Gradient In Smoking Research Articles

Educational inequalities, urbanicity and levels of non-communicable diseases risk factors: evaluating trends in Argentina (2005\u20132013)

BackgroundWe investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity.MethodsWe used data from three large national surveys on NCD risk factors (Encuesta Nacional de Factores de Riesgo; ENFR2005–2009-2013) conducted in urban areas of Argentina (n = 108,489). We used gender-stratified logistic random-intercept models (individuals nested within provinces) to determine adjusted associations of self-reported individual NCD risk factors (hypertension, diabetes, obesity, and current smoking) with education and urbanicity.ResultsIn both men and women, the prevalence of obesity and diabetes increased over time but smoking decreased. Hypertension prevalence increased over time in men. Higher urbanicity was associated with higher odds of smoking and lower odds of hypertension in women but was not associated with NCD risk factors in men. Obesity increased more over time in more compared to less urbanized provinces (in men) while smoking decreased more over time in less urbanized provinces. All risk factors had a higher prevalence in persons with lower education (stronger in women than in men), except for diabetes in men and smoking in women. Educational inequalities in obesity (in men) and hypertension (in men and women) became stronger over time, while an initial inverse social gradient in smoking for women reverted and became similar to other risk factors over time. In general, the inverse associations of education with the risk factors became stronger with increasing levels of province urbanicity.ConclusionIncreasing prevalence of diabetes and obesity over time and growing inequities by education highlight the need for policies aimed at reducing NCD risk factors among lower socioeconomic populations in urban environments in Argentina.

The social gradient in smoking: individual behaviour, norms and nicotine dependence in the later stages of the cigarette epidemic

The cigarette epidemic tends to develop in a similar pattern across diverse populations in different parts of the world. First, the prevalence of smoking increases, then it plateaus and finally it declines. The decline in smoking prevalence tends to be more pronounced in higher social strata. The later stages of the cigarette epidemic are characterized by emerging and persisting socioeconomic gradients in smoking. Due to its detrimental health consequences, smoking has been the subject of extensive research in a broad range of academic disciplines. I draw on literature from both the social and medical sciences in order to develop a model in which physiological nicotine dependence, individual smoking behaviour and norms surrounding smoking in the immediate social environment are related through reflexive processes. I argue that the emergence and persistence of social gradients in smoking at the later stages of the cigarette epidemic can be attributed to a combination of the pharmacological properties of nicotine, network homophily and the unequal distribution of material and non-material resources across social strata.

Increasing similarities between young adults\u2019 smoking and snus use in Norway: a study of the trends and stages of smoking and snus epidemic from 2010 to 2018

BackgroundThe prevalence of smoking has been decreasing in Norway for decades. In contrast, the prevalence of snus use has recently increased substantially, especially among females. While there is a clear social gradient in smoking, with a higher smoking prevalence among individuals with low socioeconomic status (SES), a possible social gradient in snus use has been less studied. The aim of the current study was to investigate the trends of smoking and snus use and to examine whether ongoing changes in snus use are similar to prior smoking epidemic development.MethodsThe study was based on the 2010 (n = 5836), 2014 (n = 13,319) and 2018 (n = 24,515) waves from a nation-wide, cross-sectional, health survey of higher education in Norway (the SHoT study). Variables on smoking, snus use, gender, age and SES were used. Chi-square tests and logistic regression analyses were used to test significance, and Mantel–Haenszel weights were used to test the trends in stratified cross-tabulations.ResultsDaily smoking decreased from 5.9 to 1.5% between 2010 and 2018, while daily snus use increased from 13.4 to 19.9%. Female snus use almost doubled, from 10.9 to 19.2%. Low SES was associated with both daily smoking and snus use across all three waves. Occasional smoking was also associated with low SES at all waves, but occasional snus use was only associated with low SES in 2010. There were no significant changes over time in either the association between occasional or daily smoking and SES or the association between occasional or daily snus use and SES.ConclusionsThe overall smoking decrease indicated that the Norwegian smoking epidemic is in its latest stage. Steady male snus use, doubled female snus use and a clear social gradient in snus use all indicate that the snus epidemic in Norway has progressed. If this trend continues, a main implication is that snus prevalence will soon peak, first in males and then in females.

