摘要：Objectives. We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures. Methods. We analyzed data from the 2000 National Health Interview Survey. Results. Overall, the prevalence of current smoking was greatest among persons in—and independently associated with—working class jobs, low educational level, and low income. Attempts to quit showed no socioeconomic gradient, while success in quitting was greatest among those with the most socioeconomic resources. These patterns held in most but not all race/ethnicity–gender groups. Finer resolution of smoking patterns was obtained using a relational UK occupational measure, compared to the skill-based measure commonly used in US studies. Conclusions. Reducing social disparities in smoking requires attention to the complexities of class along with race/ethnicity and gender. Reducing health disparities is a key goal of US public health practice, including tobacco control. 1 Along with Healthy People 2010 ’s first goal, “to increase quality and years of healthy life,” the second goal is “to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.” 1 As comprehensive as this list is, however, one category highly relevant to social disparities in health is missing: occupation. Not only is occupation the link that binds education and income—in that we attain educational credentials enabling us to be employed in certain jobs, at which we earn a wage or salary—but it is also an important determinant of health in its own right. 2– 4 At issue are ways in which work affects health, whether directly by hazardous exposures 5 or, more indirectly, by influencing health behaviors. 6– 11 Few nationally representative US studies, however, have examined the population burden of smoking in relation to occupation, as revealed by a PubMed search for titles or articles containing the terms “occupation” and “smoking” and “national.” 12– 19 The National Center for Health Statistics does not include occupational categories in reports of smoking based on National Health Interview Surveys, 20– 25 with the exception of a report from National Institute for Occupational Safety and Health. 26 Among the extant studies, none simultaneously assessed the effect of occupation, education, income, race/ethnicity, and gender on smoking. Moreover, all grouped occupations in relation to skill and industry (e.g., “white collar” vs “blue collar”) or specific types of jobs (e.g., “construction laborers”). None used typologies explicitly premised on understanding social class as a social relation, involving issues of power and property, or used categories that capture a defining aspect of working class occupations, for example, being a nonsupervisory employee . 4, 27– 29 The net result is a dearth of data on the working class burden of smoking, which cannot be gleaned from data pertaining only to education or income alone. To address gaps in knowledge about the relationship of occupational class and smoking, we used data from a nationally representative sample of US adults to analyze current smoking, attempts to quit smoking, and former smoking. Our primary objective was to ascertain the population burden of smoking as patterned by occupational class and other aspects of social position, including income, education, race/ethnicity, and gender. Secondarily, we compared estimates of occupational patterns of smoking obtained by employing the typical US “collar” skill/industry schema 26 and the United Kingdom’s new occupational classification schema, explicitly “constructed to measure employment relations and conditions of occupations.” 27
