Cross-National Patterns of Health Inequality: Education and Tobacco Use in the World Health Survey

Fred C. Pampel, University of Colorado at Boulder
Justin T. Denney, University of Colorado at Boulder

Spreading tobacco use from the West to other parts of the world, especially among disadvantaged socioeconomic groups, raises concerns about the indisputable harm to global public health and questions about underlying patterns of health inequality. We propose hypotheses based on economic cost and diffusion theories that posit rising educational disparities in tobacco use with higher national income and more advanced stages of cigarette diffusion. Using World Health Survey data for 99,661 men and 123,953 women from 50 low- to upper-middle-income nations, we examine educational disparities in smoking within and across nations. In support of the hypotheses, multilevel logistic regression models of smoking show that national income and cigarette diffusion widen educational disparities among young men, narrow disparities among older women, and have weak influences among younger women and older men. The results suggest that the meaning of educational advantages for health behavior varies widely across national and social contexts.