Social differences in 20-year trends in daily smoking among Lithuanian adult population

Abstract Background Tobacco control measures carried out in the countries can affect social inequalities in the smoking habit. This study aimed to examine the 20-year trends in social patterning of daily smoking in Lithuania. Methods The data were obtained from 11 biannual cross-sectional postal surveys of Lithuanian Health Behaviour Monitoring, beginning in 1994. Each survey used a randomly selected nationally representative independent sample of 3000-4000 inhabitants aged 20-64 drawn from the population register. In total, 8738 men and 11822 women participated in the surveys. The analysis of daily smoking involved the respondents who had smoked daily for at least one year. Results The prevalence of daily smoking was increasing up to the year 2000, especially among women, while a decreasing trend in men and levelling off a trend in women was observed afterwards. In the last survey, 33.3% of men and 12.5% of women were daily smokers. The proportion of daily smokers was higher among younger than older participants; however, the age difference in smoking decreased over time. The highly educated men and women smoked less than those with low education. The odds ratio (OR) of smoking in men with university versus lower education was 0.42 (95% CI 0.37-0.47) and in women - 0.68 (95% CI 0.60-0.78). The proportion of smoking men decreased in all educational groups; however, the differences in the smoking prevalence remained. Since 2000, the educational gradient in smoking among women was increasing due to a decline in smoking prevalence among women with university education. More women living in big cities than in non-urban areas were daily smokers (OR 1.29; 95% CI 1.15-1.44). Over 20 years, no consistent difference in the smoking trends by place of residence was found in both genders. Conclusions The 20-year trends in social patterning of daily smoking differed between men and women. Inequalities in daily smoking by age and education remained in both genders. Key messages In Lithuania, the trends and social differences in daily smoking were related to gender. Comprehensive tobacco control measures targeting young and lower educated groups should be implemented aiming to reduce social inequalities in smoking.

Education and adult mortality in middle-income countries: Surprising gradients in six nationally-representative longitudinal surveys

BackgroundThere are large differences in adult mortality across schooling groups in many high-income countries (HICs). An important open question is whether there are similar gradients in adult mortality in middle-income countries (MICs), where schooling and healthcare quality tends to be lower and health-related behaviors are often not strongly patterned by schooling.MethodsWe present one of the first international-comparative studies on schooling differences in adult mortality across MICs using harmonizedlongitudinal data on adults ages 50+ from China, Costa Rica, Indonesia, Mexico, South Africa, and South Korea. We use Cox proportional hazards models to estimate differences in the hazard of mortality across schooling groups overall and separately by sex and broad age groups. We also estimate schooling gradients in smoking and body mass index to determine whether risk factor gradients potentially explain mortality patterns.ResultsOnly adults with tertiary schooling have a consistent adult mortality advantage compared to those with no schooling. We do not find evidence that individuals with primary schooling have a lower hazard of mortality compared to individuals with no schooling in five of the six countries. The mortality advantage for individuals with secondary schooling is mixed, with evidence of lower mortality relative to those with no schooling in Mexico, South Africa, and South Korea. Gradients in BMI and smoking are inconsistent across countries and unlikely to explain mortality differences.ConclusionsWe find that adult mortality and risk factor gradients in MICs can be much different than the established patterns seen in modern HICs. Our results highlight that adult mortality gradients are not an inevitability and are not found in all populations. Understanding what factors give rise to inequalities in adult mortality and what can be done to minimize gradients while still ensuring continued mortality improvements in MICs is a crucial focus for research and policy.

Class Status and Social Mobility on Tobacco Smoking in Post-Reform China Between 1991 and 2011.

There is growing attention to social mobility's impact on tobacco use, but few studies have differentiated the two conceptually distinct mechanisms through which changes in social class can affect tobacco smoking: the class status effect and the mobility effect. I applied Diagonal Reference Modeling to smoking and heavy smoking among respondents of the 1991 China Health and Nutrition Survey who were revisited two decades later in 2011 (n = 3841, 49% male, baseline mean age was 38 years). I divided the sample into six social classes (non-employment, self-employed, owners, workers, farmers, and retirees) and measured social mobility by changes in income and occupational prestige. About 61.7% of men were smokers and those from the classes of workers, owners, and self-employees consumed more cigarettes compared to the unemployed, but women smokers (3.7%) tend to be from the lower classes (unemployed and farmers). Controlling for social class, each 1000 Yuan increase in annual income led to smoking 0.03 more cigarettes (p < .05) and 1% increase (p < .05) in the likelihood of heavy smoking among men, but the income effect is null for women. Upwardly mobile men (a 10-points surge in occupational prestige) smoked like their destination class (weight = 78%), whereas men with downward mobility were more similar to peers in the original class (weight = 60%). Contrary to the social gradient in smoking in other industrial countries, higher class status and upward mobility are each associated with more smoking among Chinese men, but not among women. Tobacco control policies should prioritize male smoking at workplaces and the instrumental purposes of using tobacco as gifts and social lubricant. Taxation may counter the surge in smoking brought by individuals' income increase after upward mobility. Caution should be paid to women joining the similar social gradient in smoking as they gain foothold in the labor market.

