Socioeconomic differences in nicotine exposure and dependence in adult daily smokers

BMC Public Health. 2019 Apr 3;19(1):375. doi: 10.1186/s12889-019-6694-4.


Background: Socioeconomic status (SES) is a major determinant of tobacco use but little is known whether SES affects nicotine exposure and the degree of nicotine dependence.

Methods: The Pennsylvania Adult Smoking Study is a cross-sectional study of smoke exposure and nicotine dependence among adults conducted in central Pennsylvania between June 2012 and April 2014. The study included several measures of SES, including assessments of education and household income, as well as occupation, home ownership, health insurance, household density and savings accounts. Measurements included saliva for the nicotine metabolites cotinine (COT), 3-'hydroxycotinine (3HC) and total metabolites (COT +3HC). Puffing behavior was determined using portable smoking topography devices.

Results: The income levels of lighter smokers (< 20 cigarettes per day) was $10,000 more than heavier smokers. Higher Fagerström Test for Nicotine Dependence scores were associated with lower income and job status, scores ranged from 5.4 in unemployed, 4.4 in blue-collar, and 3.8 in white-collar workers. In principal components analysis used to derive SES indicators, household income, number in household, and type of dwelling were the major SES correlates of the primary component. Job category was the major correlate of the second component. Lower SES predicted significantly higher adjusted total nicotine metabolite levels in the unemployed group. Job category was significantly associated with total daily puffs, with the highest level in the unemployed, followed by blue-collar workers, after adjustment for income.

Conclusions: Among smokers, there was a relationship between lower SES and increased nicotine dependence, cigarettes per day and nicotine exposure, which varied by job type.

Keywords: Cotinine; Income; Occupations; Principal components analysis; Tobacco use disorder.

MeSH terms

  • Adult
  • Cotinine / analogs & derivatives
  • Cotinine / analysis
  • Cross-Sectional Studies
  • Data Collection
  • Employment*
  • Female
  • Humans
  • Income
  • Male
  • Middle Aged
  • Nicotine / analysis*
  • Occupations*
  • Pennsylvania / epidemiology
  • Saliva / chemistry
  • Smoke / analysis
  • Smokers
  • Smoking* / epidemiology
  • Social Class*
  • Tobacco Products
  • Tobacco Use
  • Tobacco Use Disorder* / epidemiology


  • Smoke
  • hydroxycotinine
  • Nicotine
  • Cotinine