Socioeconomic Status, Smoking, and Health: A Test of Competing Theories of Cumulative Advantage

• Published in: Journal of health and social behavior 2004-09, Vol.45 (3), p.306-321
• Main Authors: Pampel, Fred C., Rogers, Richard G.
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adolescents; Adult; Adult and adolescent clinical studies; Aged; Attrition (Research Studies); Behavior; Biological and medical sciences; Cigarette smoking; Disadvantaged; Disadvantaged Environment; Disadvantaged groups; Employment Level; Ethnicity; Exercise; Female; Gender Differences; General populations; Health; Health Behavior; Health problems; Health Programs; Health risks; Health Status; Health Surveys; Humans; Income inequality; Inequality, Socioeconomic Status, and Health; Life Style; Lifestyle; Low socioeconomic status; Male; Measures (Individuals); Medical sciences; Medical Services; Middle Aged; Morbidity; Mortality; Mortality Rate; Mortality Rates; National Health Interview Survey; National Surveys; Outcome Measures; Prevention and actions; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Race; Resource Materials; Risk; Risk factors; Scope of employment; Smoking; Smoking - adverse effects; Smoking - economics; Smoking cessation; Social Behavior; Social Class; Social interaction; Social Status; Socioeconomic Influences; Socioeconomic Status; Socioeconomics; Statistical Analysis; Surveys; Tobacco smoking; Workforce
• ISSN: 0022-1465; 2150-6000
• DOI: 10.1177/002214650404500305

Although both low socioeconomic status and cigarette smoking increase health problems and mortality, their possible combined or interactive influence is less clear. On one hand, the health of low status groups may be harmed least by unhealthy behavior such as smoking because, given the substantial health risks produced by limited resources, they have less to lose from damaging lifestyles. On the other hand, the health of low status groups may be harmed most by smoking because lifestyle choices exacerbate the health problems created by deprived material conditions. Alternatively, the harm of low status and smoking may accumulate additively rather than multiplicatively. We test these arguments with data from the 1990 U.S. National Health Interview Survey, and with measures of morbidity and mortality. For ascribed statuses such as gender, race, and ethnicity, and for the outcome measure of mortality, the results favor the additive argument, whereas for achieved status and morbidity, the results support the vulnerability hypothesis-that smoking inflicts greater harm among disadvantaged groups.