Inequalities In Smoking Prevalence Research Articles

Trends in socioeconomic inequalities in behavioural non-communicable disease risk factors: analysis of repeated cross-sectional health surveys in England between 2003 and 2019

BackgroundPrevious studies have shown that those in lower socioeconomic positions (SEPs) generally have higher levels of behavioural non-communicable disease (NCD) risk factors. However, there are limited studies examining recent trends in inequalities. This study examined trends in socioeconomic inequalities in NCD behavioural risk factors and their co-occurrence in England from 2003–19.MethodsThis time-trend analysis of repeated cross-sectional data from the Health Survey for England examined the relative index of inequalities (RII) and slope index of inequalities (SII) in four NCD behavioural risk factors: smoking; drinking above recommended limits; insufficient fruit and vegetables consumption; and physical inactivity.FindingsPrevalence of risk factors has reduced over time, however, this has not been consistent across SEPs. Absolute and relative inequalities increased for physical inactivity; relative inequalities also increased for smoking; for insufficient fruit and vegetable consumption, the trends in inequalities depended on SEPs measure. Those in lower SEPs experienced persistent socioeconomic inequalities and clustering of behavioural risk factors. In contrast, those in higher SEPs had higher prevalence of excessive alcohol consumption; this inequality widened over the study period.InterpretationInequalities in smoking and physical inactivity are persisting or widening. The pattern of higher drinking in higher SEPs obscure the fact that the greatest burden of alcohol-related harm falls on lower SEPs. Policy attention is required to tackle increasing inequalities in smoking prevalence, low fruit and vegetable consumption and physical inactivity, and to reduce alcohol harm.

Implementing a smoking cessation training for lower socioeconomic groups into local policy in Amsterdam, the Netherlands: Identifying preconditions and barriers among multiple stakeholder groups

Abstract Background Socioeconomic inequalities in smoking prevalence are high, partly because smoking cessation programs are insufficiently accessible and suitable for smokers with a lower socioeconomic position (SEP). To make it easier for this target group to access suitable smoking cessation programs, it is necessary to structurally implement such programs into local policies. The study aims to identify preconditions and barriers for the implementation of smoking cessation programs for people with low SEP from the perspective of key stakeholders. Methods The Feel Free! Smoking cessation rolling group training has been previously developed for people from lower socio-economic groups and was implemented in Amsterdam Noord. Semi-structured interviews were held with 25 stakeholders consisting of participants, trainers, professionals in the neighbourhood and stakeholders of the municipality. The interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The Implementation Framework of Fleuren will be used to structure the presentation. Results The main preconditions found are effective recruitment of participants by local professionals, having a central coordinator for implementation within the neighbourhood network, and offering a smoking cessation program with a clear added value for participants. The main barriers found are challenges in setting up a sustainable financial structure, allocation of organizational tasks, and high participant absences and dropout. More results will be presented in detail. Conclusions This study shows that action is required from various stakeholders to facilitate the implementation process. These findings can inform policy makers and implementers to choose strategies to implement suitable smoking cessation programs into local policy.

Spotlight on tobacco guidance: NICE public health guidance update

The updated NICE guidelines on tobacco recommend cost-effective and evidence-based interventions to prevent smoking initiation and promote smoking cessation across the life course. E-cigarettes are a cost-effective adjunct to support smoking cessation in adults, but their long-term effects are yet to be fully understood. Concerted efforts from healthcare and public health providers are required to reach underserved groups and hence address stark and longstanding inequalities in smoking prevalence and associated ill health in England.

Relative and absolute socioeconomic inequality in smoking: time trends in Germany from 1995 to 2013

PurposeThis study aimed to investigate time trends in relative and absolute socioeconomic inequality in smoking prevalence in Germany using several indicators for socioeconomic position. MethodsWe conducted a repeated cross-sectional study using representative samples of the German population aged between 25 and 64 years in 1995, 1999, 2005, 2009, and 2013 (n = 857,264). Socioeconomic position was measured by indicators for income, education, and occupation. Relative and absolute socioeconomic inequalities were estimated with the regression-based relative index of inequality and the slope index of inequality, respectively. Trends in inequalities were estimated with interaction terms for time and relative index of inequality/slope index of inequality. ResultsHighest and increasing smoking prevalence was observed among long-term unemployed and people with less than 60% of the median household income. Between 1995 and 2013, relative increases in inequalities in smoking prevalence ranged from 31% (95% confidence interval, 26%–36%; men, occupation) to 94% (95% confidence interval, 84%–104%; women, education). Absolute increases ranged from 6.2 (95% confidence interval, 4.7–7.6) percentage points (men, occupation) to 20.3 (95% confidence interval, 18.9–21.7) percentage points (women, education). ConclusionsRelative and absolute socioeconomic inequalities in smoking prevalence increased in Germany between 1995 and 2013, with regard to income, education, and occupation, particularly among women.

