Cigarette Smoking and All-Cause and Cause-Specific Adult Mortality in the United States

This study illuminates the association between cigarette smoking and adult mortality in the contemporary United States. Recent studies have estimated smoking-attributable mortality using indirect approaches or with sample data that are not nationally representative and that lack key confounders. We use the 1990–2011 National Health Interview Survey Linked Mortality Files to estimate relative risks of all-cause and cause-specific mortality for current and former smokers compared with never smokers. We examine causes of death established as attributable to smoking as well as additional causes that appear to be linked to smoking but have not yet been declared by the U.S. Surgeon General to be caused by smoking. Mortality risk is substantially elevated among smokers for established causes and moderately elevated for additional causes. We also decompose the mortality disadvantage among smokers by cause of death and estimate the number of smoking-attributable deaths for the U.S. adult population ages 35+, net of sociodemographic and behavioral confounders. The elevated risks translate to 481,887 excess deaths per year among current and former smokers compared with never smokers, 14 % to 15 % of which are due to the additional causes. The additional causes of death contribute to the health burden of smoking and should be considered in future studies of smoking-attributable mortality. This study demonstrates that smoking-attributable mortality must remain a top population health priority in the United States and makes several contributions to further underscore the human costs of this tragedy that has ravaged American society for more than a century.     

Birth outcome, not pregnancy process: Reply to van der Veen

In a recent article (Frisbie. Forbes. and Pullum 1996) we documented racial/ethnic differences in birth outcomes according to a more fine-grained classification than has typically been employed in the demographic literature. In his commentary, van der Veen focuses on the measurement of one of the dimensions of that classification, maturity of the infant. as proxied by the fetal growth ratio. The crux of the critique is easily seen in van der Veen's statement that “all of my disagreements with Frisbie et al. 's method arise from their particular use of a postnatal standard for the assessment of intrauterine growth.” Our critic misunderstands our objective: He fails to realize our interest in birth outcome, not pregnancy process, and does not perceive that our intent was to extend the research extant in both the demographic and public-health literatures in which patently postnatal (i.e., ex utero) measures are taken as outcomes interesting in their own right and/or as risk factors for infant mortality and infant and childhood morbidity. Specifically, he does recognize that we purposefully expanded our focus to include moderately compromised births to determine if they were at higher risk than the normal births with whom they are conventionally categorized. Our discussion draws on research cited in the original article, on studies cited by our critic, and on a few more recent investigations. Although we have never argued that ours is the only, or even the best, approach in all cases, we try to clarify the rationale for, and adduce additional empirical evidence of, the utility of the method we used.     

The Importance of Spousal Education for the Self-Rated Health of Married Adults in the United States

Education’s benefits for individuals’ health are well documented, but it is unclear whether health benefits also accrue from the education of others in important social relationships. We assess the extent to which individuals’ own education combines with their spouse’s education to influence self-rated health among married persons aged 25 and older in the United States (N = 337,846) with pooled data from the 1997–2010 National Health Interview Survey. Results from age- and gender-specific models revealed that own education and spouse’s education each share an inverse association with fair/poor self-rated health among married men and women. Controlling for spousal education substantially attenuated the association between individuals’ own education and fair/poor self-rated health and the reduction in this association was greater for married women than married men. The results also suggest that husbands’ education is more important for wives’ self-rated health than vice versa. Spousal education particularly was important for married women aged 45–64. Overall, the results imply that individuals’ own education and spousal education combine to influence self-rated health within marriage. The results highlight the importance of shared resources in marriage for producing health.     

Access to Healthcare Among Working‐Aged Hispanic Adults in the United States*

Objectives. The purpose of this research is to examine differences in access to and sources of healthcare for working‐aged adults among major Hispanic subpopulations of the United States. Nativity, duration in the United States, citizenship, and sociodemographic factors are considered as key predictors of access to and sources of care. Methods. Using pooled National Health Interview Surveys from 1999–2001, logistic and multinomial logistic regression models are estimated that compare Mexican Americans, Puerto Ricans, Cuban Americans, and other Hispanics with non‐Hispanic blacks and non‐Hispanic whites. Results. Mexican Americans, Puerto Ricans, and other Hispanics display significantly less access to care than non‐Hispanics whites, with immigrant status and socioeconomic status variables accounting for some, but not all, of the differences. For sources of care, Mexican‐American, Puerto Rican, and other Hispanic adults were all much more likely than non‐Hispanic whites to report clinics or emergency rooms as their source of regular care. Conclusions. There are wide differences in access to and sources of care across racial and ethnic groups in the United States. Mexican‐American adults, regardless if born in Mexico or the United States, appear to be most in need of access to regular and high‐quality care. Naturalization may be an especially important factor in greater access to regular and high‐quality care for Hispanic immigrants.     

