Document Type: Original Article


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


Background and aims: Minorities’ Diminished Returns (MDRs) refer to the smaller effects of
educational attainment for ethnic minorities compared to the majority group. As a result of MDRs,
research has documented more than expected tobacco use among Hispanics and African Americans
(AAs) with high educational attainment. In theory, some of this increased risk may be due to lower
tobacco harm knowledge. Accordingly, the present study compared ethnic groups for the association
between educational attainment and tobacco harm knowledge among American adults in order to
better understand a potential mechanism behind MDRs of educational attainment on tobacco use of
Hispanics and AAs.
Methods: The current cross-sectional study used baseline data of 27,405 adults, which were obtained
from the Population Assessment of Tobacco and Health (2013) study a nationally representative survey
in the United States. The independent and dependent variables were educational attainment and
tobacco harm knowledge, respectively. In addition, age, gender, employment, and poverty status were
the covariates and ethnicity was the moderator. Finally, linear regression was used to analyze the data.
Results: Educational attainment was inversely associated with tobacco harm knowledge in the pooled
sample (b = 0.11, 95% CI = 0.09 - 0.13). Ethnicity showed a statistically significant interaction with
educational attainment (b = -0.05, 95% CI = -0.10 - 0.00 for AAs and b = -0.14, 95% CI = -0.19 - -0.09
for Hispanics versus non-Hispanics), suggesting that the effect of educational attainment on tobacco
harm knowledge was smaller for Hispanics and AAs compared to non-Hispanics and Whites.
Conclusion: In general, although high educational attainment increases tobacco harm knowledge,
highly educated Hispanics and AAs still report a disproportionately low level of tobacco harm
knowledge. Eventually, the MDRs of educational attainment on tobacco harm knowledge may explain
why highly educated Hispanics remain at high risk of tobacco use.