24-Year trends in educational inequalities in adult smoking prevalence in the context of a national tobacco control program: The case of Brazil

Brazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25–69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born ≥1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979–1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains.

Long-term trends in smoking prevalence and its socioeconomic inequalities in Korea, 1992\u20132016

BackgroundThe aim of this study was to investigate long-term trends in smoking prevalence and its socioeconomic inequalities in Korea.MethodsData were collected from 10 rounds of the Social Survey of Statistics Korea between 1992 and 2016. A total of 524,866 men and women aged 19 or over were analyzed. Age-adjusted smoking prevalence was calculated according to three major socioeconomic position indicators: education, occupational class, and income. The prevalence difference, prevalence ratio, slope index of inequality (SII), and relative index of inequality (RII) were calculated to examine the magnitude of inequality in smoking.ResultsSmoking prevalence among men decreased from 71.7% in 1992 to 39.7% in 2016, while smoking prevalence among women decreased from 6.5% in 1992 to 3.3% in 2016. Socioeconomic inequalities in smoking prevalence according to the three socioeconomic position indicators were found in both men and women throughout the study period. In general, absolute and relative socioeconomic inequalities in smoking, measured by prevalence difference and prevalence ratio for education and occupational class, widened during the study period among Korean men and women. In men, the SII for income increased from 7.6% in 1999 to 10.8% in 2016 and the RII for income also increased from 1.11 in 1999 to 1.31 in 2016. In women, the SII for income increased from 0.1% in 1999 to 2.4% in 2016 and the RII for income increased from 1.39 in 1999 to 2.25 in 2016.ConclusionPro-rich socioeconomic inequalities in smoking prevalence were found in men and women. Socioeconomic inequalities in smoking have increased in parallel with the implementation of tobacco control policies. Tobacco control policies should be developed to decrease socioeconomic inequalities in cigarette use in Korea.

Tobacco Control Policy in Scotland: A Qualitative Study of Expert Views on Successes, Challenges and Future Actions.

The Scottish Government launched a tobacco control strategy in 2013 with the ambition of making Scotland tobacco smoke-free by 2034. However, 17% of the adult population in Scotland smoke cigarettes. This study aimed to provide insight into why policies are successful or not and provide suggestions for future policy actions. Individual interviews with ten tobacco control experts were conducted and the results were analyzed using thematic analysis. Key successes included strong political leadership, mass media campaigns, legislation to address availability and marketing of cigarettes and tobacco products, and legislation to reduce second-hand smoke exposure. Challenges included implementing policy actions, monitoring and evaluation of tobacco control actions, addressing health inequalities in smoking prevalence, and external factors that influenced the success of policy actions. Key suggestions put forward for future policy actions included addressing the price and availability of tobacco products, maintaining strong political leadership on tobacco control, building on the success of the ‘Take it Right Outside’ mass media campaign with further mass media campaigns to tackle other aspects of tobacco control, and developing and testing methods of addressing inequalities in cigarette smoking prevalence. The findings of this study can inform future tobacco control policy in Scotland and have relevance for tobacco control policies in other countries.

Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in Argentina: Analysis of three cross-sectional nationally representative surveys in 2005, 2009 and 2013.

BackgroundUnderstanding patterns of socio-economic inequalities in tobacco consumption is key to design targeted public health policies for tobacco control. This study examines socio-economic inequalities in smoking and involuntary exposure to tobacco smoke between 2005 and 2013.MethodsData were derived from the Argentine National Risk Factors Surveys, conducted in 2005, 2009, and 2013. Two inequality measures were calculated: the age-adjusted prevalence ratio (PR) and the disparity index (DI). Educational level, household income per consumer unit and employment status were used as proxies for socio-economic status (SES). Generalized linear models were used in the analysis.ResultsPrevalence of smoking decreased from 29.7% to 25.1% between 2005 and 2013, mainly in women (p<0.001). Despite the overall prevalence reduction, socio-economic inequalities in smoking persisted. For both men and women, the DI was moderately high for smoking (14.47%-33.06%) across the three surveys. In men, the PR indicated a higher smoking prevalence for lower educational levels and lower household income throughout the analyzed period. In women, unlike previous years, the 2013 survey showed disparity related to unemployment. Involuntary exposure to tobacco smoke in 2013 was associated with educational level and household income, with lower involuntary exposure among those with higher SES.ConclusionsWhile overall smoking rates have decreased in Argentina, socio-economic disparities related to tobacco smoking persist. Comprehensive tobacco control programs targeted to address these inequalities are essential in developing strategies to reduce health disparities in tobacco-related diseases.

