The Persistence of Educational Disparities in Smoking

Besides reducing overall smoking prevalence, do anti-tobacco policies to raise prices and restrict locations for smoking also reduce educational disparities? Theories emphasizing proximate disincentives answers yes, suggesting that the policy changes create stronger disincentives for smoking among low education groups. A social resource or fundamental cause theory suggests in contrast that flexible and broad resource advantages of high education groups maintain inequalities in health behavior despite policy changes. Using 24 National Health Interview Surveys, this study tests these claims by describing smoking prevalence by education level from 1976 to 2006 in the United States and giving special attention to the last ten years when tax and clean-air policies have expanded. Logistic regression models that allow trends in smoking to vary by education, race, ethnicity, and nativity find a small decline in educational disparities in smoking. However, this decline stemmed from trends among Hispanic and foreign-born respondents; in contrast, smoking disparities among white, African American, and native-born respondents show no evidence of narrowing. Likely due to the greater resources of high education groups for health behavior, changes in prices and restrictions thus far have done little to reduce educational disparities.