Protective Effects of Educational Attainment Against Cigarette Smoking; Diminished Returns of Indian Americans and Alaska Natives in the National Health Interview Survey (NHIS)

Document Type: Original Article


1 Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

2 Charles R Drew University


Background: Although educational attainment is protective against health risk behaviors such as smoking, Minorities’ Diminished Returns theory posits that these protective effects are smaller for ethnic minority than the majority groups.
Aims: compare the effects of educational attainment on smoking status of American Indian Alaska Native (AIAN) and White adults.
Methods: Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21114 individuals entered our analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator.
Results: Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that was suggestive that the protective effects of educational attainment against smoking is smaller for AIAN than Whites.
Conclusions: In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites. The result is additional risk of smoking in highly educated AIANs. To reduce ethnic disparities I tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.



Conflicts of Interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.



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