{"doi":"10.4236/jbm.2021.94003","title":"Social Determinants of Change in Smoking Status over a 26-Year Follow up Period among Middle-Aged and Older Americans","abstract":"Educational attainment and income are among major socioeconomic status (SES) indicators that are inversely associated with cigarette smoking. Marginalization-related Diminished Returns (MDRs), however, are weaker protective effects of SES indicators for racial and ethnic minority groups compared to non-Hispanic White people. The aim is to test whether racial and ethnic differences exist in the effects of educational attainment and income on cigarette smoking of middle-aged and older American adults. This is a 26-year longitudinal study using data from the Health and Retirement Study (HRS), a nationally representative study of middle-aged and older adults in the US. A total number of 11,316 middle-aged and older adults (age ≥ 50) were followed for up to 26 years. The independent variables were educational attainment and income. The dependent variables were always smoking and being quitters over the follow-up time. Age, gender, self-rated health, and chronic medical conditions were the covariates. Race/ethnicity was the moderator. Logistic regressions were used to analyze the data. Most participants were never smokers (n = 7950), followed by quitters (n = 1765), always smokers (n = 1272), and initiators (n = 329). Overall, high educational attainment (OR = 0.92, 95% CI = 0.90 - 0.95) and income (OR = 0.99, 95% CI = 0.99 - 0.99) reduced the odds of being always smoker. High educational attainment (OR = 1.05, 95% CI = 1.02 - 1.08) was associated with higher odds of being a quitter. Ethnicity, however, showed significant interactions with education on both outcomes suggesting that the effects of educational attainment on reducing the odds of always being a smoker (OR = 1.24, 95% CI = 1.14 - 1.35) and increasing the odds of quitting (OR = 0.84, 95% CI = 0.75 - 0.93) were smaller for Hispanics than non-Hispanics. In the United States, middle-aged and older Hispanic adults remain at high risk of smoking cigarettes despite high educational attainment. That is, high educational attainment may better help non-Hispanic than Hispanic middle-aged and older adults to avoid cigarette smoking. As a result, we may observe a more than expected burden of tobacco use in middle class Hispanic middle-aged and older adults. Policymakers should not reduce racial and ethnic tobacco inequalities to SES gap, as ethnic tobacco disparities may persist in high SES levels as well.","journal":"Journal of Biosciences and Medicines","year":2021,"id":211045,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9539,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":328467,"name":"Shervin Assari","orcid":"0000-0002-5054-6250","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-18T23:52:16.049481Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}