Abstract
BackgroundCigarette smoking is a major cause of health disparities. We aimed to determine social characteristics associated with smoking status and age at smoking initiation in the ethnically-diverse population of Israel.MethodsThis is a cross-sectional survey, based on data collected during 2010 by the Israel Bureau of Statistics, in a representative nationwide sample of 7,524 adults (≥20 years). Information collected by personal interviews included a broad set of demographic and socio-economic characteristics and detailed information on smoking habits. Associations between social characteristics and smoking habits were tested in multivariable regression models.ResultsCurrent smoking was more frequent among men than among women (30.9 % vs. 16.8 %; p < 0.0001). In multivariable regression analysis, the association of some social characteristics with smoking status differed by gender. Lower socioeconomic status (reflected by higher rate of unemployment, lower income, possession of fewer material assets, difficulty to meet living expenses) and lower educational level were significantly associated with current smoking among men but not among women. Family status other than being married was associated with higher likelihood of being a current smoker, while being traditional or observant was associated with a lower likelihood of ever smoking among both gender groups. Arab minority men and male immigrants from the former Soviet Union countries were more frequently current smokers than Israeli-born Jewish men [adjusted odds ratio (95 % confidence interval): 1.53 (1.22, 1.93) and 1.37 (1.01-1.87), respectively]. Compared to Israeli-born men, the age at smoking initiation was younger among male immigrants, and older among Arab minority men [adjusted hazard ratio (95 % confidence interval): 1.360 (1.165-1.586), and 0.849 (0.749-0.962), respectively]. While the prevalence of current smoking was lower in younger birth cohorts, the age at smoking initiation among ever-smokers declined as well.ConclusionsAmong several subgroups within the Israeli population the smoking uptake is high, e.g. Arab men, men who are less affluent, who have lower educational level, and male immigrants. These subgroups should be prioritized for intervention to reduce the burden of smoking. To be effective, gender, cultural background and socioeconomic characteristics should be considered in the design and implementation of culturally-congruent tobacco control and smoking prevention and cessation interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13584-016-0095-2) contains supplementary material, which is available to authorized users.
Highlights
Cigarette smoking is a major cause of health disparities
Data on cigarette smoking were obtained from the following set of questions: “Do you smoke cigarettes?” If answered affirmatively, people were asked “How many cigarettes do you smoke per day?” and “At what age did you start smoking?” People who denied smoking in the first question were further asked: “Did you ever smoke cigarettes?” If answered affirmatively, they were subsequently asked about the number of cigarettes they used to smoke per day, the age of smoking initiation and age at smoking cessation
There was a transient decline in ever-smoking rates among women who were born in the 60s, but this trend did not continue thereafter (Fig. 2; p < 0.0001)
Summary
Cigarette smoking is a major cause of health disparities. We aimed to determine social characteristics associated with smoking status and age at smoking initiation in the ethnically-diverse population of Israel. Tobacco smoking is associated with increased morbidity and mortality risk due to cardiovascular disease, malignant neoplasms and chronic obstructive lung disease [1]. In 2014, more than 7,000 deaths in Israel were attributed to smoking [4]. The WHO global burden of disease study suggests that smoking, the single most important risk factor, accounted for 26 % of male deaths and 9 % of female deaths in developed countries [5]. Tobacco smoking, including second-hand smoking, is a leading factor for global disease burden, accounting for 6.3 % of disability-adjusted life years (DALYs; sum of years lived with disability and years of life lost). In 2010, tobacco smoking accounted for 31 % of global ischemic heart disease DALYs [6]
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