Smoking Prevalence Inequalities Among Roma and Non-Roma Population in Spain Between 2006 and 2014.

Tobacco consumption is unequally distributed in society. The objective was to identify trends in tobacco use among the General and Spanish Roma populations in 2006 and 2014, years characterized by strengthening of anti-smoking policy in Spain. We calculated prevalences and logistical regression models based on the Spanish National Health Survey (2006/2012) and the National Health Survey of the Roma population (2006/2014). Smoking decreased only in men in the General population (OR 0.885). In the Roma population, there were no significant changes observed for the 2years studied (OR: men 1.095, and women 1.147). In fact, Roma men smoke 4.2 cigarettes more, and they have a younger age of initial tobacco use. Smoking behavior of the Roma population has not changed, and there has been no reduction in inequalities in tobacco use among the two populations, despite public policies designed to reduce tobacco use in Spain.

Decomposition of socioeconomic inequalities in cigarette smoking: the case of Namibia

BackgroundNamibia has one of the highest levels of income inequality in the world. Increased smoking prevalence, especially among the youth, may leave the country facing the spectre of higher smoking-related disease prevalence in the years to come. This study examines socioeconomic inequalities in smoking in Namibia and explores the drivers of this inequality.MethodsData are obtained from the Namibia 2013 Demographic and Health Survey, a nationally representative survey. Concentration curves and indices are calculated for cigarette smoking prevalence and intensity to assess the respective inequalities. Smoking intensity is defined as the number of cigarette sticks smoked within the last 24 h before the survey. We use a decomposition technique to identify the contribution of various covariates to socioeconomic inequalities in smoking prevalence and intensity.ResultsThe concentration indices for socioeconomic inequality in cigarette smoking prevalence and smoking intensity are estimated at 0.021 and 0.135, respectively. This suggests that cigarette smoking is more prevalent among the wealthy and that they smoke more frequently compared to less wealthy Namibians. For smoking intensity, the biggest statistically significant contributors to inequality are marital status, wealth and region dummy variables while for smoking prevalence, education and place of dwelling (urban vs rural) are the main contributors.ConclusionWhile overall inequality in smoking prevalence and intensity is focused among the wealthy, the contribution of region of residence and education warrant some attention from policy makers. Based on our results, we suggest an assessment of compliance and enforcement of the Tobacco Products Control Act, that initially focuses on regions with reportedly low education statistics followed by an appropriate implementation strategy to address the challenges identified in implementing effective tobacco control interventions.

Inequalities in smoking and obesity in Europe predicted to 2050: Findings from the EConDA project.

The aim of this study was to project educational inequalities in obesity and smoking prevalence to 2050 based on past obesity and smoking trends by education level. Data on obesity (body mass index ≥ 30) and smoking prevalence (current smokers) by education level (tertiary education and less than tertiary) from nationally representative cross-sectional surveys were collected for the following six countries participating in the Economics of Chronic Diseases project (EConDA): England, Finland, Lithuania, the Netherlands, Poland (obesity only) and Portugal (obesity only). A nonlinear multivariate regression model was fitted to the data to create longitudinal projections to 2050. Inequalities were measured with a prevalence ratio and a prevalence difference using projected obesity/smoking prevalence. Educational inequalities in obesity prevalence are projected to increase in Finland, Lithuania and England for men, and in Lithuania and Poland for women, by 2050. Obesity prevalence is projected to increase faster among the more advantaged groups in England, Portugal, Finland and the Netherlands among women, and Portugal and the Netherlands among men, narrowing inequalities. In contrast to obesity, smoking prevalence is projected to continue declining in most of the countries studied. The decline is projected to be faster in relative terms among more advantaged groups; therefore, relative educational inequalities in smoking prevalence are projected to increase in all countries. Widening educational inequalities in obesity and smoking prevalence are expected in several European countries if current trends in obesity and smoking prevalence are unaltered. This will impact on inequalities in morbidity and mortality of associated diseases such as diabetes, coronary heart disease and chronic obstructive pulmonary disease.

