Do socio-economic gradients in smoking emerge differently across time by gender? Implications for the tobacco epidemic from a pregnancy cohort in California, USA

Understanding current patterns of population smoking by socioeconomic position (SEP) can be substantially enhanced by research that follows birth cohorts over long periods of time, yet such data in the US are rare. Information from birth cohorts followed during critical time periods when the health consequences of smoking became widely known can inform the ways in which current smoking prevalence has been shaped by the historical processes that preceded it. The present study utilizes data from a substudy of the Child Health and Development Study pregnancy cohort (N=1612). Women were queried about smoking status in 1959–1962, 1971–1972 and 1977–1980. Women were divided into three cohorts based on date of birth. Offspring represented another birth cohort assessed for smoking in 1977–1980. Results indicated that the overall prevalence of smoking exhibited cohort-specific patterns that persisted across time. Notably, the youngest maternal cohort (born 1937–1946) had high smoking prevalence throughout and showed no appreciable decrease (44.7%, 41.4%, 40.1% for 1959–1962, 1971–1972, and 1977–1980). Results also indicated that the relation of smoking to SEP exhibited cohort-specific patterns over time. Among the oldest birth cohort (born 1914–1930), no inverse relation of SEP to smoking was observed at any time; in contrast, an inverse relation emerged by 1959–1962 among the youngest cohort of mothers. Among the adolescent offspring, there was a strong SEP gradient (OR=2.0, 95% CI=1.4–3.0) that was stronger than in any maternal birth cohort at any assessment (β=0.40, SE=0.1, p<0.01). We conclude that SEP gradients in smoking emerge across birth cohorts rather than time alone, with increasingly strong gradients across time especially among younger cohorts.