Onset and persistence of daily smoking: The interplay of socioeconomic status, gender, and psychiatric disorders

Gains in reducing the prevalence of smoking observed over the past 40 years have been substantially lower among lower socioeconomic status (SES) groups and women. In parallel, there have been strong and consistent associations of psychiatric disorders with SES, gender, and smoking. Yet few studies have examined the interrelations among these factors to identify their unique and shared contributions. In this study we examine (1) to what degree SES and gender predict new onset of daily smoking and persistence during the current period when rates of smoking have been stable overall; and (2) given the association of psychiatric disorders with gender, SES, and cigarette smoking, to what degree psychiatric disorders explain or alter the associations between gender, SES, and cigarette smoking. Methods: Longitudinal data for U.S. adults come from Waves 1 (2001-2002) and 2 (2003-2004) of the National Epidemiologic Study of Alcohol and Related Conditions (N = 34,653). DSM-IV mood, anxiety, and Substance use disorders were assessed with AUDADIS-IV. Logistic regression was used to estimate risk of transitions to daily smoking and persistence over the 3-year follow-up. Results: Gender, education, occupation, anxiety disorders, and substance use disorders (SUDs) independently predicted the onset of daily smoking at W2, with greater gender differences observed at lower levels of education. However, no interactions were found between active psychiatric disorders and either gender or SES in predicting the onset of daily smoking. Only being Native American/Alaskan, having an active SUD, and number of cigarettes smoked per day predicted persistence of daily smoking at W2. (C) 2009 Elsevier Ireland Ltd. All rights reserved.