REDUCING SMOKING AMONG INDIGENOUS NURSING STUDENTS USING INCENTIVES

IntroductionThe Better Help for Smokers to Quit government health target introduced in 2009 (Ministry of Health, 2009) thrust nurses into the frontline to encourage more people to make more quit attempts more often. Using the target's ABC approach, nurses were expected to Ask all clients if they smoked, give Brief advice about quitting if clients were a current smoker and offer to refer to or directly provide Cessation treatment (pharmacological and behavioural). Poor knowledge about smoking and attitudes towards people who smoked has been found to impede nurses' capacity to provide smoking cessation support to their clients (Wong et al., 2007) and nurses' own smoking was a significant barrier (Gifford, Wilson, Boulton, Walker, & Shepherd-Sinclair, 2013; Slater, McElwee, Fleming, & McKenna, 2006). The internal conflict faced by nurses who are themselves addicted to tobacco smoking is compounded for Maori nurses who are seen not only as role models for their profession but importantly for their Maori communities (Gifford, Wilson et al., 2013).Reducing smoking among nurses, particularly Maori nurses is a priority for nursing organisations (New Zealand Nurses Organisation [NZNO], 2010; Smokefree Nurses, 2010). In a survey of Maori NZNO members, 21.5% disclosed that they smoked (Gifford, Walker, Clendon, Wilson, & Boulton, 2013). A quarter of the 386 survey participants (12% of NZNO Maori members) were student nurses and smoking was disproportionately higher among them at 36%. Of the nurses who smoked, 68% agreed that being a nurse and a smoker was a conflict, 84% agreed that they would feel guilty if seen smoking while in uniform and only 34% believed that nurses who smoked could give effective advice to others about stopping smokingDisparate rates of smoking between Maori nurses and their non-Maori colleagues reflect the overall inequalities in smoking prevalence between Maori (38%) and the general population (16.6%) (Ministry of Health, 2015). In response, there have been numerous calls for culturally salient by Maori for Maori cessation interventions (Glover & Cowie, 2010; Glover, Kira, & Smith, 2016; Grigg, Waa, & Bradbrook, 2008; Maori Select Committee, 2010; Smokefree Nurses, 2010).Maori nurses who smoke are highly motivated to quit, but they were dismissive of many of the current tobacco control strategies supposed to help them (Gifford, Walker et al., 2013). For example, they were angered by strategies they believed 'persecuted' and stigmatised people who smoked, and strategies that removed personal choice (Gifford, Walker et al., 2013). Sixty-one percent thought tobacco excise tax increases were punishing and small numbers thought that removing cigarettes from sight at the point of sale or implementing plain packaging wouldn't have any effect on their continued smoking or motivation to quit (Gifford, Wilson et al., 2013). Maori nurses concurred with previous recommendations and suggested programmes combining incentives with collective support could be effective in achieving cessation (Gifford, Wilson et al., 2013).Incentives are emerging as an effective method to motivate quitting and support greater abstinence (Cahill & Perera, 2011; Giles, Robalino, McColl, Sniehotta, & Adams, 2014; Marteau, Thorne, Aveyard, Hirst, & Sokat, 2013). Two New Zealand trials suggest incentives may increase cessation intervention efficacy for Maori (Glover et al., 2014; Glover, Kira, Walker, & Bauld, 2015). We proposed to test a scholarship programme incentivising Maori nursing students who smoked to recruit a quit mate (a whanau/family member or friend) and quit smoking. Requiring involvement of a quit mate addresses the criticism that current cessation approaches do not acknowledge the centrality of the family for Maori and are too focused on the individual (Fernandez & Wilson, 2008; Gifford, Walker et al., 2013). Requiring student participants to recruit and support a whanau member to also quit could boost motivation to participate and to succeed at quitting. …

Commentary on Nuyts et al. (2018): Education is the key to preventing growing inequalities in smoking prevalence.

Commentary on Nuyts et al. (2018): Education is the key to preventing growing inequalities in smoking prevalence.

Inequalities in smoking prevalence: a missed opportunity for tobacco control in Pakistan.

