Educational attainment and cigarette smoking: a causal association?
Educational attainment and cigarette smoking: a causal association?
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DOI：
10.1093/ije/dym250
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发表时间：
2008-06-01
影响因子：
7.7
通讯作者：
Buka, Stephen L.
中科院分区：
文献类型：
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作者：
Gilman, Stephen E.;Martin, Laurie T.;Buka, Stephen L.
背景：尽管有大量证据表明低教育程度与吸烟风险有关，但这种联系是否具有因果关系尚未得到令人信服的证实。方法我们在1959年建立的出生队列中调查了教育程度与终生吸烟模式之间的关系(1311例)。我们控制了入学前测量的一系列潜在混杂因素，并估计了兄弟姐妹固定效应模型来控制未测量的家庭吸烟易感性。结果在整个参与者样本中，对多个童年因素(包括社会经济地位、智商、行为问题和医疗条件)进行调整的回归分析表明，高中以下教育程度的个人吸烟年数较高[比率比(RR)1.58，可信区间(CI)1.31，1.91]。然而，在兄弟姐妹固定效应分析中，RR为1.23(CI为0.80，1.93)。同样，在全样本中估计的调整后的模型显示，高中教育程度以下的个人短期(RR 0.40；CI 0.23，0.69)和长期(RR 0.59；CI 0.42，0.83)戒烟尝试较少，戒烟可能性较小(优势比0.34；CI 0.19，0.62)。在控制家庭吸烟易感性的兄弟姐妹固定效应模型中，教育对戒烟的影响被减弱。结论反复观察到的吸烟教育差异的很大一部分可归因于兄弟姐妹共同的因素，这些因素导致教育生涯缩短和终生吸烟轨迹。因此，减少吸烟方面的差异，包括教育上的差异，可能需要采取一些方法，把重点放在影响成年人一生中吸烟风险的早期因素上。
Background Despite abundant evidence that lower education is associated with a higher risk of smoking, whether the association is causal has not been convincingly established.Methods We investigated the association between education and lifetime smoking patterns in a birth cohort established in 1959 and followed through adulthood (n 1311). We controlled for a wide range of potential confounders that were measured prior to school entry, and also estimated sibling fixed effects models to control for unmeasured familial vulnerability to smoking.Results In the full sample of participants, regression analyses adjusting for multiple childhood factors (including socioeconomic status, IQ, behavioural problems, and medical conditions) indicated that the number of pack-years smoked was higher among individuals with less than high school education [rate ratio (RR) 1.58, confidence interval (CI) 1.31, 1.91]. However, in the sibling fixed effects analysis the RR was 1.23 (CI 0.80, 1.93). Similarly, adjusted models estimated in the full sample showed that individuals with less than high school education had fewer short-term (RR 0.40; CI 0.23, 0.69) and long-term (RR 0.59; CI 0.42, 0.83) quit attempts, and were less likely to quit smoking (odds ratio 0.34; CI 0.19, 0.62). The effects of education on quitting smoking were attenuated in the sibling fixed effects models that controlled for familial vulnerability to smoking.Conclusions A substantial portion of the education differential in smoking that has been repeatedly observed is attributable to factors shared by siblings that contribute to shortened educational careers and to lifetime smoking trajectories. Reducing disparities in cigarette smoking, including educational disparities, may therefore require approaches that focus on factors early in life that influence smoking risk over the adult life span.