Black-White Differentials in Adult Homicide Mortality in the United States

Objective . This article examines individual level black-white differences in adult homicide mortality. Homicide is a major social problem and a central cause of preventable death in the United States. A homicide not only claims one life prematurely but can also devastate a family, friends, and a neighboring community. Methods . We link eight consecutive years of the National Health Interview Survey (1987–94) to the Multiple Cause of Death file through the National Death Index (1987–97), and use Cox proportional hazard models to examine the role of social factors in black-white homicide mortality in the United States. Results . We find that individual level sociodemographic characteristics—age, sex, marital status, education, employment status, and geographic factors—explain almost 35 percent of the racial differences in homicide mortality. Conclusions . These results demonstrate the contributions that National Center for Health Statistics data can make to criminological literature and reveal the mechanisms through which blacks experience higher homicide mortality than whites. Such illumination may lead to a reduction in the fourth leading preventable cause of death in the United States.     

Educational Attainment and Adult Mortality in the United States: A Systematic Analysis of Functional Form

A vast literature has documented the inverse association between educational attainment and U.S. adult mortality risk but given little attention to identifying the optimal functional form of the association. A theoretical explanation of the association hinges on our ability to describe it empirically. Using the 1979–1998 National Longitudinal Mortality Study for non-Hispanic white and black adults aged 25–100 years during the mortality follow-up period (N = 1,008,215), we evaluated 13 functional forms across race-gender-age subgroups to determine which form(s) best captured the association. Results revealed that the preferred functional form includes a linear decline in mortality risk from 0 to 11 years of education, followed by a step-change reduction in mortality risk upon attainment of a high school diploma, at which point mortality risk resumes a linear decline but with a steeper slope than that prior to a high school diploma. The findings provide important clues for theoretical development of explanatory mechanisms: an explanation for the selected functional form may require integrating a credentialist perspective to explain the step-change reduction in mortality risk upon attainment of a high school diploma, with a human capital perspective to explain the linear declines before and after a high school diploma.     

Racial/Ethnic and Nativity Patterns of U.S. Adolescent and Young Adult Smoking

We document racial/ethnic and nativity differences in U.S. smoking patterns among adolescents and young adults using the 2006 Tobacco Use Supplement to the Current Population Survey (n = 44,202). Stratifying the sample by nativity status within five racial/ethnic groups (Asian American, Mexican–American, other Hispanic, non-Hispanic black, and non-Hispanic white), and further by sex and age, we compare self-reports of lifetime smoking across groups. U.S.-born non-Hispanic whites, particularly men, report smoking more than individuals in other racial/ethnic/nativity groups. Some groups of young women (e.g., foreign-born and U.S.-born Asian Americans, foreign-born and U.S.-born Mexican–Americans, and foreign-born blacks) report extremely low levels of smoking. Foreign-born females in all of the 25–34 year old racial/ethnic groups exhibit greater proportions of never smoking than their U.S.-born counterparts. Heavy/moderate and light/intermittent smoking is generally higher in the older age group among U.S.-born males and females, whereas smoking among the foreign-born of both sexes is low at younger ages and remains low at older ages. Taken together, these findings highlight the importance of considering both race/ethnicity and nativity in assessments of smoking patterns and in strategies to reduce overall U.S. smoking prevalence and smoking-attributable health disparities.     

Differential mortality risks from violent causes for foreign- and native-born residents of the USA

This paper examines the differences in adult violent causes (homicide, suicide, vehicle accidents, and otheraccidents) for mortality risks between the Americanforeign- and native-born adult populations, whileconsidering the length of time lived in the USA and the influences of other socio-demographic characteristics. Data came from the National Health InterviewSurvey-National Death Index linked file for the years1989--1995. Cox proportional hazards modelsestimate the association between nativity, length ofstay, and mortality risk for each violent cause. Theresults show that foreign-born persons differ in their risks of violent death vis-á-vis the native-bornpopulation by the amount of the time they have livedin the USA. In particular, recent immigrants (lessthan 15 years) display higher risks fromhomicide, lower risks from suicide, and lower risksfrom other accidents (not vehicle) than thenative-born individuals. This pattern is differentfor longer-term immigrants (15 or more years) whohave, for the most part, similar risks from othercauses of violent death compared to native-bornresidents. The findings suggest that there arecompositional differences between immigrants by length of stay and that the process of acculturation mayinclude the amplification or diminution of risks ofvarious causes of violent death.