Income, income inequality and youth smoking in low- and middle-income countries

Authors

  • David X. Li,

    Corresponding author
    • Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
    Search for more papers by this author
  • G. Emmanuel Guindon

    1. Département d'administration de la santé, Université de Montréal, Montréal, QC, Canada
    2. Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), Université de Montréal, Montréal, QC, Canada
    3. Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada
    Search for more papers by this author

Correspondence to: David X. Li, Centre for Global Health Research, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, Canada M5B 1W8. E-mail: dxl@jhmi.edu

Abstract

Aims

To examine the relationships between income, income inequality and current smoking among youth in low- and middle-income countries.

Design

Pooled cross-sectional data from the Global Youth Tobacco Surveys, conducted in low- and middle-income countries, were used to conduct multi-level logistic analyses that accounted for the nesting of students in schools and of schools in countries.

Participants

A total of 169 283 students aged 13–15 from 63 low- and middle-income countries.

Measurements

Current smoking was defined as having smoked at least one cigarette in the past 30 days. Gross domestic product (GDP) per capita was our measure of absolute income. Contemporaneous and lagged (10-year) Gini coefficients, as well as the income share ratio of the top decile of incomes to the bottom decile, were our measures of income inequality.

Findings

Our analyses reveal a significant positive association between levels of income and youth smoking. We find that a 10% increase in GDP per capita increases the odds of being a current smoker by at least 2.5%, and potentially considerably more. Our analyses also suggest a relationship between the distribution of incomes and youth smoking: youth from countries with more unequal distributions of income tend to have higher odds of currently smoking.

Conclusions

There is a positive association between gross domestic product and the odds of a young person in a low- and middle-income country being a current smoker. Given the causal links between smoking and a wide range of youth morbidities, the association between smoking and income inequality may underlie a substantial portion of the health disparities observed that are currently experiencing rapid economic growth.

Ancillary