INTRODUCTION
Despite its overall decline in the U.S., trends in cigarette smoking could vary by intersection with demographic characteristics. We explored trends in education-related disparities in current smoking among U.S. adults by race (Black/African American and White), sex, and U.S. census region.
METHODS
Data were from U.S. civilian non-institutionalized adults (aged 18+ years) who self-identified as Black and White and participated in the 1995-2019 Tobacco Use Supplement to the Current Population Survey. We estimated average annual percent changes in current cigarette smoking by the intersections of race, sex, census region, and educational attainment. We calculated educated-related prevalence differences (PDs) in current cigarette smoking by subtracting the prevalence of bachelor's degrees from that of <high school in 1995-1996 and 2018-2019, then examined their variations by the intersection of sex, race, and region. Weighted multivariable logistic regression models were used to test education*survey year interactions across sexes, races, and regions.
RESULTS
Education-related disparities in current cigarette smoking increased over time, especially among Black/African American male (PD1995-1996=22.8%; PD2018-2019=27.2%) and female adults (PD1995-1996=12.1%; PD2018-2019=16.5%). By region, Black/African American male adults in the Midwest showed the largest increase in education-related current cigarette smoking disparities, followed by Black/African American male and female adults in the South, and White male and female adults in the Midwest. These findings were because of small to no declines in the prevalence of current cigarette smoking among those with <high school education.
CONCLUSION AND RELEVANCE
The gap in prevalence of current cigarette smoking by education widened over time, especially among Black/African American adults in certain regions.
IMPLICATIONS
Despite the decline in the prevalence of current cigarette smoking in the U.S. population overall, such public health gain may not benefit all individuals equally. Using the data from a U.S. representative serial cross-sectional survey study during 1995-2019, we found that disparities in current cigarette smoking prevalence between those with <high school versus bachelor's degree education widened especially among Black/African American adults. Future research to investigate the barriers for progress among Black/African American adults with <high school education could inform interventions to reduce racial and education-related cigarette smoking disparities.