Updated 30 August 2013

Clever people don't smoke

Better educated middle-aged Americans are less likely to smoke and more apt to be physically active than their less educated peers, according to a new study.

Better educated middle-aged Americans are less likely to smoke and more apt to be physically active than their less educated peers. They are also more inclined to make healthy changes in general and in the face of new medical conditions and adhere to them, according to a new study in the September issue of the Journal of Health and Social Behavior.

"This study documents that there are very large differences by education in smoking and physical activity trajectories in middle age, even though many health habits are already set by this stage of the life course," said study author Rachel Margolis, an assistant professor of sociology at the University of Western Ontario. "Health behaviour changes are surprisingly common between ages 50 and 75, and the fact that better educated middle-aged people are more likely to stop smoking, start physical activity, and maintain both of these behaviours over time has important health ramifications."

In her study, "Educational Differences in Healthy Behavior Changes and Adherence Among Middle-aged Americans", Margolis draws on data from the Health and Retirement Study (HRS), a longitudinal study of ageing that is nationally representative of the US population above 50. Her analysis considers more than 16,600 HRS participants aged 50-75 during the study period 1992-2010.

Education affects behaviour

Margolis found that 15% of college-educated respondents smoked at some point between ages 50-75, compared to 14% of college dropouts. There were also large differences by education in physical activity over the study period. For example, 14% of college-educated respondents were physically active at all interviews during the study period, compared with 2% of those with less than a high school education. In addition to college graduates and high school dropouts, Margolis analysed people with only a high school degree and individuals with some college education.

According to Margolis, health problems arise throughout the life course and how people respond to new medical conditions can shape their future health. "I studied whether education affected the likelihood that people changed their behaviour after they learned they had a condition that necessitated behaviour modification for disease management," she said. "I found that having more education increased the odds that a person would make a healthy behaviour change when faced with a new chronic health condition. This finding helps explain why there are educational differences in chronic disease management and health outcomes."

Margolis also discovered that one's level of education became decreasingly important as a moderator of healthy behaviour changes upon diagnosis as age increased. Having more education increased the odds of smoking cessation among people in their 50s who were diagnosed with a new condition, but not those in their 60s or early 70s.

A small, select group

"Well-educated smokers in their 60s and early 70s are a small and select group," Margolis said. "They may be the most addicted or the most stubborn."

Another possible explanation for why well-educated smokers in their 50s were more likely to quit than those in their 60s and early 70s is that the longer people expect to live when they get sick, the more likely they are to make a healthy behaviour change, Margolis said.

Interestingly, although Margolis found that better-educated people were much more likely to, for example, quit smoking when they got sick, her research also revealed that those with lower levels of education were also more likely to quit after receiving a negative diagnosis than when they were healthy.

"To improve overall population health, my research suggests that health practitioners and policymakers can take better advantage of the fact that people from all educational backgrounds are more inclined to make healthy changes at the point of diagnosis and focus on encouraging healthy changes at that time," she said.




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