Inequalities in smoking: influence of social chain of risks from adolescence to young adulthood: a prospective population-based cohort study.

backgroundThe pathway between socioeconomic disadvantages and smoking is a process that requires an understanding of life-course influence. PURPOSE: This study investigated pathways of social risks at different life stages that are linked to adolescent smoking and maintenance of smoking through to young adulthood.

methodA cohort consisting of all pupils (n = 1083) from one Swedish city were followed from age 16 to age 30 (1981-1995), with a 96.4% response rate.

resultOdds ratios of being a smoker at age 30 among low educated were 2.54 for men and 2.53 for women. Using structural equation model analysis for men and women, a strong chain of risks was found from age 16 linking to smoking at age 30: adolescents with adverse socioeconomic status (SES) were more likely from a divorced family. Being from a divorced family and having poor contact with their parents influenced their smoking directly and through peers. Adolescents with adverse SES were also likely to be unpopular in school, which affected their smoking behavior directly and through peers. These socially disadvantaged participants, who were smokers at age 16, continued smoking until age 30 years. The risk pathways were similar for both men and women.

conclusionsAdult smoking reflects the cumulative influence of multiple socioeconomic and psychosocial chains of risks experienced during upbringing. The programs that are addressed to reduce smoking among socially disadvantaged adolescents would have an impact in reducing smoking inequalities in adults.