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Socio-Economic Status_ Mental Health and Smoking

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					Socio-Economic Status, Mental Health
           and Smoking


                      Richard Layte
                   Economic and Social
                    Research Institute
Introduction

• Smoking is the most important and most preventable
cause of premature mortality
• Lower SES associated with higher prevalence of
smoking across countries and this contributes to SES
health gradients
• Lower SES more likely to start smoking but less likely to
quit
• Lower SES positions associated with worse mental
health
• Smoking also associated with anxiety disorder and
psychological distress
• Could worse mental health explain differentials in quit
rates?                                                      2
Data Sources

   Slán 2007 – National Health and Lifestyle
    Survey
   Two-Stage clustered sample
   Sample frame An Post GEO-Directory
   10,364 respondents 18+ (62% response rate)
   ESeC social class measure used
   Data on current and past smoking
   SF-36 psychological distress scale
    dichotomised <=52
   WHO CIDI-SF Generalised Anxiety Disorder
                                                 3
Social Class Differentials in Smoking

 100%
  90%
  80%
  70%
  60%
  50%
  40%
  30%
  20%
  10%
   0%
        Higher Prof Lower Prof.    Clerical    Self-Emp   Lower Sup &   Routine &
          & Man       & Man.                                 Tech        Service

                       Never      Previously   Sometimes      Daily
                                                                                4
Life Time Determination of Smoking?

                          4
 Odds of Smoking Daily



                         3.5
                          3
                         2.5
                          2
                         1.5
                          1
                         0.5
                          0
                               Parents     + < Upper   + Manual   + Income       +
                               Unskilled    2ndary     W/Class       Poor    Unemployed
                                           Education
                                                                                          5
Odds of Psychological Distress by Class
  Odds of Distress Caseness


                                2
                              1.8
                              1.6
                              1.4
                              1.2
                                1
                              0.8
                              0.6
                              0.4
                              0.2
                                0
                                    Higher Prof Lower Prof.   Clerical   Self-Emp   Lower Sup   Routine
                                      & Man       & Man.                             & Tech     Sales &
                                                                                                Service

                                                                 Men     Women
                                                                                                          6
Odds of GAD by Class
  Odds of Anxiety Casesness


                               4
                              3.5
                               3
                              2.5
                               2
                              1.5
                               1
                              0.5
                               0
                                    Higher Prof Lower Prof.   Clerical   Self-Emp   Lower Sup   Routine
                                      & Man       & Man.                             & Tech     Sales &
                                                                                                Service

                                                                 Men     Women
                                                                                                          7
Odds of Smoking Daily by Class, Anxiety and
Psychological Distress - Men


                         5
 Odds of Smoking Daily




                         4

                         3

                         2

                         1

                         0
                             Higher Prof Lower Prof.   Clerical      Self-Emp    Lower Sup &   Routine &
                               & Man       & Man.                                   Tech        Service

                                            No Anxiety or Distress     Anxiety    Distress
                                                                                                           8
Odds of Smoking Daily by Class, Anxiety and
Psychological Distress – Women


                         5
 Odds of Smoking Daily




                         4

                         3

                         2

                         1

                         0
                             Higher Prof Lower Prof.   Clerical      Self-Emp    Lower Sup &   Routine
                               & Man       & Man.                                   Tech       Sales &
                                                                                               Service

                                            No Anxiety or Distress     Anxiety    Distress
                                                                                                         9
Odds of Reporting that Giving up Smoking
Would ‘Make it Harder to Handle Stress in my
Life’ – Men
 2.5

  2

 1.5

  1

 0.5

  0
       Higher Prof   Lower Prof.   Clerical       Self-Emp   Lower Sup &   Routine
         & Man         & Man.                                   Tech       Sales &
                                                                           Service

                         No Distress or Anxiety    Anxiety    Distress
                                                                                     10
Odds of Reporting that Giving up Smoking
Would ‘Make it Harder to Handle Stress in my
Life’ – Women
    5
  4.5
    4
  3.5
    3
  2.5
    2
  1.5
    1
  0.5
    0
        Higher Prof   Lower Prof.   Clerical       Self-Emp   Lower Sup &   Routine
          & Man         & Man.                                   Tech       Sales &
                                                                            Service

                          No Distress or Anxiety    Anxiety    Distress
                                                                                      11
Odds of ‘Trying’ or ‘Actively Planning’
to Quit Smoking - Women


  1.2

   1

  0.8

  0.6

  0.4

  0.2

   0
        Higher Prof   Lower Prof.   Clerical       Self-Emp    Lower Sup &   Routine
          & Man         & Man.                                    Tech       Sales &
                                                                             Service

                                    Class Effect    Distress
                                                                                       12
Discussion

• Controlling for age, working class individuals
are 2.5 times more likely to smoke than non-
manuals
• Working class women more likely to report
clinically significant distress and GAD; men
distress
• Class differentials in perception of effect of
stress on quitting, but only for women
• Class differentials and effect of distress on
quitting, but only for women
• Gendered implications for cessation policy
                                                   13

				
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