Abstract
Introduction: The social inequality in smoking in the Western countries has been increasing. It has been suggested that the most important strategy to reduce health inequalities related to socio economic status (SEP) is to promote smoking cessation in persons with low SEP. One could fear that a smoking cessation intervention might benefit smokers with high SEP more, and thereby increase the social inequality in smoking. We wanted to investigate whether the effect differed across SEP. Methods: The study was an individual multi-factorial lifestyle intervention study with a control group, Inter99 (1999-2006), Copenhagen, Denmark. We included 1991 daily-smokers with self-reported information on education in the intervention group, and 1135 in the control group. Smokers in the intervention group were repeatedly offered individual life-style-counselling and group-based smoking cessation. We used generalised linear mixed models under the assumption of missing at random, including interaction term between intervention effect and SEP. Results: The gap in self-reported abstinence rates increased over time between persons with high and low education. Probability of abstinence was significantly higher in the intervention group than in the control group, at all follow-up-visits but the effect of the intervention changed over time. The differences in quit-rates across educational groups were not significantly different in the intervention than in the control group at any time. Conclusion: In this randomised population-based intervention study we found that smokers across all educational levels benefited from the anti-smoking intervention, and that the intervention did not increase the social inequality in smoking, as one could have feared.
Highlights
The social inequality in smoking in the Western countries has been increasing
Our hypothesis is that the intervention did not increase the social inequality in smoking
At five-year follow-up, smokers with low education in the intervention group reported to quit at the higher rates than smokers with moderate education in the control group
Summary
The social inequality in smoking in the Western countries has been increasing. It has been suggested that the most important strategy to reduce health inequalities related to socio economic status (SEP) is to promote smoking cessation in persons with low SEP. One could fear that a smoking cessation intervention might benefit smokers with high SEP more, and thereby increase the social inequality in smoking. Conclusion: In this randomised population-based intervention study we found that smokers across all educational levels benefited from the anti-smoking intervention, and that the intervention did not increase the social inequality in smoking, as one could have feared. The study suggests that the most important strategy to reduce health inequalities related to social position is to promote smoking cessation in persons with low social position. The social inequality in smoking in the Western countries has been increasing in the last decades [5,6,7,8,9] and an English report (Securing good health for the whole population) concluded “We do not know what messages and interventions work to get lower socioeconomic groups to stop smoking” [10]. In the worst case a strategy could have the opposite effect, and increase the social inequality in smoking
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