Socioeconomic status and tobacco expenditure among Australian households: results from the 1998-99 Household Expenditure Survey.(Research Report)

J Epidemiol Community Health 2003;57:798-801

Objective: To investigate the relation between socioeconomic status (SES) and tobacco expenditure among Australian households.

Design and setting: Cross sectional study (The Household Expenditure Survey 1998-99) by the Australian Bureau of Statistics, based on a multi-stage national sample of 9682 households.

Participants: From selected households, all members aged 15 and over were interviewed.

Main results: Lower SES was associated with higher odds of reporting tobacco expenditure. Among smoking households, those from lower SES spent more of their funds on tobacco. For example, households headed by a person with no educational qualification spent 34% more on tobacco than those headed by a person with a university degree. Blue collar households spent 23% more than professional households. Percentage of total household expenditure on tobacco in the first income quintile was 62% more than that of households in the fifth quintile.

Conclusion: Antismoking interventions and policies that are specifically aimed at lower SES groups can potentially improve social equality. They can also ameliorate social inequalities in health, given that much of the SES differentials in morbidity and mortality are attributed to the pronounced SES gradient in smoking.

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Tobacco use is the largest single cause of mortality and morbidity in Australia. It is estimated to kill over 19 000 Australians each year and is responsible for about 10% of the entire national burden of disease and injury. (1) It is also associated with a diminution of household funds and lowered standards of living. In Australia, being a smoking household and, among smoking households, spending more on tobacco is strongly associated with an increased chance of experiencing financial stress. Even among high income households, smoking is shown to be a significant predictor of financial stress. (2) This association has also been observed internationally. (3-5)

There is solid evidence that lower socioeconomic status (SES) is associated with higher likelihood of smoking. (6-8) Not only individual level indicators of SES (for example, education, income and occupation) are related to smoking, but area level indicators of disadvantage are shown to be significant predictors of smoking, such that for example people living in disadvantaged neighbourhoods are more likely to be smokers, after controlling for relevant individual level factors. (6)

While the association of SES and smoking has been well established, SES variations in household expenditure on tobacco have received scant attention. It will be of concern if lower SES households, which already have limited financial resources, are more likely to report tobacco expenditure or spend a larger proportion of their funds on tobacco. My aim was to investigate the relation between SES and whether or not a household reported tobacco expenditure, using the 1998-99 Household Expenditure Survey in Australia. My aim was also to examine SES variations in amount spent on tobacco among smoking households.

METHODS

Sample

The 1998-99 Household Expenditure Survey conducted by the Australian Bureau of Statistics (ABS) provides detailed information on expenditure, income, and household characteristics of a national sample of 6892 households from private dwellings. (9) A stratified multistage area sample design was used in which collection districts were selected at the first stage, blocks at the second stage, and dwellings at the last stage. The strata were local government areas in capital cities, and major urban centres, minor urban, and rural parts in other regions. Data collection involved personal interviews and two week expenditure diaries distributed among all residents aged 15 and over from selected households. Response rate was 77%.

Measurement

Respondents were asked to report expenditure on tobacco in the past two weeks. For each household the dataset provided a single tobacco expenditure variable, which is the sum across household members. This was halved to represent weekly expenditure. About 92.5% of reported tobacco expenditure pertained to cigarettes, and nearly all to smoking tobacco. Six measures of socioeconomic status were used: income, education, occupation, unemployment, type of housing occupancy, and index of relative socioeconomic disadvantage (IRSD).

The sample was divided into quintiles of equivalent …