Abstract A103: Joint associations of education and neighborhood socioeconomic status on smoking prevalence: The Multiethnic Cohort Study
Authors: Walsh Catherine P. , Lee Younghan , Shariff-Marco Salma , Wilkens Lynne , Marchand Loic Le , Haiman Christopher A. , Cheng Iona , Park S. Lani 
Published: December 2023

Abstract
Background: Smoking is the leading cause of cancer and cancer death. Individual- and neighborhood-level measures of socioeconomic status (SES) have been separately associated with racial and ethnic differences in smoking rates. However, the joint associations of individual- and neighborhood-level SES on smoking have not been studied. Thus, we examined the joint association of education and neighborhood SES (nSES) on smoking status in the Multiethnic Cohort (MEC) study. Methods: We conducted a cross-sectional study of the joint association of nSES and education with smoking for 166,475 MEC participants (26,350 African American, 50,207 Japanese American, 34,490 Latino, 12,326 Native Hawaiian, and 43,102 White participants) recruited from predominately Los Angeles County and Hawaii. Smoking status, education, and other demographics and health behaviors were reported at baseline (1993-1996). Neighborhood SES (nSES) was derived using 1990 US Census data on education, occupation, unemployment, household income, poverty, rent, and house values and assigned to geocoded baseline addresses; and categorized into quintiles using LA County and Hawaii nSES distributions. The joint nSES and education measure was categorized into 4 levels using high nSES (quintiles 4-5), low nSES (quintiles 1-3), high education (≥ high school), and low education (&lt; high school). The study outcome was current smoking vs. non-smoking (never or former smoking). Poisson regression was used to estimate prevalence ratios (PR) and 95% CIs for the joint association of nSES and education with current smoking, adjusting for sex, race/ethnicity, marital status, physical activity, occupation, alcohol, obesity, 2015 healthy eating index, and clustering by census block group. Subgroup analyses were conducted by state (CA and HI), sex, and race/ethnicity. Results: For CA MEC participants, smoking prevalence was highest with low nSES and low education, followed by low nSES and high education, and high nSES and low education (PR=1.50, 1.33, and 1.29, respectively). This pattern was found in females but not males and in African American and Japanese American participants but not Latino or White participants. For HI MEC participants, smoking prevalence was highest with low nSES and low education, followed by high nSES and low education, and low nSES and high education (PR=1.41, 1.36, and 1.20, respectively). This pattern was found in males and females in HI and across all racial and ethnic groups. Interestingly, in Native Hawaiian participants, the smoking prevalence with low nSES and low education was similar to those with high nSES and low education (PR=1.54 and 1.52, respectively). Conclusion: In the MEC, smoking prevalence was highest in CA for females, African American, and Japanese American participants in joint SES categories with low nSES, while in HI, low education appeared more influential, especially among Native Hawaiian participants. These findings demonstrate the importance of considering both individual and neighborhood-level SES measures on smoking prevalence.
Citation Format: Catherine P. Walsh, Younghan Lee, Salma Shariff-Marco, Lynne Wilkens, Loic Le Marchand, Christopher A. Haiman, Iona Cheng, S. Lani Park. Joint associations of education and neighborhood socioeconomic status on smoking prevalence: The Multiethnic Cohort Study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A103.