Socioeconomic inequalities in smoking in The Netherlands before and during the Global Financial Crisis: a repeated cross-sectional study.

Fiona E Benson,Jan-Willem Bruggink,Vera Nierkens,Mirte Ag Kuipers,Karien Stronks,Anton E Kunst

doi:10.1186/s12889-015-1782-6

Fiona E Benson, Jan-Willem Bruggink + Show 4 more

Open Access

https://doi.org/10.1186/s12889-015-1782-6

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Abstract

BackgroundThe Global Financial Crisis (GFC) increased levels of financial strain, especially in those of low socioeconomic status (SES). Financial strain can affect smoking behaviour.This study examines socioeconomic inequalities in current smoking and smoking cessation in The Netherlands before and during the Global Financial Crisis (GFC).MethodsParticipants were 66,960 Dutch adults (≥18 years) who took part in the annual national Health Survey (2004–2011). Period was dichotomised: ‘pre-’ and ‘during-GFC’. SES measures used were income, education and neighbourhood deprivation. Outcomes were current smoking rates (smokers/total population) and smoking cessation ratios (former smokers/ever smokers). Multilevel logistic regression models controlled for individual characteristics and tested for interaction between period and SES.ResultsIn both periods, high SES respondents (in all indicators) had lower current smoking levels and higher cessation ratios than those of middle or low SES. Inequalities in current smoking increased significantly in poorly educated adults of 45–64 years of age (Odds Ratio (OR) low educational level compared with high: 2.00[1.79-2.23] compared to pre-GFC 1.67[1.50-1.86], p for interaction = 0.02). Smoking cessation inequalities by income in 18–30 year olds increased with borderline significance during the GFC (OR low income compared to high income: 0.73[0.58-0.91]) compared to pre-GFC (OR: 0.98[0.80-1.20]), p for interaction = 0.051).ConclusionsOverall, socioeconomic inequalities in current smoking and smoking cessation were unchanged during the GFC. However, current smoking inequalities by education, and smoking cessation inequalities by income, increased in specific age groups. Increased financial strain caused by the crisis may disproportionately affect smoking behaviour in some disadvantaged groups.

Highlights

The Global Financial Crisis (GFC) increased levels of financial strain, especially in those of low socioeconomic status (SES)
The trend in the total population is towards decreasing current smoking and increasing smoking cessation (Figure 1)
Smoking prevalence decreased and smoking cessation increased during the GFC (Table 1)

Summary

Introduction

The Global Financial Crisis (GFC) increased levels of financial strain, especially in those of low socioeconomic status (SES). General socioeconomic conditions changed in many European countries after the global economy went into recession in 2008 [2,3] This Global Financial Crisis (GFC) led to decreased public spending in many European countries [4], and to large increases in unemployment in EU member states [5]. Financial strain can affect an individual’s smoking behaviour through a mechanism described as tension reduction [7,8], which was originally developed to explain the impact of tension on alcohol use. According to this theory individuals attempt to ameliorate the effects of feeling anxiety by more frequently enacting behaviours which give temporary relief.

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