Socioeconomic disparities in smoking are partially explained by chronic financial stress: marginal structural model of older US adults

BackgroundA persistent socioeconomic gradient in smoking has been observed in a variety of populations. While stress is hypothesised to play a mediating role, the extent of this mediation is unclear....

Explaining the social gradient in smoking and cessation: the peril and promise of social mobility.

Smoking in high‐income countries is now concentrated in poor communities whose relatively high smoking prevalence is explained by greater uptake but above all by lower quit rates. Whilst a number of barriers to smoking cessation have been identified, this is the first paper to situate cessation itself as a classed and cultural practice. Drawing on ethnographic research carried out in a working‐class community in the North of England between 2012 and 2015, I theorise smoking cessation as a symbolic practice in relation to the affective experience of class and social mobility. I show that ambivalence about upward mobility as separation and loss translated into ambivalence about smoking cessation. The reason for this was that the social gradient in smoking operated dynamically at the level of the individual life course, i.e. smoking cessation followed upward mobility. A serious health problem was an appropriate reason to quit but older women continued to smoke despite serious health problems. This was linked to historical gender roles leading to women placing a low priority on their own health as well as the intergenerational reproduction of smoking through close affective links with smoking parents.

Daily stress as link between disadvantage and smoking: an ecological momentary assessment study

BackgroundThere is a well-established social gradient in smoking, but little is known about the underlying behavioral mechanisms. Here, we take a social-ecological perspective by examining daily stress experience as a process linking social disadvantage to smoking behavior.MethodA sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether socioeconomic disadvantage (indicated by educational attainment, income and race) exerts indirect effects on smoking (cigarettes per day) via daily stress. Stress experience was assessed at the end of each day using Ecological Momentary Assessment methods. Data were analyzed using random effects regression with a lower-level (2-1-1) mediation model.ResultsOn the within-person level lower educated and African American smokers reported significantly more daily stress across the monitoring period, which in turn was associated with more smoking. This resulted in a small significant indirect effect of daily stress experience on social disadvantage and smoking when using education and race as indicator for social disadvantage. No such effects were found when for income as indicator for social disadvantage.ConclusionThese findings highlight the potential for future studies investigating behavioral mechanisms underlying smoking disparities. Such information would aid in the development and improvement of interventions to reduce social inequality in smoking rates and smoking rates in general.

Smoking Among Immigrant Groups in the United States: Prevalence, Education Gradients, and Male-to-Female Ratios.

Immigrants in the United States are less likely to smoke than those born in the United States, but studies have not fully described the diversity of their smoking patterns. We investigate smoking by world region of birth and duration of residence in the United States, with a comprehensive approach covering current prevalence levels, education gradients, and male-to-female ratios. The data originate from the National Health Interview Surveys, 2000-2015, and the sample of 365 404 includes both US-born and foreign-born respondents aged 25-70 years. World region of birth and duration of residence in the United States measure immigrant characteristics. Current cigarette smoking was analyzed using logistic regression. Immigrant groups were protected from smoking and had weaker education gradients in smoking and larger male-to-female smoking ratios than the US-born population. However, large differences emerged among the immigrant groups for region of birth but less so for duration of residence in the United States. For example, immigrants from sub-Saharan Africa and the Indian subcontinent have low prevalence, weak education gradients, and high male-to-female ratios. Immigrants from Europe have the opposite pattern, and immigrants from Latin America fall between those two extremes. The stage of the cigarette epidemic in the region of birth helps explain the diverse group profiles. Duration of residence in the United States does less to account for the differences in smoking than region of birth. The findings illustrate the heterogeneity of immigrant populations originating from diverse regions across the world and limited convergence with the host population after immigration. The study identifies immigrant groups that, because of high smoking prevalence related to levels in the host country, should be targeted for cessation efforts. It also identifies immigrant groups with low prevalence for which anti-smoking programs should encourage maintenance of healthy habits. Many immigrant groups show strong education disparities in smoking, further suggesting that smokers with lower levels of education be targeted by public health programs.

