Smoking is a cause of social inequality in health, but is social position is cause of smoking?

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The paper by Hart and colleagues describes occupational class differences in cause specific mortality among women who had never smoked.1 In the accompanying commentary smoking is discussed as if it was a mediator of the relationship between social position and health.2 But the uptake of smoking will likely take place many years before the individual's own social position has formed. For example, this author moved into occupational class I at age 26, but ceased being a never smoker around age 14. A similar argument can be made for weight gains over the life course that, in the end, result in obesity (for an elaborate example of these misconceptions, see e.g. Mortensen et al.).3 I think this highlights the need for great caution when we apply prescriptive interpretations to descriptive studies.

Smoking is a cause of social inequality in health: If smoking was eliminated social differences would decrease. Also, social position is an important factor (causal or not) in smoking cessation. But one's own adult social position is likely not a terribly important cause of never smoking.

(1) Hart CL, Gruer L, Watt GC. Cause specific mortality, social position, and obesity among women who had never smoked: 28 year cohort study. BMJ 2011; 342:d3785.

(2) Mackenbach JP. What would happen to health inequalities if smoking were eliminated? BMJ 2011; 342:d3460.

(3) Mortensen LH, Diderichsen F, Smith GD, Andersen AM. The social gradient in birthweight at term: quantification of the mediating role of maternal smoking and body mass index. Hum Reprod 2009; 24(10):2629-2635.
Publikationsdatojul. 2011
StatusUdgivet - jul. 2011

ID: 34335549