摘要：Objectives . This study examined whether area-level characteristics are associated with individual smoking behavior among women. Methods . Analyses included 648 women enrolled as control patients in the Carolina Breast Cancer Study (1993–1996). Smoking and covariate information was obtained from interviews. Area-level characteristics included census block-group education level, poverty, unemployment, car–home ownership, crowding, and, for 431 women, city-level crime rates. Results . In multivariate logistic regression models, no area characteristics were clearly associated with a history of smoking. Among those who had ever smoked, continued smoking was associated with living in low-education areas (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.9), highunemployment areas (OR = 1.7, 95% CI = 1.0, 2.8), and high-crime areas (OR = 1.6, 95% CI = 0.8, 3.2). Conclusions . The present findings are consistent with a growing literature suggesting that area-level social and economic disadvantage influences individual smoking behavior. Despite a decline in smoking since the 1960s, 1 smoking prevalence rates among US women remain substantial. 2 Factors recognized as influencing smoking behavior include socioeconomic position, 1– 3 stress, 4– 6 parental and peer influence, 7, 8 and community norms. 9, 10 Moreover, among 4 recently conducted studies in Europe on determinants of smoking, 11– 14 3 of the studies suggest that area-level socioeconomic characteristics influence smoking. 11– 13 We examined the association between area-level characteristics and individual smoking behavior in a sample of North Carolina women. We conducted separate analyses to distinguish between correlates of smoking initiation and of continuing to smoke. Given possible links between environment, stress, and smoking behavior, 15– 17 we focused on area-level characteristics that may serve as stressors, 18– 20 including socioeconomic disadvantage, 11– 13, 21 crowding, 22, 23 and high crime rates. 15, 18
