Protective Effects of Educational Attainment Against Cigarette Smoking; Diminished Returns of American Indians and Alaska Natives in the National Health Interview Survey.

Abstract

Background\nAlthough educational attainment is protective against health risk behaviors such as smoking, Minorities Diminished Returns theory posits that these protective effects are smaller for ethnic minority than the majority groups.\n\n\nAims\ncompare the effects of educational attainment on smoking status of American Indian Alaska Native (AIAN) and White adults.\n\n\nMethods\nData came from the National Health Interview Survey (NHIS - 2015). A total number of 21114 individuals entered our analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator.\n\n\nResults\nOverall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that was suggestive that the protective effects of educational attainment against smoking is smaller for AIAN than Whites.\n\n\nConclusions\nIn the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites. The result is additional risk of smoking in highly educated AIANs. To reduce ethnic disparities I tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.