Age, cumulative psychosocial risk factors, and health disparities in U.S. adult cigarette smoking: 2002-2019.

Abstract

Understanding psychosocial factors that underpin smoking disparities is important for developing targeted interventions to reduce tobacco use and its associated adverse health consequences. This study investigated associations between cumulative psychosocial risks, age, and the interplay of these two factors in U.S. smoking disparities over time. Participants included adults aged ≥ 18 years in the 2002-2019 US National Survey on Drug Use and Health. Psychosocial factors were combined into a cumulative-risk index with four levels: No-, Low-, Moderate-, and High-risk. Logistic regression analyses tested whether smoking prevalence varied by risk level and age over time. Greater cumulative risk was associated with higher smoking prevalence. Using No-risk group prevalence (4.2%) as the comparator, smoking prevalence was greatest in the High-risk group (50.8%; OR = 20.9 [95% CI, 19.8-22.0]), followed by the Mod-risk group (29.7%; OR = 5.8 [5.6-5.9]), and low-risk group (15.2%; OR = 2.4 [95% CI, 2.4-2.5]). Importantly, these disparities persisted over time. Smoking prevalence declined across time in all age groups under age 65 and the rate of decline decreased with age: Age 18-25 showed the greatest decline (34.4% to 13.7%; OR = .88 [95% CI, .88-.88]), followed by age 35-49 (29.4% to 20.8%; OR = .95 [.94-.95]), age 26-34 (30.2% to 22.4%; OR = .95 [.94-.95]), and Age 50-64 showed the slowest decline trend (21.3% to 18.8%; OR = .96 [95% CI, .96-.97]). No significant decline over time for age 65 + years was observed (10.4% to 8.7%; OR = 1.00 [.98-1.01]). There was a significant association of risk level and age in changes of smoking prevalence over time. For ages 18-25 and 35-49, smoking prevalence declined over time across all risk levels. For Ages 26-34, smoking prevalence decreased between 2012 and 2019 across all risk levels but not during 2002-2011. However, for ages 50-64 and 65 + , smoking prevalence was stable for all risk levels between 2002 and 2019. Despite overall declines in smoking prevalence, disparities by cumulative risk levels and age remained steady and substantial over nearly two decades. Including consideration of smoking disparities by cumulative risk levels and age may enhance the development of more targeted and effective interventions to reduce smoking prevalence.