (2015). Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: A systematic review and meta-analysis. BMC Public Health, 15, 400. https://doi.org/10.1186/s12889-015-1720-7
Kessler, R. C., & Ustün, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121. https://doi.org/10.1002/mpr.168
Kivimäki, M., Batty, G. D., Pentti, J., et al. (2020). Association between socioeconomic status and the development of mental and physical health conditions in adulthood: A multi-cohort study. Lancet. Public Health, 5(3), e140–e149. https://doi.org/10.1016/S2468-2667(19)30248-8
Kraft, P., & Kraft, B. (2021). Explaining socioeconomic disparities in health behaviours: A review of biopsychological pathways involving stress and inflammation. Neuroscience & Biobehavioral Reviews, 127, 689–708. https://doi.org/10.1016/j.neubiorev.2021.05.019
Kraus, M. W., Piff, P. K., Mendoza-Denton, R., Rheinschmidt, M. L., & Keltner, D. (2012). Social class, solipsism, and contextualism: How the rich are different from the poor. Psychological Review, 119(3), 546–572. https://doi.org/10.1037/a0028756
Kuipers, M. A. G., Jongeneel-Grimen, B., Droomers, M., et al. (2013). Why residents of Dutch deprived neighbourhoods are less likely to be heavy drinkers: The role of individual and contextual characteristics. Journal of Epidemiology and Community Health, 67(7), 587–594. https://doi.org/10.1136/jech-2012-201242
Lee, K. S., Park, C. Y., Meng, K. H., Bush, A., Lee, S. H., Lee, W. C., Koo, J. W., & Chung, C. K. (1998). The association of cigarette smoking and alcohol consumption with other cardiovascular risk factors in men from Seoul Korea. Annals of Epidemiology, 8(1), 31–38. https://doi.org/10.1016/s1047-2797(97)00113-0
Lee, Y. Y., Wang, P., Abdin, E., et al. (2020). Prevalence of binge drinking and its association with mental health conditions and quality of life in Singapore. Addictive Behaviors, 100, 106114. https://doi.org/10.1016/j.addbeh.2019.106114
Li, X. X., Zhao, Y., Huang, L. X., et al. (2018). Effects of smoking and alcohol consumption on lipid profile in male adults in northwest rural China. Public Health, 157, 7–13. https://doi.org/10.1016/j.puhe.2018.01.003
Lim, D. Y. Z., Wong, T. H., Feng, M., et al. (2021). Leveraging open data to reconstruct the Singapore Housing Index and other building-level markers of socioeconomic status for health services research. Int J Equity Health, 20, 218. https://doi.org/10.1186/s12939-021-01554-8
Lipari, R. N., & Van Horn S. (2017). Smoking and mental illness among adults in the United States. 2017 Mar 30. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430654/
Liu, K., Ding, Y., Lu, X., & Wang, Z. (2021). Trends and socioeconomic factors in smoking and alcohol consumption among Chinese people: Evidence from the 2008–2018 National Health Service Surveys in Jiangsu Province. Arch Public Health, 79(1), 127. https://doi.org/10.1186/s13690-021-00646-9
Mackenbach, J. P., Bos, V., Andersen, O., et al. (2003). Widening socioeconomic inequalities in mortality in six Western European countries. International Journal of Epidemiology, 32(5), 830–837. https://doi.org/10.1093/ije/dyg209
Mackenbach, J. P., Bopp, M., Deboosere, P., et al. (2017). Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries. Health & Place, 47, 44–53. https://doi.org/10.1016/j.healthplace.2017.07.005
Mäkelä, P., & Paljärvi, T. (2008). Do consequences of a given pattern of drinking vary by socioeconomic status? A mortality and hospitalisation follow-up for alcohol-related causes of the Finnish Drinking Habits Surveys. Journal of Epidemiology and Community Health, 62(8), 728–733. https://doi.org/10.1136/jech.2007.065672
Mather, T., Banks, E., Joshy, G., Bauman, A., Phongsavan, P., & Korda, R. J. (2014). Variation in health inequalities according to measures of socioeconomic status and age. Australian and New Zealand Journal of Public Health, 38(5), 436–440. https://doi.org/10.1111/1753-6405.12239
Mathur, C., Stigler, M. H., Perry, C. L., Arora, M., & Reddy, K. S. (2008). Differences in prevalence of tobacco use among Indian urban youth: The role of socioeconomic status. Nicotine & Tobacco Research, 10(1), 109–116. https://doi.org/10.1080/14622200701767779
Ministry of Health. (2019). CHAS scheme, https://www.moh.gov.sg/cost-financing/healthcare-schemes-subsidies/community-health-assist-scheme. Accessed 30 November 2021.
