Inequalities in Cigarette Smoking Among Low-Income and High-Income Population By Sex in Texas

BACKGROUND:  Tobacco use is a major and single most preventable cause of premature death and disease. In Texas, smoking is responsible for 24,500 annual deaths and $12.2 billion in excess medical care expenditures and lost productivity. Many factors influence tobacco use and eliminating tobacco-related disparities is one of the overarching goal of Healthy People 2020. The objective of this study was to assess inequalities in cigarette smoking among low and high income population in Texas by sex. 

METHODS:  Texas 2012 Behavioral Risk Factor Surveillance System survey data were analyzed. The sample size was 9,129 adults aged >18 years. Data were weighted to be representative of the Texas adult population. Descriptive and multivariable logistic regression was performed using SAS 9.2 for current smokers (everyday and someday) stratified by their annual household income and sex across demographics and selected risk factors. 

RESULTS:  Prevalence of cigarette smoking was higher among low-income adults than high-income adults for both men and women. Low-income men (31.4%) smoked almost double than high-income men (16.2%). Low-income white men had the highest prevalence of smoking (38.6%) and high-income women from other race had the lowest prevalence of smoking (3.8%). The prevalence of smoking was higher among low-income adults who were binge or heavy drinkers and those with depression as compared to high-income adults with the same conditions. Among low-income men, Hispanics were 0.4 times (95% CI: 0.3-0.7) less likely to smoke than whites. Low-income men with less than high school education were 5.4 times (95% CI: 2.3-12.2) more likely to smoke and high-income men were 4.7 times (95% CI: 1.9-12.1) more likely to smoke than college graduates in their group. High-income women with less than high school education were 10.8 times (95% CI: 3.2-35.8) more likely to smoke than college graduates. Adults who were divorced, separated or widowed were more likely to smoke than never married adults in both low and high-income groups but it was significant only among low-income men who were 2.6 times (95% CI: 1.4-4.8) more likely to smoke than their counterparts. The odds of smoking did not differ significantly by employment status among income groups or sex. 

CONCLUSIONS:  Inequalities exist among current smokers by their income and sex. Lower smoking prevalence was observed with higher education across all income and sex subgroups. Public health initiatives focusing on low-income population and education might help reducing the disparities and lower the overall prevalence of smoking in Texas.