The Impact of Education on Tobacco Use and Alcohol Consumption in the Dominican Republic: A Social Gradient Perspective

Education represents a permanent indicator of socio-economic status and may explain smoking and drinking behaviors. We assessed the relationship between educational attainment, tobacco use, alcohol consumption, and concurrent use among adults in the Dominican Republic (DR), and explored differentials by gender and residential location. We analyzed data from 59,565 Dominicans, aged 15 to 59 years, collected by the Demographic and Health Surveys (DHS) in 2007. Descriptive statistics and logistic regression were calculated. Regression models included gender and residential location. High educational attainment decreased the likelihood of smoking (OR=0.22, 95%CI 0.19-0.26) compared to no education (p<0.001), but increased the likelihood of consuming alcohol (OR=3.08, 95%CI 2.75-3.45; p<0.001). Higher education was protective for concurrent use (OR=0.63, 95%CI 0.51-0.77; p<0.001). Women were less likely than men to smoke (OR=0.64, 95%CI 0.59- 0.68) and to consume alcohol (OR=0.30, 95%CI 0.28-0.31). Compared to the general population, individuals at the sugar cane plantations were more likely to smoke (OR=1.23, 95%CI 1.08-1.41; p<0.001). In conclusion, there was a social gradient in tobacco use that mainly affects men and bateyes residents. The alcohol-related social gradient was reversed, but still affected men more than women. Gender specific, social class targeted interventions are needed to reduce tobacco and alcohol use in the DR.