Ministry of Health. (2020). National Population Health Survey, https://www.hpb.gov.sg/docs/default-source/default-document-library/nphs-2020-survey-report.pdf?sfvrsn=ece50aa9_0. Accessed 30 November 2021.
Ministry of manpower. (2022). Labour market statistics and publications. https://stats.mom.gov.sg/Pages/Unemployment-Summary-Table.aspx. Accessed 18 May 2022.
Murray, C. J., Aravkin, A. Y., Zheng, P., et al. (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2
Navarro-Carrillo, G., Alonso-Ferres, M., Moya, M., & Valor-Segura, I. (2020). Socioeconomic status and psychological well-being: Revisiting the Role of Subjective Socioeconomic Status. Frontiers in Psychology, 11, 1303. https://doi.org/10.3389/fpsyg.2020.01303
Ng, C. W., Tan, W. S., Gunapal, P. P., Heng, W. L. Y., & BH. (2014). Association of socioeconomic status (SES) and social support with depressive symptoms among the elderly in Singapore. Annals of the Academy of Medicine, Singapore, 43(12), 576–587.
Pathirana, T. I., & Jackson, C. A. (2018). Socioeconomic status and multimorbidity: A systematic review and meta-analysis. Australian and New Zealand Journal of Public Health, 42(2), 186–194. https://doi.org/10.1111/1753-6405.12762
Peña, S., Mäkelä, P., Valdivia, G., Helakorpi, S., Markkula, N., Margozzini, P., & Koskinen, S. (2017). Socioeconomic inequalities in alcohol consumption in Chile and Finland. Drug and Alcohol Dependence, 173, 24–30. https://doi.org/10.1016/j.drugalcdep.2016.12.014
Pennanen, M., Broms, U., Korhonen, T., et al. (2014). Smoking, nicotine dependence and nicotine intake by socio-economic status and marital status. Addictive Behaviors, 39(7), 1145–1151. https://doi.org/10.1016/j.addbeh.2014.03.005
Probst, C., Roerecke, M., Behrendt, S., & Rehm, J. (2014). Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: A systematic review and meta-analysis. International Journal of Epidemiology, 43(4), 1314–1327. https://doi.org/10.1093/ije/dyu043
Rehm, J., Gmel, G. E., Sr., Gmel, G., Hasan, O. S., Imtiaz, S., Popova, S., Probst, C., Roerecke, M., Room, R., Samokhvalov, A. V., & Shield, K. D. (2017). The relationship between different dimensions of alcohol use and the burden of disease—An update. Addiction, 112(6), 968–1001.
Sahni, S., Talwar, A., Khanijo, S., & Talwar, A. (2017). Socioeconomic status and its relationship to chronic respiratory disease. Advances Respiratory Medecine, 85(2), 97–108. https://doi.org/10.5603/arm.2017.0016
Shahwan, S., Abdin, E., Shafie, S., et al. (2019). Prevalence and correlates of smoking and nicotine dependence: Results of a nationwide cross-sectional survey among Singapore residents. British Medical Journal Open, 9(10), e032198.
Silveira, C. M., Siu, E. R., Anthony, J. C., et al. (2014). Drinking patterns and alcohol use disorders in São Paulo, Brazil: The role of neighborhood social deprivation and socioeconomic status. PLoS ONE, 9(10), e108355. https://doi.org/10.1371/journal.pone.0108355
Ministry of Health. (2010). Healthy minds, healthy communities: National Mental Health Blueprint, Singapore 2007–2012. (p. 4). Singapore: Ministry of Health. Call no.: RSING 362.2095957 HEA. Accessible from https://eresources.nlb.gov.sg/history/events/768c27a5-a785-413b-98a0-2fad1d8479e0. Accessed 18 May 2022.
