Socioeconomic inequalities in adolescent smoking behaviour and neighbourhood access to tobacco products.

Abstract

Youth smoking is an important aspect of tobacco research as most adult smokers first experiment with and initiate tobacco use during their adolescence. Policy makers and researchers have given youth smoking issues a significant amount of attention over the last 20 years and this has led to significant reductions in youth smoking prevalence in New Zealand. More recently the decline in youth smoking prevalence has reached a plateau. Evidence now shows that while overall smoking prevalence has reduced, inequalities between ethnic and social groups has actually increased. This is an international trend. Young people living in low socioeconomic status areas and belonging to minority ethnic groups are at much higher risk of being a current smoker than their less deprived peers. A number of overseas studies have investigated the spatial relationship between aspects of the neighbourhood environment and adolescent smoking behaviour in an attempt to identify the most at risk groups. In particular the effect of neighbourhood socioeconomic status and the degree of access to tobacco outlets is believed to influence adolescent smoking behaviour. In New Zealand analysis of this type has mainly focused on adult smoking behaviour and the effect of tobacco outlet access is as yet unstudied.

This study examines the effect of neighbourhood and high school socioeconomic status on adolescent smoking behaviour, attitudes and beliefs in Christchurch. Using information from the 2006 New Zealand Census, spatial variations in reported neighbourhood smoking prevalence have been examined. In addition, analysis of responses to smoking questions in the 2008 Year 10 In-depth Survey have been carried out show how school socioeconomic status can influence underlying attitudes and beliefs young people hold towards smoking and tobacco products. Spatial analysis has also been performed on the census dataset to investigate the relationship between neighbourhood access to tobacco outlets and youth smoking behaviour after controlling for neighbourhood deprivation. To supplement each of these quantitative data sources, focus group interviews were carried out at two high schools (one low and one high socioeconomic status). Findings from these interviews are presented as further insight into adolescent attitudes and beliefs towards smoking.

Results of this research show that there is a socioeconomic effect at both a neighbourhood and school level on all adolescent smoking behaviours, attitudes and beliefs examined, except for smoking cessation. There is also evidence of greater access to tobacco outlets in low socioeconomic neighbourhoods but not so around high schools. Increased access to tobacco outlets is linked to increased adolescent smoking prevalence, more so among females than males, but this relationship disappeared in age groups 20 and above.