Abstract
The original four-stage model of the cigarette epidemic has been extended with diffusion of innovations theory to reflect socio-economic differences in cigarette use. Recently, two revisions of the model have been proposed: (1) separate analysis of the epidemic stages for men and women, in order to improve generalization to developing countries, and; (2) addition of a fifth stage to the smoking epidemic, in order to account for the persistence of smoking in disadvantaged social groups. By developing a cohort perspective spanning a 35-year time period in France and the USA, we uncover distinctive features which challenge the currently held vision on the evolution of smoking inequalities within the framework of the cigarette epidemic. We argue that the reason for which the model may not be fit to the lower educated is that the imitation mechanism underlying the diffusion of innovations works well with regard to adoption of the habit, but is much less relevant with regard to its rejection. Based on those observations, we support the idea that the nature and timing of the epidemic differs enough to treat the stages separately for high and low education groups, and discuss policy implications.
Highlights
We observe in the United States a somewhat parallel decline in the two educational groups, the cigarette epidemic modelasfits the experience of higher education well, and with a relatively stable absolute difference, opposed to a divergent evolutiongroups in France, with an perhaps applies to most of the population, it does not represent the experience of all groups
The while the prevalence among men and evolveofsimilarly during the past decades, cigarette epidemic model fits thewomen experience higher education groups well, and they sharply diverge according to educational level, which supports the idea that education perhaps applies to most of the population, it does not represent the experience of all groups
High education groups have already advanced to the final stage of the rejection becoming in turn an innovative behavior in its own right that diffuses based on cigarette epidemic in many including and prevention the United[17]
Summary
In order to further investigate the model along those lines, we examine patterns of change in smoking in different educational categories from successive cohorts. For the purpose of attaining a certain degree of generality, we consider two countries, the United States and France, which widely differ in the timing of the cigarette epidemic. Sales of manufactured cigarettes peaked in 1963 in the United States as opposed to 1985 in France [14]. Given this two-decade lag and the greater maturity of the epidemic in the United States, we may expect the least educated to be much more advanced in their imitation of the rejection of smoking of the higher educated in the United States than in France. The questions are: considering prolonged periods of time, how did the smoking habits of the lower educated and those of the higher educated evolve over cohorts? How did those patterns depart from the expectations defined by the epidemic model? What theoretical and policy implications might follow from divergence of results from the model?
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