Cultural, material, and psychosocial correlates of the socioeconomic gradient in smoking behavior among adults.

BACKGROUND The aim was to identify the correlates of educational differences in smoking among adults. METHODS We used data from the baseline of a Dutch longitudinal study, relating to a population of 2,462 respondents, ages 25-74. Logistic regression was used to assess the educational gradient in smoking. Current smokers were compared with former and never smokers, respectively. RESULTS The risk of being a current smoker compared with being a former/never smoker was higher among lower educational groups. For example, the odds of being a current smoker compared with never smoker among persons in the lowest level was more than five times as high as that for persons in the highest level. A substantial part (20-40%) of the increased risk of being a smoker among lower groups appeared to be associated with adverse material conditions. The financial situation especially accounted for that effect. One of the cultural factors, i.e., locus of control, was found to account for approximately 30% of the educational gradient in the case in which smokers were compared with former smokers. Psychosocial factors, i.e., neuroticism and coping styles, accounted for less of the gradient in smoking than cultural and material factors. CONCLUSIONS On the basis of the results, we hypothesize that both cultural and material factors contribute to the higher smoking rates among lower socioeconomic groups. Psychosocial factors seem to be less important. If our results are confirmed in more powerful studies, this would indicate, first, that possibilities for a reduction of smoking differences may be found in tailoring smoking cessation programs to the more externally oriented locus of control and the coping styles that are common among lower educational groups, and second, that a reduction of smoking differences may follow from an improvement of the material living conditions of lower socioeconomic groups.