Dataset Information

Association between marital status and cigarette smoking: Variation by race and ethnicity.

ABSTRACT: It is unclear whether health risk behaviors differ by nuanced marital statuses and race/ethnicity. We examined the association between detailed marital status and current cigarette smoking among U.S. adults by race/ethnicity. Data were from four Health Information National Trends (HINTS) study cycles collected in 2011-2017 with a nationally representative sample of adults 30?years and older (n?=?11,889). Current cigarette smoking prevalence was compared across detailed marital statuses (married, cohabiting, divorced, widowed, separated, single/never married) by race/ethnicity. Adults who had the highest prevalence of cigarette smoking were non-Hispanic Black cohabitors (36.2%), separated non-Hispanic White adults (35.3%), and single/never married Hispanic adults (28.2%). It is noteworthy that widowed adults had lower cigarette smoking prevalence than those who were divorced or separated across races/ethnicities. Taken together, this study demonstrates how cigarette smoking prevalence varies by intersection of marital status and race/ethnicity. Ensuring the equitable implementation of a comprehensive best-practice tobacco prevention and control program that includes prevention and treatment is important to reduce the burden of cigarette smoking in these populations.

SUBMITTER: Ramsey MW

PROVIDER: S-EPMC6995657 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Association between marital status and cigarette smoking: Variation by race and ethnicity.

Ramsey Michael W MW Chen-Sankey Julia Cen JC Reese-Smith Jacqueline J Choi Kelvin K

Preventive medicine 20181218

It is unclear whether health risk behaviors differ by nuanced marital statuses and race/ethnicity. We examined the association between detailed marital status and current cigarette smoking among U.S. adults by race/ethnicity. Data were from four Health Information National Trends (HINTS) study cycles collected in 2011-2017 with a nationally representative sample of adults 30 years and older (n = 11,889). Current cigarette smoking prevalence was compared across detailed marital statuses (married, ...[more]

PMID: 30576684

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Project description:ImportancePatterns of cigarette smoking and smoking cessation vary considerably across demographic groups in the US, but there is limited evidence on whether the hazards of smoking and benefits of quitting vary across these groups. Population-specific evidence on the benefits of quitting smoking may motivate cessation among groups historically underrepresented in medical research.ObjectiveTo quantify the association between smoking, smoking cessation, and mortality by race, ethnicity, and sex.Design, setting, and participantsThis nationally representative, prospective cohort study used data from the US National Health Interview Survey collected via questionnaire between January 1997 and December 2018 among adults aged 25 to 84 years at recruitment. Participants were followed up for cause-specific mortality through December 31, 2019.ExposuresSelf-reported smoking status at recruitment, age at quitting smoking, and years since quitting smoking.Main outcomes and measuresThe main outcomes were all-cause mortality and mortality from cancer, cardiovascular disease, and lower respiratory disease. Adjusted mortality rate ratios comparing never, former, and current smokers were calculated using Cox proportional hazards regression. Weighted analyses were conducted by race, ethnicity, and sex as reported by participants.ResultsAmong the 551 388 participants in the main analyses, the mean (SD) age at recruitment was 48.9 (15.3) years; 307 601 (55.8%) were women, 87 207 (15.8%) were Hispanic, 75 545 (13.7%) were non-Hispanic Black, 355 782 (64.5%) were non-Hispanic White, and 32 854 (6.0%) identified as other non-Hispanic race and ethnicity. There were 74 870 deaths among participants aged 25 to 89 years during follow-up (36 792 [49.1%] among men; 38 078 [50.9%] among women). The all-cause mortality rate ratio (RR) for current vs never smoking was 2.80 (95% CI, 2.73-2.88) overall. The RRs were similar by sex but varied by race and ethnicity: Hispanic, 2.01 (95% CI, 1.84-2.18); non-Hispanic Black, 2.19 (95% CI, 2.06-2.33); non-Hispanic White, 3.00 (95% CI, 2.91-3.10); and other non-Hispanic race and ethnicity, 2.16 (95% CI, 1.88-2.47). When comparing those who quit smoking before age 45 years with never smokers, all-cause mortality RRs were 1.15 (95% CI, 1.03-1.28) among Hispanic individuals, 1.16 (95% CI, 1.07-1.25) among non-Hispanic Black individuals, 1.11 (95% CI, 1.08-1.15) among non-Hispanic White individuals, and 1.17 (95% CI, 0.99-1.39) among other non-Hispanic individuals.Conclusions and relevanceIn this prospective cohort study, among men and women from diverse racial and ethnic groups, current smoking was associated with at least twice the all-cause mortality rate of never smoking. Quitting smoking, particularly at younger ages, was associated with substantial reductions in the relative excess mortality associated with continued smoking.

Project description:ImportanceWhile the adverse association between smoking and head and neck squamous cell carcinoma (HNSCC) survival has been well described, there are also inconclusive studies and those that report no significant changes in HNSCC survival and overall mortality due to smoking. There is also a lack of studies investigating the association of marital status on smoking status at diagnosis for patients with HNSCC.ObjectiveTo examine the association between patient smoking status at HNSCC diagnosis and survival and the association between marital status and smoking in these patients.Design, setting, and participantsThis retrospective cohort study was conducted by querying the Saint Louis University Hospital Tumor Registry for adults with a diagnosis of HNSCC and treated at the university academic medical center between 1997 and 2012; 463 confirmed cases were analyzed.Main outcomes and measuresCox proportional hazards regression analysis was used to evaluate association of survival with smoking status at diagnosis and covariates. A multivariate logistic regression model was used to assess whether marital status was associated with smoking at diagnosis adjusting for covariates.ResultsOf the 463 total patients (338 men, 125 women), 92 (19.9%) were aged 18 to 49 years; 233 (50.3%) were aged 50 to 65 years; and 138 (29.8%) were older than 65 years. Overall, 56.2% of patients were smokers at diagnosis (n = 260); 49.6% were married (n = 228); and the mortality rate was 54.9% (254 died). A majority of patients were white (81.0%; n = 375). Smokers at diagnosis were more likely to be younger (ie, <65 years), unmarried, and to drink alcohol. We found a statistically significant difference in median survival time between smokers (89 months; 95% CI, 65-123 months) and nonsmokers at diagnosis (208 months; 95% CI, 129-235 months). In the adjusted Cox proportional hazards model, patients who were smokers at diagnosis were almost twice as likely to die during the study period as nonsmokers (hazard ratio, 1.98; 95% CI, 1.42-2.77). In the multivariate logistic regression analysis, unmarried patients were 76% more likely to use tobacco than married patients (adjusted odds ratio, 1.76; 95% CI, 1.08-2.84).Conclusions and relevanceSmokers were almost twice as likely as nonsmokers to die during the study period. We also found that those who were married were less likely to be smokers at diagnosis. Our study suggests that individualized cancer care should incorporate social support and management of cancer risk behaviors.

Dataset Information

Association between marital status and cigarette smoking: Variation by race and ethnicity.

Publications

Association between marital status and cigarette smoking: Variation by race and ethnicity.

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