Average household income, crime, and smoking behaviour in a local area: The Finnish 10-Town study

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Abstract

Social environments, like neighbourhoods, are increasingly recognised as determinants of health. While several studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour, little is known of the health effects of neighbourhood crime rates. Using the ongoing 10-Town study in Finland, we examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behaviour in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behaviour among women was substantially explained by the area-level crime rate. This study extends our knowledge of potential pathways through which social environmental factors may affect health.

Introduction

Social environments, like neighbourhoods, are increasingly recognised as determinants of health independent of individual-level risk factors (Chuang, Cubbin, Ahn, & Winkleby, 2005; Diez Roux, 2001; Diez Roux et al., 1997; Kleinschmidt, Hills, & Elliot, 1995; Lawlor, Davey Smith, Patel, & Ebrahim, 2005; Lee & Cubbin, 2002; Macintyre, Ellaway, & Cummins, 2002; Pickett & Pearl, 2001; Reijneveld, 2002; Sundquist, Malmström, & Johansson, 1999; Tseng, Yeatts, Millikan, & Newman, 2001; Yen & Kaplan, 1999; Yen & Syme, 1999). The mechanisms suggested to link neighbourhood characteristics to health are the stressors to which people are exposed, the resources available to deal with them, and the forms of social interaction (Macintyre et al., 2002). According to a classic theory of the Chicago school (Sampson & Groves, 1989; Shaw & McCay, 1942) social disorganisation, defined as the “inability of a community structure to realise the common values of its residents and maintain effective social controls” is associated with high crime rate in neighbourhoods, which, in turn, acts as a stressor among the residents (Kawachi, Kennedy, & Wilkinson, 1999; Kennedy, Kawachi, Prothrow-Stith, Lochner, & Gupta, 1998; Sampson, Raudenbush, & Earls, 1997; Steptoe & Feldman, 2001).

Recently, the concept of social capital has emerged as a plausible mechanism explaining neighbourhood variations in crime (Coleman, 1990; Kawachi et al., 1999; Putnam, 1993). There is evidence to support the hypothesis that social disorganisation and high crime rate are associated with low social capital in the area (Kawachi et al., 1999). Thus, area-level crime rate may act as a proxy of social capital in the area. Social capital has been suggested to affect health behaviours in at least three ways (Patterson, Eberly, Ding, & Hargreaves, 2004): by promoting more effective diffusion of health information (Rogers, 1983), by increasing the likelihood that norms of healthy behaviour are adopted, and by exerting social control over deviant health behaviour (Berkman & Glass, 2000). Furthermore, stress has been associated more strongly with smoking intensity than with smoking status (Kouvonen, Kivimäki, Virtanen, Pentti, & Vahtera, 2005) which suggests that lack of social capital may also be related to smoking intensity.

While several previous studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour among people who live in these localities, little is known of the health effects of the area-level crime rate (Stafford, Cummins, Macintyre, Ellaway, & Marmot, 2005; Sundquist et al., 2006). A relationship between low neighbourhood socio-economic status and smoking status has been shown in previous studies (Chuang et al., 2005; Datta et al., 2006; Diez Roux et al., 1997; Kleinschmidt et al., 1995; Lee & Cubbin, 2002; Reijneveld, 2002; Sundquist et al., 1999; Tseng et al., 2001). Three, however, have reported null findings (Hart, Ecob, & Davey Smith, 1997; Lee & Cubbin, 2002; Ross, 2000). One study has reported a link between low neighbourhood socio-economic status and greater smoking intensity, as indicated by the number of cigarettes smoked (Chuang et al., 2005). The only study on neighbourhood crime rate and smoking behaviour reported a non-significant association, but this study ignored smoking intensity and was limited to women in relatively few localities (Tseng et al., 2001).

To increase understanding of the effects of social environments on health, we examined the association of the average household income rate and crime rate measured at the local area level, with individual smoking behaviour, namely smoking status, smoking intensity and past smoking among over 20,000 residents from a large variety of localities in Finland. We also examined whether local area crime rate is one of the mechanisms through which area-level income is associated with smoking. Finally, we assessed whether there were any interaction between individual level occupational status and local area characteristics associated with smoking (Datta et al., 2006; Pickett & Pearl, 2001).

Section snippets

Design and participants

This study is a part of the ongoing 10-Town study of local government employees in 10 Finnish towns (Vahtera, Poikolainen, Kivimäki, Ala-Mursula, & Pentti, 2002). The ethics committee of the Finnish Institute of Occupational Health has approved the study. Between October 2000 and February 2001, 32,299 (67%) employees responded to a survey with questions on smoking habits.

We obtained information on gender, age, occupational status and the postal zip code of the place of residence of each

Results

Table 1 shows descriptive statistics of the participants according to the local area crime rate. In terms of age and gender, there were no great differences between the categories of area-level income and crime. Men lived more often in the low-income areas than women. Manual and lower grade non-manual workers were overrepresented whereas higher-grade non-manual workers were underrepresented in the high-crime and low-income areas.

Table 2 presents the relationship of local area household income

Discussion

In this large cohort of a working population, we found that low average household income and high crime rate at the local area level were related to a higher probability of being a smoker among men and women. Moreover, we found that both of these disadvantageous local area characteristics were associated with a higher smoking intensity and a lower likelihood of being an ex-smoker, among both genders. Past research has found an association between low neighbourhood socio-economic status and

Conclusion

The present study extends knowledge of potential pathways through which factors of social environment may affect health. Adverse local area characteristics were associated with smoking, which is the largest preventable risk factor for morbidity and mortality in all developed countries (Bergen & Caporaso, 1999). Reducing the excessive smoking of people in a low socio-economic position may not be dependant only on individual-focused prevention. In order to prevent smoking, interventions should

Acknowledgements

This study was supported by the Finnish Work Environment Foundation and the Academy of Finland (Projects no. 105195 and 117604) and the participating towns. The sponsors of the study had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, and preparation, review, or approval of the manuscript. We thank Jaana Pentti from Finnish Institute of Occupational Health and Juha Helenius from Ministry of the Interior for their generous

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