Socioeconomic Differences in Smoking and Cessation Across a Period of Rapid Economic Growth in an Upper-Middle-Income Country.

Higher smoking rates and lower cessation rates among the poor compared to the rich are evident in high-income countries. In low and middle-income countries (LMICs), many of which are in the early stages of tackling the tobacco epidemic, more knowledge is required of the socioeconomic inequalities in smoking. This is especially the case for upper-middle-income countries, where smoking prevalence is highest. This study examines trends in the socioeconomic gradient in smoking and cessation among adults across a period of rapid economic development in Malaysia, an LMIC with an upper-middle-income economy. The socioeconomic trends in smoking were analyzed using data from cross-sectional National Health and Morbidity Surveys for the years 1996, 2006, and 2011. Household per capita income was used as a measure of socioeconomic position. As a measure of inequality, the concentration index that quantified the degree of socioeconomic inequality in a health outcome was computed. Smoking was assessed in current and former smokers. The study population was examined by gender, region, and age group. This study found a trend of an increasingly higher smoking prevalence among the poor and higher cessation rates among the rich. With the exception of younger women in Peninsular Malaysia, the socioeconomic gradient in current smoking is concentrated among the poor. For former smokers, especially men, distributions across the years were mostly concentrated among the rich. It is important to ensure that health policies, programs, and interventions consider the potential impact of the socioeconomic patterning in smoking on equity in health. Findings on the socioeconomic gradient in smoking and cessation from Malaysia across a period of rapid economic development will contribute to addressing the paucity of knowledge on the socioeconomic gradient of smoking and cessation in other progressing LMICs. This study provides evidence from an upper-middle-income country, of an increasing trend of smoking among the poor and an increasing trend of cessation rates among the rich, particularly for men. We found opposing trends for younger adult women in the more developed, Peninsular Malaysia. More rich young women were found to have taken up smoking compared to socioeconomically less advantaged young women.

How will e-cigarettes affect health inequalities? Applying Bourdieu to smoking and cessation

This paper uses the work of Bourdieu to theorise smoking and cessation through a class lens, showing that the struggle for distinction created the social gradient in smoking, with smoking stigma operating as a proxy for class stigma. This led to increased policy focus on the health of bystanders and children and later also to concerns about electronic cigarettes. Bourdieu’s concept of habitus is deployed to argue that the e-cigarette helps middle-class smokers resolve smoking as a symptom of cleft habitus associated with social mobility or particular subcultures. E-cigarette use is also compatible with family responsibility and sociable hedonism; aspects of working-class habitus which map to the ‘practical family quitter’ and the ‘recreational user’ respectively. The effectiveness of class stigma in changing health behaviours is contested, as is the usefulness of youth as a category of analysis and hence the relevance of concerns about young people’s e-cigarette use outside a class framework of smoking and cessation. With regard to health inequalities, whilst middle-class smokers have in class disgust a stronger incentive to quit than working-class smokers, there is potential for tobacco control to tap into a working-class ethos of family care and responsibility.

Smoking Behaviour in Germany Evidence from the SOEP

As in most OECD countries, smoking prevalence and cigarette consumption have been decreasing in Germany since the early 2000s. This paper analyses whether smoking prevalence and cigarette consumption, as well as their development over time, differ between socio-economic subgroups. Identifying these differences provides insights into the effect of policy interventions on German smoking behaviour. Based on data from the Socio-Economic Panel (SOEP), a large longitudinal study of the German population, we find that both the decline in smoking prevalence and the decline in average cigarette consumption were probably driven by a behavioural change of younger people, as well as of those with a high educational level and those with a high income. People who quit smoking were on average more highly educated, had a higher income and had most likely a lower cigarette consumption (before quitting). In contrast, smoking prevalence increased among people who were older than 45 and had a low educational level and among those who were unemployed. Smoking prevalence among women was relatively constant over time. Indeed, the smoking prevalence of women and men converged over time, especially in older age groups. Daily cigarette consumption of smokers increased among 66-to-75-year-olds, although it decreased in all other age groups. One explanation might be that the tobacco control measures were successful only in certain socio-economic subgroups. Not only smoking prevalence, but also smoking intensity was higher among men, among those with a lower educational level and among those with a lower income. Especially for younger birth cohorts, smoking prevalence among those with a lower educational level was particularly high. Thus, based on data from 1998 through 2014, the so-called social gradient in smoking was only a distinct feature of younger birth cohorts, and not of older ones.

