INTRODUCTION: Despite the known health problems associated with tobacco use, adolescents continue to initiate and develop regular patterns of tobacco use. Globally adult tobacco consumption is strongly associated with poverty, with those in lower socioeconomic classes using tobacco at higher rates. The association between socioeconomoic status (SES) and tobacco use for youth, however, is much less clear. Understanding the role of SES in initiation and progression of tobacco use among adolescents can improve our ability to design effective interventions targeting adolescent tobacco use behavior. The aim of this dissertation was to examine the impact of SES on tobacco use in youth across different countries, presented in three related manuscripts.
METHODS: In the first manuscript, the effect of both individual and community- level SES on smoking outcome was evaluated in the Minnesota Adolescent Community Cohort (MACC) study, a population-based, observational cohort study designed to assess the effects of tobacco control policies and programs on adolescent smoking. Additionally, the cross-level interaction of these two SES measures was examined. The analyses employed a multiple group, multiple cohort growth model. In the second manuscript latent class analysis (LCA) was used to establish classes of tobacco acquisition in the Mobilizing Youth for Tobacco Related Initiatives (MYTRI) study, a large-scale intervention trial in two large cities in India. The third manuscript explored change in tobacco use over time and the moderating effect of SES on change, also in the MYTRI study. Additionally, the distribution of related psychosocial risk factors across schools type was also evaluated.
RESULTS: In paper 1, individual-level SES was associated with smoking (low SES was associated with higher adolescent smoking), but community-level SES was not. However, the results for cross-level interaction show that community socioeconomic context affected smoking behavior differentially depending on individual socioeconomic position (i.e., community-level SES had stronger effects on low individual-SES adolescents than on high individual-level SES youth). The results from paper 2 suggest that a 3-latent class and a 4-latent class model were most appropriate for this adolescent population, in private and government schools, respectively. Although, the number of latent classes was the same at both time points, the meaning of these classes differed over time. Finally, in paper 3, the findings about the relationship between SES and tobacco were inconsistent, suggesting a potential change over time in the association of SES and tobacco use. At baseline, low SES was associated with higher prevalence of tobacco use but the relation between SES and tobacco use reversed two years later. These findings were mirrored in the distribution of related psychosocial risk factors.
CONCLUSIONS: This dissertation served to examine the relationship between SES and adolescent tobacco use in two different countries/settings. Reducing tobacco initiation and progression in low SES youth that are disproportionately affected is dependent upon effective and sustainable interventions as well as a more comprehensive understanding of the role SES in influencing an adolescent's tobacco use behavior.