Educational disparities in rates of smoking among diabetic adults: the translating research into action for diabetes study.
OBJECTIVE
We assessed educational disparities in smoking rates among adults with diabetes in managed care settings.


METHODS
We used a cross-sectional, survey-based (2002-2003) observational study among 6538 diabetic patients older than 25 years across multiple managed care health plans and states. For smoking at each level of self-reported educational attainment, predicted probabilities were estimated by means of hierarchical logistic regression models with random intercepts for health plan, adjusted for potential confounders.


RESULTS
Overall, 15% the participants reported current smoking. An educational gradient in smoking was observed that varied significantly (P<.003) across age groups, with the educational gradient being strong in those aged 25 to 44 years, modest in those aged 45 to 64 years, and nonexistent in those aged 65 years or older. Of particular note, the prevalence of smoking observed in adults aged 25-44 years with less than a high school education was 50% (95% confidence interval: 36% to 63%).


CONCLUSIONS
Approximately half of poorly educated young adults with diabetes smoke, magnifying the health risk associated with early-onset diabetes. Targeted public health interventions for smoking prevention and cessation among young, poorly educated people with diabetes are needed.
Karter
Andrew J
AJ
Division of Research, Kaiser Permanente, Oakland, Calif, and Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, USA. Andy.J.Karter@kp.org
Stevens
Mark R
MR
Gregg
Edward W
EW
Brown
Arleen F
AF
Tseng
Chien-Wen
CW
Marrero
David G
DG
Duru
O Kenrik
OK
Gary
Tiffany L
TL
Piette
John D
JD
Waitzfelder
Beth
B
Herman
William H
WH
Beckles
Gloria L
GL
Safford
Monika M
MM
Ettner
Susan L
SL
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003625:Data Collection; D003920:Diabetes Mellitus; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology