Social capital, economic conditions, marital status and daily smoking: A population-based study

doi:10.1016/j.puhe.2010.01.003

Public Health

Volume 124, Issue 2, February 2010, Pages 71-77

https://doi.org/10.1016/j.puhe.2010.01.003 Get rights and content

Summary

Objective

To investigate the association between marital status and daily smoking, adjusting for economic conditions and trust.

Study design

Cross-sectional study.

Methods

In total, 27,757 individuals aged 18–80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the association between marital status and daily smoking, adjusting for economic (material) conditions and trust. A multivariate analysis was performed to investigate the importance of possible confounders concerning the differences in daily smoking according to marital status.

Results

Smoking prevalence was 14.9% among men and 18.1% among women. The odds ratios of daily smoking for middle-aged respondents, born abroad, medium/low education, problems paying bills, low trust, and unmarried and (particularly) divorced respondents were significantly higher than those for their reference groups. Low trust was significantly higher among divorced and unmarried respondents compared with married/cohabitating respondents. Adjustment for economic conditions reduced the odds ratios of daily smoking among divorced subjects; this was not seen following adjustment for trust.

Conclusions

Never-married subjects and (particularly) divorced subjects showed a significantly higher prevalence of daily smoking than married/cohabitating respondents. Economic conditions have a significant effect on the association between marital status and daily smoking, but this was not seen for trust.

Introduction

Tobacco smoking is a major health concern internationally.1, 2 In Sweden, the prevalence of smoking has decreased progressively among men over the past 40 years, but the prevalence started to decrease later among women.³ Daily smoking is strongly associated with being middle-aged, born abroad⁴ and having low socio-economic status (e.g. low education).⁵ The prevalence of daily smoking depends on factors such as the rate of smoking initiation, mortality among smokers compared with non-smokers, and the rate of quitting smoking. In Sweden, smoking cessation is associated with being male, being born in Sweden and having higher socio-economic status.⁶ Smoking cessation is a complex phenomenon which includes social, psychological and biological factors, such as nicotine dependence.7, 8 Studies suggest that marital status is also associated with daily smoking. Men and women who are widowed, never married and (especially) divorced seem to have a higher prevalence of daily smoking than men and women who are married or cohabitating.⁹ There are both economic (material) hypotheses and social hypotheses regarding why divorced people and other people living alone are more likely to be daily smokers than married people.

Marital status may influence men and women in different ways. Material disadvantage is most prevalent among divorced women and never-married men. Never-married women often display high levels of involvement in social activities, which may influence health through both psychological and biological mechanisms. Social and material inequalities are intertwined with the interaction between gender and marital status.¹⁰

Social capital is a social trait which seems to affect health. A country or community with high levels of social capital is characterized by high social participation among citizens, high generalized trust in other people, high trust in institutions and generalized reciprocity in society.11, 12 Social capital has been suggested to promote health by several causal pathways, including a decrease in psychosocial stress, more healthy behaviours by the influence of norms and values, increased access to health care and amenities, and a decline in the risk of violent crime.¹³ Daily smoking and smoking cessation have been shown to be associated with aspects of social capital such as generalized (horizontal) trust in other people and social participation.14, 15 Social capital and trust have been suggested to be associated with smoking both by psychosocial stress mechanisms and by affecting norms and values concerning smoking behaviour. Social capital also seems to be associated with marital status. Fukuyama suggested that, in the USA, one causal factor behind the decline in social capital, measured as generalized trust in other people, may be higher divorce rates and more people living alone than previously.16, 17 One hypothesis may be that the divorce experience may lead to lower levels of social capital such as trust in other people, and more distrust in the norms and values of society concerning smoking, which may affect smoking behaviour. In contrast, marriage leads to more activity in community organizations and at home, but tends to decrease socializing with friends. Church- and youth-related activities are more common among married people.¹² Marital status may thus influence trust and social activity, which may influence health.

