Socioeconomic inequity and smoking initiation among young adolescents in Taiwan: A multilevel analysis

Objectives: Utilizing monthly allowance as a proxy measure for youth's socioeconomic position (SEP), the present study examined the extent to which absolute and relative SEP was associated with smoking initiation among 13-15 year olds. Methods: The analyses were built upon the 2010 Global Youth Tobacco Survey (GYTS) in Taiwan. Information concerning sociodemographics, smoking history, and contextual smoking exposure (e.g., family and school) were assessed via self-report. Incident smoking was defined by having the first cigarette no more than two years before survey. Complex survey and multilevel analyses were constructed to estimate association. Results: More than one fifth had tried smoking on at least one occasions, with 8.4% being incident smokers (n=1824). Intra-class correlation of smoking initiation at class- and school-level was estimated 0.15 and 0.09, respectively. Youth with male gender, older age, smoking parents, smoking teachers, and higher monthly allowance were 2~5 times more likely to start smoking; getting allowance lower than 20% of class increased tobacco initiation by 46% (95% confidence interval [CI]: 6%-95%). As to school effects, youth's odds to start smoking was elevated with the rate of experienced smoking students, smoking teachers, and lower socioeconomic students at; however, the odds ratio was lowered to 0.67 while the schools were composed largely by students in lower SEP (95% CI: 0.48-0.95). Conclusions: Youth's risk of tobacco initiation was differentially affected by absolute and relative SEP, both individually and contextually. Future research is needed to delineate possible mechanisms underlying unfavorable health behaviors associated with relatively disadvantaged background in early adolescence.