Huisman M, Kunst AE, Mackenbach JPEducational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 14: 106-113

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
Tobacco control (Impact Factor: 5.93). 05/2005; 14(2):106-13. DOI: 10.1136/tc.2004.008573
Source: PubMed


To determine those groups who are at increased risk of smoking related diseases, we assessed in which male and female generations smoking was more prevalent among lower educated groups than among the higher educated, in 11 European countries.
Cross sectional analysis of data on smoking, covering the year 1998, from a social survey designed for all member states of the European Union.
Higher and lower educated men and women aged 16 years and older from 11 member states of the European Union.
Age standardised prevalence rates by education and prevalence odds ratios of current and ever daily smoking comparing lower educated groups with higher educated groups.
A north-south gradient in educational inequalities in current and ever daily smoking was observed for women older than 24 years, showing larger inequalities in the northern countries. Such a gradient was not observed for men. A disadvantage for the lower educated in terms of smoking generally occurred later among women than among men. Indications of inequalities in smoking in the age group 16-24 years were observed for all countries, with the exception of women from Greece and Portugal.
Preventing and reducing smoking among lower educated subgroups should be a priority of policies aiming to reduce inequalities in health in Europe. If steps are not taken to control tobacco use among the lower educated groups specifically, inequalities in lung cancer and other smoking related diseases should be anticipated in all populations of the European Union, and both sexes.

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    • "Probability of smoking initiation is higher in people with low education while probability of quitting smoking is higher in highly educated people [7–12]. Educational inequalities in smoking habits affect both sexes in Northern Europe, while they are apparently restricted to men in Southern Europe [7]: however, recently the prevalence of current smokers has been reported to decrease with increasing educational level both in Italian men and women, although the trend was significant only in men [13]. As regards occupation, blue collars and unemployed have a higher risk of starting smoking and a lower risk of quitting than white collars [14–17]. "
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    ABSTRACT: Background Socioeconomic inequalities in smoking habits have stabilized in many Western countries. This study aimed at evaluating whether socioeconomic disparities in smoking habits are still enlarging in Italy and at comparing the impact of education and occupation. Methods In the frame of the GEIRD study (Gene Environment Interactions in Respiratory Diseases) 10,494 subjects, randomly selected from the general population aged 20–44 years in seven Italian centres, answered a screening questionnaire between 2007 and 2010 (response percentage = 57.2%). In four centres a repeated cross-sectional survey was performed: smoking prevalence recorded in GEIRD was compared with prevalence recorded between 1998 and 2000 in the Italian Study of Asthma in Young Adults (ISAYA). Results Current smoking was twice as prevalent in people with a primary/secondary school certificate (40-43%) compared with people with an academic degree (20%), and among unemployed and workmen (39%) compared with managers and clerks (20-22%). In multivariable analysis smoking habits were more affected by education level than by occupation. From the first to the second survey the prevalence of ever smokers markedly decreased among housewives, managers, businessmen and free-lancers, while ever smoking became even more common among unemployed (time-occupation interaction: p = 0.047). At variance, the increasing trend in smoking cessation was not modified by occupation. Conclusion Smoking prevalence has declined in Italy during the last decade among the higher socioeconomic classes, but not among the lower. This enlarging socioeconomic inequality mainly reflects a different trend in smoking initiation.
    Full-text · Article · Aug 2014 · BMC Public Health
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    • "While prevalence mixes initiation and cessation, measures of the age of initiation capture additional information on timing. Cross-national studies of smoking typically rely on education as a measure of socioeconomic position (Cavelaars et al., 2000; Giskes et al., 2005; Huisman et al., 2005), as education more strongly predicts smoking than income or occupation (Barbeau et al., 2004). "
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    ABSTRACT: This study investigates the evolution of educational disparities in smoking uptake across cohorts for men and women in three countries. Nationally representative surveys of adults in France, Germany and the United States in 2009-2010 include retrospective measures of age of uptake that are compared for three cohorts (born 1946-1960, 1961-1975, and 1976-1992). Discrete logistic regressions and a relative measure of education are used to model smoking histories until age 34. The following patterns are found: a strengthening of educational disparities in the timing of uptake from older to younger cohorts; an earlier occurrence of the strengthening for men than women and for the United States than France or Germany; a faster pace of the epidemic in France than in the United States, and; a divide between the highest level of education and the others in the United States, as opposed to a gradient across categories in France. Those differences in smoking disparities across cohorts, genders and countries help identify the national and temporal circumstances that shape the size and direction of the relationship between education and health and the need for policies that target educational disparities.
    Full-text · Article · Jul 2014 · Social Science & Medicine
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    • "Our study supports previous research finding that tobacco smoking in general is strongly associated with low socioeconomic status (SES) [39], consequently increasing the health inequalities between people with high and low education and high and low incomes. We found that having less than high school as highest education level was associated with a four-fold higher risk of smoking before pregnancy. "
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    ABSTRACT: Background Some women continue smoking during pregnancy despite the extensive information available on the dangers smoking poses to their fetus. This study aimed to examine the prevalence and determinants of smoking before and during pregnancy and the extent of smoking during pregnancy from a European perspective in relation to maternal sociodemographic characteristics, health literacy, morbidity, and pregnancy-related factors. Methods This multinational, web-based study evaluated pregnant women and new mothers in 15 European countries recruited from October 2011 to February 2012. Data were collected via an anonymous online questionnaire. Results Of 8344 women included, 2944 (35.3%) reported smoking before pregnancy, and 771 (26.2%) continued smoking during pregnancy, 88 (11.4%) of whom smoked more than 10 cigarettes per day. There was a wide variation among the 15 European countries in smoking rates before and during pregnancy, ranging from 25.0% (Sweden) to 50.0% (Croatia) before and 4.2% (Iceland) to 18.9% (Croatia) during pregnancy. Women who lived in Eastern Europe, without a spouse/partner, with a low education level and unplanned pregnancy, who did not take folic acid, and consumed alcohol during pregnancy were the most likely to smoke before pregnancy. Women who lived in Eastern or Western Europe, without a spouse/partner, with a low education level and health literacy, being a housewife, having previous children and unplanned pregnancy, and who did not take folic acid were the most likely to continue smoking during pregnancy. Women who smoked more than 10 cigarettes per day during pregnancy were the most likely to be living in Eastern Europe and to have a low education level. Conclusion Women with fewer resources living in Western or Eastern Europe are more likely not only to smoke before pregnancy but also to continue smoking during pregnancy. These high-risk women are characterized as living alone, having high school or less as highest education level, having low health literacy, being a housewife, having previous children, having unplanned pregnancy, and no use of folic acid. Our findings indicated that focus on smoking cessation is important in antenatal care in Europe as many women smoke before pregnancy, and still continue to do so in pregnancy.
    Full-text · Article · Jun 2014 · BMC Pregnancy and Childbirth
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