Abstract
BackgroundSouthern European countries were traditionally characterized by a higher prevalence of smoking among high socioeconomic groups. Though, recent studies show a reversal of inequalities in Italy and Spain, for example. We investigated whether this evolution also applied to Portugal by describing the evolution of socioeconomic inequalities in smoking between 1987 and 2006.MethodsWe used data from the four Portuguese national health interview surveys (N = 120,140) carried out so far. Socioeconomic status was measured by the educational and income levels of respondents. Socioeconomic inequalities were measured through Odds Ratios (OR), Relative Inequality Indexes (RII), and Concentration Indexes (CI) on being current, ever, and former smoker, adjusting for sex and age. Analyses were performed separately for men and women, and for different birth cohorts.ResultsAmong men, smoking was initially more concentrated in high-socioeconomic status individuals (RII = 0.84, 95% Confidence Intervals [95% CI] 0.76-0.93, 1987) but this pattern reversed in the last survey (RII = 1.49, 95% CI 1.34-1.65, 2005/6). Indeed, higher cessation rates were observed among high-socioeconomic groups among all respondents (RII = 0.89, 95% CI 0.84-0.95), coupled with higher initiation rates among the worse-off in younger cohorts (RII = 1.18, 95% CI 1.05-1.31, for youngest generation, 2005/6). Among women, the richer and more educated smoked more in all surveys (RII = 0.21, 95% CI 0.16-0.27, 2005/6), despite being also more likely to quit (RII = 0.41, 95% CI 0.30-0.55). The pattern among women evolved towards a reduction of inequality, which however remained favourable to the worse-off.ConclusionsInequalities have been increasingly unfavourable to the worse-off in Portugal, although better-off women are still more likely to smoke. Worrisome inequality trends have been observed among the youngest generations, which call for the rapid implementation of equity-oriented tobacco control policies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1664-y) contains supplementary material, which is available to authorized users.
Highlights
Southern European countries were traditionally characterized by a higher prevalence of smoking among high socioeconomic groups
Findings show that over the 1987–2006 period inequalities in smoking behaviour reversed for men, related to higher cessation rates among high socioeconomic groups in all surveys analysed coupled with higher initiation rates among low socioeconomic groups in the first three surveys, in younger cohorts (1960–1969)
Authors justify this pattern with the later emancipation of women and with the proximity to Southern European countries, where there is a higher acceptability of smoking among women, coupled with a conservative environment in low socioeconomic and rural groups [22]
Summary
Southern European countries were traditionally characterized by a higher prevalence of smoking among high socioeconomic groups. Recent studies show a reversal of inequalities in Italy and Spain, for example. We investigated whether this evolution applied to Portugal by describing the evolution of socioeconomic inequalities in smoking between 1987 and 2006. Male prevalence reaches a peak (around 50 to 80%) and prevalence among women increases rapidly. As the health hazards of tobacco become known, the third phase is characterized by a decrease in prevalence among men. This decrease is mainly explained by reduced prevalence among individuals with higher education, who are, for example, more influenced by health
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