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Smoking, Social Class and Gender: the Diffusion of the Tobacco Epidemic Among Older Adults in Ireland

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Smoking, Social Class and Gender: the Diffusion of the Tobacco Epidemic Among Older Adults in Ireland Smoking, Social Class and Gender: The Diffusion of the Tobacco Epidemic among Older Adults in Ireland Keishia Taylor September 2014 This thesis is submitted to the School of Social Work and Social Policy, Trinity College Dublin, in partial fulfilment of the requirements for the degree of Masters in Applied Social Research under the supervision of Dr Philip Curry Declaration I declare that this thesis is entirely my own work. It has not been submitted to this or any other institution for degree or publication. I authorise the University of Dublin to lend this thesis to other institutes or individuals. I further agree that this thesis may be copied at the request of other institutes or individuals for the purpose of scholarly work. ______________________________ Keishia Taylor Date i Acknowledgements I would like to thank Dr Philip Curry for his guidance, expertise and dedication as my supervisor and my classmates for their camaraderie over the last few months. I am very grateful to my friends and family for all of their encouragement and most of all to Bren for his endless patience and unwavering support. For my Dad ii Abstract Background: Half of all regular smokers die from smoking-related diseases. In Ireland, smoking is the highest cause of preventable mortality, representing almost one in five deaths each year. The spread of tobacco can be described using the diffusion model of the tobacco epidemic, which provides a framework for differences in smoking behaviour. The interrelation of gender and social class, mediated by age and life experience, is critical for understanding the diffusion of tobacco in high-income countries. Methods: Secondary analysis of TILDA data collected from 8504 Irish older adults was conducted and the independent relationships of age, gender and social class with smoking were examined. A multinomial regression model was used to examine the relationships collectively, including the interaction effects of age with gender and social class. Results: Age, gender and social class were all independently related to smoking, with younger respondents, males and those with low social class being more likely to smoke. Men were much more likely than women to have previously smoked and the odds increase with age for men and decrease with age for women. Among older age groups, gender had a stronger effect on smoking than social class, but among younger age groups, social class had a stronger effect than gender. Conclusions: The findings supported the existence of the diffusion model of the tobacco epidemic and previous research that lower social class women are more likely to smoke and less likely to quit. Further research into psychosocial factors, clustered health behaviours and cessation among older people using longitudinal analysis or structural equation modelling may be useful. Improved targeted cessation interventions for less successful subgroups may be of benefit, helping to achieve public health targets and reduce inequalities in smoking. KEYWORDS: Smoking; tobacco epidemic; older adults; social class; gender; Ireland. iii Table of Contents List of Tables ................................................................................................................................................... vii List of Figures .................................................................................................................................................. vii Abbreviations ................................................................................................................................................. viii Introduction ............................................................................................................... 1 Chapter 1: Literature Review .................................................................................. 3 1.1 Introduction ................................................................................................................................................3 1.2 Smoking as a Priority Public Health Issue ............................................................................................3 1.3 The Diffusion Model of the Tobacco Epidemic ..................................................................................5 1.3.1 The Diffusion Model and Gender ...............................................................................................6 1.4 Social Gradient of Smoking .....................................................................................................................7 1.4.1 Social gradient and gender ...........................................................................................................9 1.5 Smoking Initiation ................................................................................................................................... 10 1.5.1 Initiation and gender ................................................................................................................... 10 1.6 Smoking Cessation ................................................................................................................................. 11 1.6.1 Cessation and gender ................................................................................................................. 12 1.6.2 Cessation and Social Support ................................................................................................... 13 1.7 Older People and Smoking ................................................................................................................... 14 1.8 The Irish Context ................................................................................................................................... 15 1.8.1 Smoking and Tobacco Control in Ireland ............................................................................. 15 1.8.2 Ageing and Smoking in Ireland ................................................................................................. 17 1.8.3 Transformed Social Contexts .................................................................................................. 17 1.9 The Current Study ................................................................................................................................. 20 Chapter 2: Methodology ......................................................................................... 22 2.1 Introduction ............................................................................................................................................. 22 2.2 TILDA ........................................................................................................................................................ 22 2.2.1 Design ............................................................................................................................................ 22 2.2.2 Access and Ethical Approval ..................................................................................................... 23 2.2.3 Data Collection ............................................................................................................................ 23 2.2.4 Sampling and Participants .......................................................................................................... 24 2.3 Sample Profile .......................................................................................................................................... 24 2.4 Variables .................................................................................................................................................... 26 2.4.1 Smoking status ............................................................................................................................. 26 2.4.2 Age .................................................................................................................................................. 26 2.4.3 Social Class.................................................................................................................................... 26 iv 2.4.4 Social Isolation ............................................................................................................................. 35 2.5 Analysis ..................................................................................................................................................... 36 Chapter 3: Findings ................................................................................................. 38 3.1 Introduction ............................................................................................................................................. 38 3.2 Are gender, age and social class independently related to smoking in older people in Ireland? ............................................................................................................................................................. 38 3.2.1 Is gender related to smoking? .................................................................................................. 38 3.2.2 Is age related to smoking among older adults? .................................................................... 39 3.2.3 Is social class related to smoking? ........................................................................................... 41 Summary .................................................................................................................................................. 44 3.3 How do gender, age and social class
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