Educational Attainment and Tobacco Harm Knowledge Among American Adults: Diminished Returns of African Americans and Hispanics

Int J Epidemiol Res. Winter 2020;7(1):


Background and objectives: Minorities' Diminished Returns (MDRs) refer to the smaller effects of educational attainment for ethnic minorities compared to the majority group. As a result of MDRs, research has documented more than expected tobacco use among Hispanics and African Americans (AAs) with high educational attainment. In theory, some of this increased risk may be due to lower tobacco harm knowledge. Accordingly, the present study compared ethnic groups for the association between educational attainment and tobacco harm knowledge among American adults in order to better understand a potential mechanism behind MDRs of educational attainment on tobacco use of Hispanics and AAs.

Methods: The current cross-sectional study used baseline data of 27,405 adults, which were obtained from the Population Assessment of Tobacco and Health (2013) study, a nationally representative survey in the U.S. The independent and dependent variables were educational attainment and tobacco harm knowledge, respectively. In addition, age, gender, employment, and poverty status were the covariates, and ethnicity was the moderator. Finally, linear regression was used to analyze the data.

Results: Educational attainment was inversely associated with tobacco harm knowledge in the pooled sample (b = 0.11, 95% CI = 0.09 - 0.13). Ethnicity showed a statistically significant interaction with educational attainment (b = -0.05, 95% CI = -0.10 - 0.00 for AAs and b = -0.14, 95% CI = -0.19 - -0.09 for Hispanics versus non-Hispanics), suggesting that the effect of educational attainment on tobacco harm knowledge was smaller for Hispanics and AAs compared to non-Hispanics and Whites.

Conclusion: In general, although high educational attainment increases tobacco harm knowledge, highly educated Hispanics and AAs still report a disproportionately low level of tobacco harm knowledge. Eventually, the MDRs of educational attainment on tobacco harm knowledge may explain why highly educated Hispanics remain at high risk of tobacco use.

Keywords: Education; Ethnicity; Population groups; Smoking; Socioeconomic position; Socioeconomic status; Tobacco use.