HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.083501v1 98/2/365    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Karter, A. J. Articles by Ettner, S. L. PubMed PubMed Citation Articles by Karter, A. J. Articles by Ettner, S. L. Related Collections Tobacco Control Diabetes Managed Care Prevention Socioeconomic Factors Smoking Cessation

Andrew J. Karter, PhD, Mark R. Stevens, MSPH, MA, Edward W. Gregg, PhD, Arleen F. Brown, MD, PhD, Chien-Wen Tseng, MD, David G. Marrero, PhD, O. Kenrik Duru, MD, Tiffany L. Gary, PhD, John D. Piette, PhD, Beth Waitzfelder, PhD, William H. Herman, MD, Gloria L. Beckles, MD, MSc, Monika M. Safford, MD and Susan L. Ettner, PhD

Andrew J. Karter is with the Division of Research, Kaiser Permanente, Oakland, Calif, and the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle. Mark R. Stevens, Edward W. Gregg, and Gloria L. Beckles are with the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga. Arleen F. Brown, O. Kenrik Duru, and Susan Ettner are with the Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles. Chien-Wen Tseng and Beth Waitzfelder are with the Pacific Health Research Institute, Honolulu, Hawaii. David G. Marrero is with the Indiana University Diabetes Research and Training Center, Indianapolis, Ind. Tiffany L. Gary is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. John D. Piette is with the Ann Arbor Veterans’ Affairs Medical Center and the University of Michigan, Ann Arbor. William H. Herman is with the Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical Center, Ann Arbor. Monika M. Safford is with the Deep South Center on Effectiveness, Birmingham Veterans Administration Medical Center, Birmingham, Ala, and the Department of Preventive Medicine, University of Alabama, Birmingham.

Correspondence: Requests for reprints should be sent to Andrew J. Karter, 2000 Broadway, Oakland, CA 94612 (e-mail: Andy.J.Karter{at}kp.org).

Objectives. We assessed educational disparities in smoking rates among adults with diabetes in managed care settings.

Methods. We used a cross-sectional, survey-based (2002–2003) observational study among 6538 diabetic patients older than 25 years across multiple managed care health plans and states. For smoking at each level of self-reported educational attainment, predicted probabilities were estimated by means of hierarchical logistic regression models with random intercepts for health plan, adjusted for potential confounders.

Results. Overall, 15% the participants reported current smoking. An educational gradient in smoking was observed that varied significantly (P<.003) across age groups, with the educational gradient being strong in those aged 25 to 44 years, modest in those aged 45 to 64 years, and nonexistent in those aged 65 years or older. Of particular note, the prevalence of smoking observed in adults aged 25–44 years with less than a high school education was 50% (95% confidence interval: 36% to 63%).

Conclusions. Approximately half of poorly educated young adults with diabetes smoke, magnifying the health risk associated with early-onset diabetes. Targeted public health interventions for smoking prevention and cessation among young, poorly educated people with diabetes are needed.