The social capital framework has not remained unquestioned. The so-called ‘neomaterialists’ claim that the research concerning social capital and public health obscures underlying political, administrative, economic and material determinants of health inequalities and other public health issues.18, 19, 20 Economic (material) conditions would thus affect marital status differences in daily smoking. Economic (material) conditions are also associated with both daily smoking and marital status.¹⁴ Both hypotheses seem plausible, because being divorced and living alone may increase the risk of fewer contacts with others and the risk of living under poorer economic/material conditions, which would hamper smoking cessation.³

This study aimed to investigate the association between marital status and daily smoking, adjusting for economic conditions and trust (social capital) in Skåne, southern Sweden.

Section snippets

Study population

The 2004 public health survey in Skåne is a cross-sectional study. In total, 27,963 randomly selected persons aged 18–80 years answered a postal questionnaire in the autumn (September–December) of 2004, resulting in a 59% participation rate. Two letters of reminder were sent to non-respondents, and a subsequent telephone call was made to the remaining non-respondents. Complete questionnaires were returned by 27,757 people (i.e. the correct person in the household according to age and gender

Results

Table 1 shows that the prevalence of daily smoking was 14.9% among men and 18.1% among women. The age distribution was fairly even across the age groups, and the proportion born in countries other than Sweden was 11.5% for men and 12.0% for women. The prevalence of high education was 32.4% for men and 39.0% for women, and 75.9% of all men and 72.5% of all women had never experienced problems with paying bills during the past year, while 3.8% of men and 4.7% of women had experienced such

Discussion

This study found that never-married and (particularly) divorced subjects had significantly higher prevalences of daily smoking than married/cohabitating subjects. Poor economic conditions seem to have a significant effect on the association between marital status and daily smoking, but this was not the case for low trust. Never-married and divorced people appear to be important target groups for tobacco prevention.

This study demonstrated a significant association between marital status and

Conclusion

Never-married and (particularly) divorced people have significantly higher prevalences of daily smoking than married/cohabitating people. Poor economic conditions affect the significant association between marital status and daily smoking, but this was not the case for trust. Never-married and divorced people seem to be important target groups for tobacco prevention.

Ethical approval

Ethics Committee at Lund University and Region Skåne.

Funding

Swedish Research Council (Vetenskapsrådet) (K2008-70X-01-3), the Swedish Research Council Linnaeus Centre for Economic Demography (VR-79), the Swedish ALF Government Grant Dnr M 2007/1656 and the Research Funds of the Malmö University Hospital.

Competing interests

None declared.

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Original ResearchSocial capital, economic conditions, marital status and daily smoking: A population-based study

Summary

Objective

Study design

Methods

Results

Conclusions

Introduction

Section snippets

Study population

Results

Discussion

Conclusion

Ethical approval

Funding

Competing interests

Lancet

J Aging Stud

Prev Med

Prevalence of cigarette smoking in developing countries

Tob Control

National Public Health Report (Folkhälsorapport)

Ethnic differences in daily smoking in Malmö, Sweden: varying influence of psychosocial and economic factors

Eur J Public Health

Psychosocial work conditions and daily smoking: a population-based study

Tob Control

Smoking cessation among daily smokers, aged 45–69 years: a longitudinal study in Malmö, Sweden

Addiction

An investigation of self-efficacy, partner support and daily stresses as predictors of relapse to smoking in self-quitters

Addiction

Regular smokers, lifetime very light smokers and reduced smokers: comparison of psychosocial and smoking characteristics in women

Health Psychol

Marital status and twins' health and behaviour: an analysis of middle-aged Danish twins

Psychosom Med

Making democracy work. Civic traditions in modern Italy

Bowling alone: America's declining social capital

Social capital and self-rated health: a contextual analysis

Am J Public Health

Socioeconomic differences in smoking cessation: the role of social participation

Scand J Public Health

Original Research
Social capital, economic conditions, marital status and daily smoking: A population-based study