Methodological systematic review of studies on social inequalities in smoking among young adults: A field coming of age?

Has the distribution of smoking across young adult transition milestones changed over the past 20 years? Evidence from the 1970 British Cohort Study (1996) and Next Steps (2015-16)

Introduction

Transitions into work and family life during young adulthood exacerbate differences in the progression of smoking over the life-course. Few have considered how changes in smoking and the transition to adulthood in the past two decades have influenced these relationships over time.

Methods

We compared the distribution of smoking at ages 25–26 across transition milestones among 3764 men and 4568 women in the 1970 British Cohort study (1996) and 3426 men and 4281 women in the Next Steps study (2015–16). We regressed occasional and daily smoking status on educational attainment, economic activity, living arrangements, relationship status, and parenthood, adjusting for family background, socio-demographics, and smoking history.

Results

There were few differences in associations between the 1996 and 2015-16 samples. Young men and women were less likely to smoke if they had higher education, were homeowners, and cohabited with a partner. Women were less likely to smoke occasionally if they were full-time students, and men were less likely to smoke daily if they were employed full-time and not living with children. However, comparing associations in 2015–16 to 1996: 1) in men, higher education had a weaker negative association and living with a partner had a stronger negative association with daily smoking; 2) in women, independently renting had a weaker positive association with daily smoking.

Conclusions

Despite considerable changes in smoking and the transition to adulthood over the past two decades, the distribution of smoking at ages 25–26 across transition milestones has been relatively stable during this time period in Great Britain.

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Smoking at ages 25–26 was associated with economic activity, living arrangements, relationship status, and parenthood in 1996 and 2015–16.

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Differences in smoking across transition milestones differed by gender.

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Differences in smoking did not substantially change between 1996 and 2015–16.

Socio-economic distribution of e-cigarette use among recent former regular smokers and current smokers at ages 25-26 in England

BACKGROUND AND AIMS

E-cigarettes may potentially help young adult smokers to quit smoking, yet little is known about differences among socio-economic groups. We examined associations between key socio-economic characteristics and e-cigarette use among recent former smokers and current smokers in a sample of young adults in England.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

We used data on 346 recent former regular (daily for 12+ months) smokers and 1913 current smokers from the ages 25-26 wave of the Next Steps cohort study (2015-2016). In multinomial logistic regression, we estimated relative risk ratios (RRR) of e-cigarette use (never, former, non-daily, daily) by educational attainment, social class [using the National Statistics Socio-economic classification (NS-SEC)] and employment status [full-time, part-time, unemployed and other 'inactivity' (e.g. stay-at-home parents and permanantly disabled)], adjusting for sex.

FINDINGS

Among recent former regular smokers, there were no patterns of association between socio-economic characteristics and e-cigarette use. Among current smokers: (1) compared with higher occupation (NS-SEC I/II), intermediate occupation (NS-SEC III/IV) was positively associated with non-daily e-cigarette use [RRR = 1.77, 95% confidence interval (CI) = 1.03-3.03]; (2) compared with full-time employment, unemployment was negatively associated with non-daily and daily e-cigarette use (RRR = 0.38, 95% CI = 0.18-0.81; RRR = 0.12, 95% CI = 0.02-0.56) and other economic inactivity was negatively associated with daily e-cigarette use (RRR = 0.39, 95% CI = 0.16-0.93).

CONCLUSIONS

Among young adult smokers in England, lower-status occupational groups were more likely to use e-cigarettes on a non-daily basis than to have never used compared with higher status occupational groups. Compared with people in full-time employment, those without employment were less likely to use e-cigarettes daily than to have never used.

The role of education and other transition milestones in the progression of social inequalities in cigarette smoking between the ages of 18 and 25: Evidence from the Canadian National Population Health Survey

Young adulthood is now considered a sensitive period in the progression of health inequalities over the life-course. This age group experiences highly dynamic and socially patterned life-course events that require nuanced modelling choices compared to those commonly used in public health sciences. To illustrate this, we estimate changes in the risk of smoking according to student status, employment status, living arrangements, and relationship status at different ages across education categories. We used longitudinal data in 1,243 young adults followed every two years between the ages of 18-19 and 24-25 in the Canadian National Population Health Survey (1994-95 to 2010-11). We examined the age-graded associations of occasional and daily smoking with educational attainment and transition statuses using random-effects multinomial logistic regression models with interaction terms. Post-secondary education, living with parents, studying, and being in a relationship were associated with a lower risk of daily smoking in main models, with some of these associations significantly varying in magnitude by age. The risk associated with living without parents at ages 18-19 disappeared by ages 24-25. Being single was both a protective factor at ages 18-19 and a risk factor at ages 24-25. Finally, the risk associated with being single was also stronger among those who did not pursue post-secondary education. These findings support the argument that the simple conceptualization of young adults' circumstances - independent from age and social context - provides a limited understanding of the progression of health inequalities over the life-course. Research needs to consider the dynamic and intersecting nature of transition milestones during this intensive life period.