Ong B. (2017). Inaugural Chee Kuan Tsee Lecture: Mental Health Care for the 21st Century. Annals of the Academy of Medicine, Singapore, 46(6), 258–262.
Singapore Statutes Online. (2016). Liquor control (supply and Consumption) act 2015. https://sso.agc.gov.sg/Act/LCSCA2015. Accessed 18 May 2022.
Sommer, I., Griebler, U., Mahlknecht, P., Thaler, K., Bouskill, K., Gartlehner, G., & Mendis, S. (2015). Socioeconomic inequalities in non-communicable diseases and their risk factors: An overview of systematic reviews. BMC Public Health, 15, 914. https://doi.org/10.1186/s12889-015-2227-y
Sreeramareddy, C. T., Harper, S., & Ernstsen, L. (2018). Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries. Tobacco Control, 27(1), 26–34. https://doi.org/10.1136/tobaccocontrol-2016-053266
Stubbs, B., Veronese, N., Vancampfort, D., et al. (2017). Perceived stress and smoking across 41 countries: A global perspective across Europe, Africa Asia and the Americas. Scientific Reports, 7(1), 7597. https://doi.org/10.1038/s41598-017-07579-w
Subramaniam, M., Vaingankar, J., Heng, D., Kwok, K. W., Lim, Y. W., Yap, M., & Chong, S. A. (2012). The Singapore Mental Health Study: An overview of the methodology. International Journal of Methods in Psychiatric Research, 21(2), 149–157. https://doi.org/10.1002/mpr.1351
Subramaniam, M., Abdin, E., Vaingankar, J. A., et al. (2019). Tracking the mental health of a nation: Prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiology Psychiatric Sciences, 29, e29. https://doi.org/10.1017/S2045796019000179
Traversy, G., & Chaput, J. P. (2015). Alcohol consumption and obesity: An update. Current Obesity Reports, 4(1), 122–130. https://doi.org/10.1007/s13679-014-0129-4
Wang, J. L., Schmitz, N., & Dewa, C. S. (2010). Socioeconomic status and the risk of major depression: The Canadian National Population Health Survey. Journal of Epidemiology and Community Health, 64(5), 447–452.
Wang, X., Zhang, T., Wu, J., Yin, S., Nan, X., Du, M., Liu, A., & Wang, P. (2019). The association between socioeconomic status, smoking, and chronic disease in inner Mongolia in Northern China. International Journal of Environmental Research and Public Health, 16(2), 169. https://doi.org/10.3390/ijerph16020169
Wee, L. E., Cher, W. Q., Sin, D., Li, Z. C., & Koh, G. C. H. (2016). Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore-a mixed methods study. BMC Family Practice, 17(1), 1–14. https://doi.org/10.1186/s12875-016-0411-5
Wong, M. C. S., Lao, X. Q., Ho, K. F., Goggins, W. B., & Tse, S. L. A. (2017). Incidence and mortality of lung cancer: Global trends and association with socioeconomic status. Science and Reports, 7(1), 14300. https://doi.org/10.1038/s41598-017-14513-7
World Health Organisation. (1995). Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organization Technical Report Series, 854, 1–452. Accessible from https://apps.who.int/iris/handle/10665/37003. Accessed 15 July 2022.
World Health Organisation. (2022). Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco. Accessed 15 July 2022.
World Health Organization. (2018). Global status report on alcohol and health 2018. World Health Organization. https://www.who.int/publications/i/item/9789241565639. License: CC BY-NC-SA 3.0 IGO. Accessed 15 July 2022.
Yun, W. J., Rhee, J. A., Kim, S. A., et al. (2015). Household and area income levels are associated with smoking status in the Korean adult population. BMC Public Health, 15, 39. https://doi.org/10.1186/s12889-015-1365-6
Zimmerman, F. J., & Katon, W. (2005). Socioeconomic status, depression disparities, and financial strain: What lies behind the income-depression relationship? Health Economics, 14(12), 1197–1215.
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AshaRani, P.V., Sin, K.Y., Abdin, E. et al. The Relationship of Socioeconomic Status to Alcohol, Smoking, and Health: a Population-Level Study of the Multiethnic Population in Singapore. Int J Ment Health Addiction 22, 438–456 (2024). https://doi.org/10.1007/s11469-022-00882-2
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DOI: https://doi.org/10.1007/s11469-022-00882-2