Ethnic differences in current smoking and former smoking in the Netherlands and the contribution of socioeconomic factors: a cross-sectional analysis of the HELIUS study

ObjectivesData exploring how much of the ethnic differences in smoking prevalence and former smoking are explained by socioeconomic status (SES) are lacking. We therefore assessed ethnic differences in smoking prevalence...

Commentary on Wang et al. (2017): Differing patterns of short‐term transitions of nondaily smokers for different indicators of socioeconomic status (SES)

Different associations are observed between the socio-economic status (SES) indicators education and income, and non-daily smoker transitions. Studies should determine carefully which SES indicator to use when studying the SES gradient in tobacco smoking, because income may be less stable over time than education in adulthood. Wang et al. have, in their study 1, provided an informative analysis of factors associated with short-term transitions of non-daily smokers based on a representative sample of the US population. Tobacco smoking is still a major health problem in economically developed countries, despite a decline in smoking prevalence in most of the countries over a long time-period. Socio-economic status (SES) is an increasingly relevant issue in smoking epidemiology in these countries due to the well-known SES gradient in smoking and the increase in the SES gradient during recent decades 2, 3. During several decades, SES has been defined in three main dimensions, which include education, occupation and income. Wang et al. do not include the SES indicator occupation, although this has long been regarded as a central 4, 5 but not exclusively important 6 indicator of SES, but they include education and income as SES indicators. Just as in other studies already referenced by the authors, the majority of non-daily smokers in the study remain non-daily smokers over time. The transitions of the non-daily smokers to daily smokers and former smokers, respectively, in the study partly reflect processes of smoking initiation and smoking cessation. Tobacco smoking, smoking initiation and smoking cessation are complex phenomena which include psychological, psychosocial and social factors as well as biological and other aspects of dependence to a varying extent across different individuals and social groups 7-10. Smoking cessation is a dynamic process which is initiated by a decision to quit, leading eventually to a long period of maintained abstinence 11. In Table 2 in the Wang et al. [1] study, the results show that the highest educational category of college graduates has a significantly lower transition rate from non-daily to daily smoker and also a significantly higher transition rate from non-daily to former smoker compared to all other lower educational categories, which is as expected, in the sense that categories with higher education levels have been found to be more likely to quit at follow-up 10, 12. In contrast, the associations between income and non-daily smoker transitions show that the category with lowest income has a significantly higher transition from non-daily to daily smoker than some of the categories with higher income, while no statistically significant differences can be observed between the lowest income category and the other income categories for the transition of non-daily to former smoker. The observed differences between educational achievement and income as SES indicators, respectively, and their associations with non-daily smoker transitions have several implications. First, while the educational level of an individual is, predominantly, decided early in adolescent or adult life, individual income may vary more throughout adult life. Consequently, studies of the SES gradient in smoking should consider thoroughly which SES indicator to use and for what purpose. Secondly, following from the first point, income as an SES indicator may reflect a less stable aspect of SES among adults and throughout adulthood than education, because for an individual it may vary over time more than education. This means that low income assessed at a given point in time may reflect a shorter or longer period of increased economic and psychosocial stress, which may affect the propensity to increase smoking intensity by going from non-daily to daily smoker. In contrast, no reverse association is observed for the transition from non-daily to former smoker, probably because the latter transition is much less connected with a high intensity of economic stress and probably psychosocial stress. Thirdly, the hypotheses following from the second observation in the second point call for further longitudinal studies, preferably using panel data as in the current paper, with further income and stress items regarding factors which may determine tobacco smoking, smoking initiation and smoking cessation 13. None.

Smoking Behaviour in Germany: Evidence from the SOEP

As in most OECD countries, smoking prevalence and cigarette consumption have been decreasing in Germany since the early 2000s. This paper analyses whether smoking prevalence and cigarette consumption, as well as their development over time, differ between socio-economic subgroups. Identifying these differences provides insights into the effect of policy interventions on German smoking behaviour. Based on data from the Socio-Economic Panel (SOEP), a large longitudinal study of the German population, we find that both the decline in smoking prevalence and the decline in average cigarette consumption were probably driven by a behavioural change of younger people, as well as of those with a high educational level and those with a high income. People who quit smoking were on average more highly educated, had a higher income and had most likely a lower cigarette consumption (before quitting). In contrast, smoking prevalence increased among people who were older than 45 and had a low educational level and among those who were unemployed. Smoking prevalence among women was relatively constant over time. Indeed, the smoking prevalence of women and men converged over time, especially in older age groups. Daily cigarette consumption of smokers increased among 66-to-75-year-olds, although it decreased in all other age groups. One explanation might be that the tobacco control measures were successful only in certain socio-economic subgroups. Not only smoking prevalence, but also smoking intensity was higher among men, among those with a lower educational level and among those with a lower income. Especially for younger birth cohorts, smoking prevalence among those with a lower educational level was particularly high. Thus, based on data from 1998 through 2014, the so-called social gradient in smoking was only a distinct feature of younger birth cohorts, and not of older ones.

