Protective Effects of Educational Attainment Against Cigarette Smoking; Diminished Returns of American Indians and Alaska Natives in the National Health Interview Survey

Introduction: Although educational attainment is protective against health risk behaviors such as smoking, the Minorities’ Diminished Return theory posits that these protective effects are smaller for ethnic minorities than majority groups. This study compared the effects of educational attainment on the smoking status of American Indian/Alaska Native (AIAN) and White adults. Methods: Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21 114 individuals entered the current analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator. Results: Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that suggested that the protective effects of educational attainment against smoking are smaller for AIAN than for Whites. Conclusion: In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites, resulting in additional risk of smoking in highly educated AIANs. To reduce ethnic disparities in tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.