Health & Medical Public Health

Parental Smoking and Child Poverty

Parental Smoking and Child Poverty

Methods


Our analyses combined findings from several national surveys, taking the most recent available at the time of the study, to estimate the number of children living in relative poverty by household structure; apply smoking prevalence data to estimate the number of children living in poor households containing smokers; and then estimate the expenditure of typical smokers in these households on tobacco. Finally we estimated the numbers of children drawn into poverty if expenditure on smoking is subtracted from household income. Where published survey sources did not provide data broken down into the required level of detail we used conservative assumptions to generate estimates. The study used publically available data and ethics approval and participant consent were therefore not required.

Definition of Poverty


Poverty was defined as living in a household with an equivalised net household income before housing costs (BHC) below 60% of the median equivalised net household income. Equivalised income is the sum of income after deductions of income tax, employee and self-employed national insurance contributions and council tax for all household members, rescaled to allow for household composition, to reflect the fact that larger households need more income to maintain the same standard of living. The data were equivalised using the modified OECD equivalence scale, using an adult couple with no children as the reference point. In 2011/12 the median equivalised household income per week was £427 BHC. Poverty was therefore defined as an equivalised income BHC of £256 or less.

Numbers of Children in Poverty


We estimated numbers of children in poverty by household composition using data from the Department for Work and Pensions' 2012 Households Below Average Income (HBAI) report. This draws on data from approximately 20,000 households in the Family Resources Survey and provides estimates of the number of all children broken down by parental marital status, and the percentage of those children living in poverty. We combined these figures with data from the report on the proportion of poor households with one, two, or three or more children (calculated as 25%, 39% and 36% respectively) to estimate the number of children living in poverty by parental marital status and family size. A worked example of these calculations is provided in Additional file 1 http://www.biomedcentral.com/1471-2458/15/507/additional. In the HBAI report children are defined as those under 16, and those aged 16–19 who are dependent (living with parents and in full time education or in unwaged government training).

Since the HBAI report does not provide data on the proportions of single parents who are male and female, we used estimates of these proportions (9% and 91% respectively) from the Office for National Statistics' (ONS) 2012 Families and Household survey to calculate the number of children living in poor households with a single mother and a single father.

Smoking Prevalence in Poor Households


To estimate the proportion of children in poverty with one or more parents who smoke, we first estimated parental smoking prevalence in these households using data from the 2012 Opinions and Lifestyle Survey. Since the survey reports do not present smoking prevalence by poverty status, and no other relevant survey data were available, we made the conservative assumption that smoking prevalence in households in poverty would be the same as that in households in the routine and manual occupational socio-economic group. The prevalence of smoking among men and women in routine and manual occupations in Britain in 2012 was 33% and 32% respectively. In fact these figures are highly likely to underestimate smoking prevalence among the poor, as among unemployed people the prevalence is substantially higher (39% in 2012).

Since the 2012 Opinions and Lifestyle survey indicated that smoking rates vary by marital status as well as socioeconomic group, we weighted the estimates of smoking prevalence in routine and manual groups by marital status. The survey estimated that while smoking prevalence in the general adult population was 20%, in adults who were single, married or cohabiting the rates were 27%, 14% and 33% respectively (these figures were not available by sex or socio-economic group). We therefore weighted smoking prevalence in men and women in relation to these figures to estimate smoking prevalence in low socioeconomic status adults by sex and marital status (see Table 1).

Number of Children in Poverty by Smoking Parental Marital Status and Number of Children in Household


These weighted smoking rates were then applied to estimate the number of children in poverty with smoking parents. For single parent households, we simply applied the smoking rates estimated for single men and women to the number of children in these households. This gave us an estimate of the number of children in poverty living with a smoking single mother or father. For two parent households, we needed to estimate how many contained one smoker and how many contained two. We therefore combined the prevalence data with estimates from an existing study of smoke-free homes and secondhand smoke exposure in children in England by Jarvis et al. This study included a nationally representative sample of 13,365 children, including 695 in 2007 on which our estimates were based. While a more recent estimate based on a larger sample from the whole of the UK would have be preferable, this estimate was the only suitable one available to us, and is likely to be reasonably representative of the whole of the UK. From this we calculated that among parents who smoked in two parent households, 65% were the only smokers, and 35% lived with an adult who also smoked. A worked example of our calculations of the number of children with smoking parents is provided in Additional file 1 http://www.biomedcentral.com/1471-2458/15/507/additional.

The Cost of Smoking in Poor Households


We estimated the average weekly cost of smoking to poor households by combining data on the number of cigarettes smoked per day by routine and manual workers for men and women with typical costs for manufactured cigarettes and hand rolling tobacco (HRT), both licit and illicit.

Opinions and Lifestyle Survey data indicate that on average, female and male routine and manual workers smoke 12 and 13 cigarettes per day respectively. We estimated the number of packets of 20 cigarettes purchased by low-income manufactured cigarette smokers per week by multiplying the number of cigarettes smoked per day by seven, and dividing by 20; and the number of packets of HRT purchased by low-income HRT smokers per week in the same way, but with the assumption that 50 grams of HRT typically makes approximately 100 cigarettes.

To estimate the average weekly spend on manufactured cigarettes and HRT, we combined our estimated weekly quantities purchased with 2012 Tobacco Manufacturers' Association (TMA) data. This indicates that the average cost of a licit packet of 20 cigarettes was £7.72, and of 50 g HRT £16.11, and that illicit tobacco typically sold for half the price of licit products.

The proportion of type of cigarettes smoked by sex and age was obtained from the OPN (Opinions and Lifestyle Survey). To make calculations more straightforward, smokers that smoked both packeted cigarettes and HRT were added on to the category they mostly smoked.

In the UK it is estimated that 73% of female and 59% of male smokers smoke mainly manufactured cigarettes (66% of women smoke only packeted, and 6% also smoke HRT, but mainly packeted. 52% of men smoke only packeted, and 7% also smoke HRT but mainly packeted). HMRC estimates that 7% of packeted cigarettes smoked are illicit, as well as 35% of HRT. Based on these figures, we estimated the proportion of smokers purchasing each type of tobacco (licit packeted, licit HRT, illicit packeted, illicit HRT), and hence the overall average spend on tobacco products.

It should be noted that our estimate is likely to be an overestimate if cheaper licit products, illicit and hand-rolled tobacco are disproportionately consumed by those in poverty.

Effect on Poverty Rates of Subtracting Tobacco Expenditure From Household Income


We estimated the number of children effectively drawn into poverty if parental expenditure on tobacco is subtracted from household income. We calculated how many children are living in a household where the income is above 60% of the median income, but by less than the average spend on tobacco.

The HBAI report provides data on households living between 60% and 70% of the median income; i.e. those living just above the poverty line. We first calculated the number of children who are living in households between 60% and 70% of the median income. We then applied the same method used to calculate the number of children in poverty with smoking parents described above, to estimate the number of children in households between 60% and 70% of the median income with one or two smoking parents.

We calculated the low income thresholds for these income groups for different household structures, which showed that the income difference between these income groups was similar to the average weekly expenditure on tobacco for two smokers calculated in the previous step. We therefore assumed that all children in two-smoker households with a household income between 60% and 70% of the median income would be drawn into effective poverty. Because the spread of the population living between 60% and 70% of the equivalised median is fairly even, we also assumed that half of all children between these thresholds with one smoking parent in two-parent households, or one smoking parent in a one-parent household, would be drawn into effective poverty.



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