Childhood conscientiousness predicts the social gradient of smoking in adulthood: a life course analysis

Background and aimsThe social gradient in smoking is well known, with higher rates among those in less advantaged socioeconomic position. Some recent research has reported that personality characteristics partly explain...

Smoking prevalence and the changing risk profiles in the UK ethnic and migrant minority populations: implications for stop smoking services

ObjectivesSmoking is the leading risk factor for disability-adjusted life-years, yet evidence with which to establish the smoking rates of people with different ethnic backgrounds and how they are changing in relation to recent migration is lacking. The objective is to provide current information on the changing risk profiles of the UK population. Study designObservational study using cross-sectional surveys. MethodsData from the Integrated Household Survey (pooled for the years 2009/10–2011/12), obtained under Special Licence, and the GP Patient Survey (2012) have been used to establish smoking prevalence in a wider range of ethnic groups in England and Wales, including the ‘mixed’ groups and amongst East European migrants, and how such prevalence differs across socio-economic classes. ResultsSmoking prevalence is substantially higher amongst migrants from East European countries (that for males exceeding 50% from three such countries and for females over 33% from four countries) and from Turkey and Greece, compared with most other non-UK born groups, and amongst ethnic groups is elevated in the ‘mixed’ groups. Rates are highest in the Gypsy or Irish Traveller group, 49% (of 162) and 46% (of 155) for males and females respectively. Across ethnic groups, rates are almost always higher in the UK born than non-UK born population with the notable exception of the ‘White Other’ group, with Prevalence Ratios (PRs) indicating a larger migrant-non-migrant differential amongst females (e.g. Indians 2.95 (2.33–3.73); Black Caribbeans 3.28 (2.73–3.94). Age-adjusted rates show the persistence of these differentials in females across age groups, though young males (18–29) in seven minority ethnic groups show lower rates in the UK-born groups. The ‘White’ and ‘Chinese’ groups show a strong socio-economic gradient in smoking which is absent in the South Asian groups and diminished in the ‘mixed’ and black groups. ConclusionsGiven the evidence that smoking behaviour is significantly different in some of the new groups, notably East European migrants, stop smoking services are failing to optimize the acceptability and, consequently, favourable outcomes for these programmes. These services need to be adapted to the particular patterns of smoking behaviour and language skills within different communities of descent.

Divergent socio-economic gradients in smoking by type of tobacco use in India [Short communication

We describe the relationship between socio-economic status and current bidi or cigarette smoking among Indian men aged ≥15 years. The prevalence of bidi smoking was 13.7% (95%CI 13.3-14.1) and that of cigarette smoking was 6.3% (95%CI 6.1-6.6). bidi smoking was concentrated among the socio-economically disadvantaged, while cigarette smoking was common among men with higher status occupations and greater levels of education and household wealth. This suggests that India has not transitioned to the later stages of the tobacco epidemic, and underscores the need for prevention and control strategies adapted to current patterns of consumption across socio-economic groups in India.

Age and socioeconomic inequalities in health: examining the role of lifestyle choices.

The role of lifestyle choices in explaining how socioeconomic inequalities in health vary with age has received little attention. This study explores how the income and education gradients in both important lifestyle choices and self-assessed health (SAH) vary with age. Repeated cross-sectional data from Norway (n=25,016) and logistic regression models are used to track the income and education gradients in physical activity, smoking, consumption of fruit and vegetables and SAH over the age range 25-79 years. The education gradient in smoking, the income gradient in consumption of fruit and vegetables and the education gradient in physical activity among males become smaller at older ages. Physical activity among females is the only lifestyle indicator in which the income and education gradients grow stronger at older ages. In conclusion, this study shows that income and education gradients in lifestyle choices may not remain constant, but vary with age, and such variation could be important in explaining corresponding age patterns of inequality in health.