Rethinking exposure in area studies on social inequities in smoking in youth and young adults

Abstract

Smoking is the main modifiable cause of premature death worldwide. It is also increasingly concentrated in younger age groups, lower social classes and deprived geographic areas. These social inequities in smoking are intrinsically unfair and have major implications for public health. As such, they must be addressed, but a better understanding of how social inequities in smoking in youth and young adults come about and could be reduced must first be sought. Part of the answer could lie in characteristics of the areas to which people are exposed. In this chapter, we review the literature on area effects and social inequities in smoking in youth and young adults. We highlight two main limitations of contemporary research and interventions: (1) the narrow focus on single, mainly residential areas, rather than multiple life environments and (2) the lack of research on the differential effect of area-level interventions on smoking across social groups. We conclude by introducing a health promotion perspective which could contribute to furthering the study of area-level influences on social inequities in smoking in youth and young adults. This perspective involves two key principles: the view that health is produced in everyday life environments, where people live, work, study and play, and the explicit focus on equity. This perspective is integrated in an ongoing research project which will be presented for illustrative purposes. As a subcomponent of the Interdisciplinary Study on Inequalities in Smoking (ISIS), the ISIS-Activity Space project explores the influence of area-level exposures measured within multiple life environments, which together form the activity space, on social inequities in smoking in a sample of young adults residing in areas of varied deprivation levels in Montreal, Canada.