Higher education doesn't protect equally against secondhand smoke

Higher levels of education promote health by helping people avoid many environmental health risks, but this benefit may not extend equally to all races and ethnicities when it comes to secondhand smoke, a U.S. study suggests

Overall, higher educational attainment was associated with lower odds of secondhand smoke exposure at work, but the protective effect was smaller for black and Hispanic people, in particular, compared with whites, researchers report in the Journal of Medical Research and Innovation.

“Historically, the assumption has been that education is the solution to health disparities, but the angle that is overlooked is that other resources don’t similarly promote health and wellbeing,” said Dr. Shervin Assari of the Charles R. Drew University of Medicine and Science in Los Angeles, who led the study.

Financial capital, family networks and community resources play a major role as well, he said.

“Your location in society shapes how much you gain. At the top of society, if you get a good education and have a lot of connections, you’ll get a good job,” he told Reuters Health by phone. “If you’re at the bottom and a get a good education but lack a strong social network, you likely won’t get great employment simply from education. Plus, the labor market discriminates.”

As a result, highly educated blacks and Hispanic people are more likely to work in lower-quality jobs, which increases their exposure to environmental factors such as secondhand smoke, the study team writes.

To examine this question, Assari and colleagues analyzed data from the 2015 National Health Interview Survey, which included a sample of nearly 16,000 employed adults. The average age of participants was 43, and they had an average of 16 years of education.

Overall, higher educational attainment was associated with lower odds of any secondhand smoke exposure at work and of daily exposure. However, highly educated nonwhites still had a higher risk of exposure compared with whites, resulting in greater risks for tobacco-related conditions such as heart disease, diabetes, cancer and stroke, the authors conclude.

“Highly educated lower- or middle-class people still suffer health problems that are unexpected,” Assari said. “If climbing the social ladder doesn’t protect as much as expected, this is huge for policymakers.”

Previous studies have shown that predatory marketing and the density of tobacco-related outlets in certain neighborhoods contribute to this disparity, Assari said.

Flavoring, point-of-sale advertising, retail displays, coupons and discounts also target racial and ethnic communities, particularly in low-income areas, the study authors write. This leads to higher smoking rates in these communities, as well as a higher likelihood of secondhand smoke exposure.

“The hypothesis here is focused on the social environment, with residential segregation, lower quality of jobs available for some sections of society, and the limited resources in schools where people of color reside,” he said. “A major part of the disparity is structural factors beyond one person’s control.”

Understanding these complex relationships among education, smoking behaviors, work environments, and sociodemographic characteristics may help policymakers tailor more effective smoking interventions, said Courtney Keeler of the University of San Francisco, who wasn’t involved in the study.

“Sometimes exploring relationships in aggregate masks underlying nuance,” she told Reuters Health by email. “I think the results push us to consider the broader, institutional factors that drive the observed outcome.”

SOURCE: Journal of Medical Research and Innovation, online July 24, 2019.