Social status, stress, and adolescent smoking

Adolescent smoking is associated with increased perceived stress and lower social status, but past research has not explored links between lower social status, stress, and smoking risk. This study examined whether the relation between social status and perceived stress could explain the association between lower social status and increased risk of smoking.

Data were collected from 1021 non-Hispanic black and white adolescents participating in a longitudinal school-based study. Students completed a questionnaire and parents provided information on their highest level of education. Hierarchical logistic regression estimated the effects of parental education, subjective social status (SSS), and stress on smoking risk.

At baseline, students from families without a college-educated parent were at greater risk of current smoking (odds ratio [OR] some college = 1.98, 95% confidence interval [CI] = 1.06-3.67, and OR high school degree or less = 3.34, 95% CI = 1.67-6.60). Higher school SSS decreased risk of current smoking (OR = .73, 95% CI = .62-.87), and higher stress increased smoking risk (OR = 1.05, 95% CI = 1.01-1.08). There was no evidence that the effects of parental education were mediated through stress. At one-year follow-up, both lower school SSS and higher baseline stress were significantly associated with smoking initiation in preliminary models, but only baseline stress (OR = 1.06, 95% CI = 1.02-1.11) predicted smoking initiation in multivariable models.

These findings indicate that higher stress and lower social status increase risk of smoking, but that stress does not explain the association between lower social status and smoking. Therefore, stress reduction interventions may not alleviate social inequalities in teen smoking, but they do hold promise for youth smoking prevention.