Pakistan is one of the highest tobacco consuming countries in South Asia and consumption is increasing. To implement equity orientated tobacco control policies, the most vulnerable groups must be identified. We aimed to identify these groups using the Pakistan Demographic and Health Survey (PDHS) 2012-13. Descriptive statistics, univariate and multivariate analyses were used to explore household and participant characteristics associated with smoking inside the home or tobacco smoking, respectively. Survey weights were used to give nationally representative findings. Data for 12 931 households, 3132 men and 13 538 women were examined. About 58.3% of surveyed households were smoke-free, 39.1% were exposed to indoor tobacco smoke every day, 2.6% less frequently. Significantly more rural households were exposed to indoor tobacco smoke than urban households (45.2% versus 34.9%). Of men, 28.3% reported smoking compared with 1.3% of women. Smoking prevalence was higher in older age groups. Increasing wealth was associated with lower smoking prevalence and indoor smoking. For men, but not women, increasing education was associated with reduced smoking. Inequalities in smoking behaviour impose harm to those who can least afford the financial and health costs. Future tobacco control policies in Pakistan must be sensitive to gender, geography and socio-economic status.

Income Differences in Smoking Prevalences in 245 Districts of South Korea: Patterns by Area Deprivation and Urbanity, 2008-2014

ObjectivesThe aim of this study was to measure income differences in smoking prevalence at the district level and to investigate correlations among area deprivation, smoking prevalence, and income differences in smoking prevalence, stratified by urbanity.MethodsData were pooled from the Community Health Survey data of South Korea between 2008 and 2014. The age-standardized prevalence of smoking and its interquintile income differences were calculated. We conducted correlation analyses to investigate the association of the deprivation index with smoking prevalence and interquintile differences in smoking prevalence.ResultsAcross 245 districts, the median prevalence of smoking in men was 45.9% (95% confidence interval [CI], 43.4 to 48.5%), with an interquartile range (IQR) of 4.6% points. In women, the median prevalence was 3.0% (95% CI, 2.4 to 3.6%) and IQR was 1.6% points. The median interquintile difference in smoking prevalence was 7.4% points (95% CI, 1.6 to 13.2% points) in men and 2.7% points (95% CI, 0.5 to 4.9% points) in women. The correlation coefficients for the association between the deprivation index and smoking prevalence was 0.58, 0.15, -0.22 in metropolitan, urban, and rural areas, respectively, among men, and 0.54, -0.33, -0.43 among women. No meaningful correlation was found between area deprivation and interquintile difference in smoking prevalence. The correlation between smoking prevalence and interquintile difference in smoking prevalence was more evident in women than in men.ConclusionsThis study provides evidence of geographical variations in smoking prevalence and interquintile difference in smoking prevalence. Neither smoking prevalence nor the deprivation index was closely correlated with interquintile income difference in smoking prevalence. Measuring inequalities in smoking prevalence is crucial to developing policies aimed at reducing inequalities in smoking.

OP11 The effects of maximising the UK’s tobacco control score on inequalities in smoking prevalence and premature coronary heart disease mortality: a modelling study

Background Smoking remains common in England, with 20% of adults smoking in 2012, little changed from 21% in 2007. Smoking is more than twice as common among the most disadvantaged socioeconomic group compared to the most affluent and is a major contributor to inequalities in smoking-related mortality. The UK has comprehensive smoking policies according to the Tobacco Control Scale (TSC; score of 74 out of 100): public information campaigns; on-pack health warnings; plain packaging; ad bans; cessation; price; and smoke-free areas. However, there remains room for improvement. We aim to evaluate the cumulative effect on smoking prevalence of all TSC components, stratified by deprivation of area of residence in England. Methods We modelled the decline in smoking prevalence that might result from maximising each component of the TSC. Effect sizes and socioeconomic gradients for all seven types of smoking policy in the UK setting were adapted from systematic reviews, primary studies and other modelling studies. Smoking prevalence in England stratified by socioeconomic circumstance, age, and gender has been published by the Office for National Statistics. We used the previously-validated IMPACT Food Policy model to link predicted changes in smoking prevalence to changes in premature coronary heart disease (CHD) mortality for ages 35–74. Health outcomes with a time horizon of 2015–2025 were stratified by quintiles of lower layer super output areas ranked by their score on the Index of Multiple Deprivation for England. Inequality in CHD mortality was assessed using the Slope Index of Inequality. A model was built in R software, and uncertainty was assessed using probabilistic sensitivity analysis. Results Improving all smoking policies to achieve a maximum score of 100 on the TSC might reduce smoking prevalence in England by approximately 3% (95% CI: 1%–4%) in absolute terms, or by approximately 15% in relative terms (7%–21%). The most disadvantaged quintile would benefit more, with absolute reductions of about 5% (2%–7%). A 20% price increase via an excise tax would be responsible for about half (42%–57%) of the overall reduction. There would be some 3300 fewer premature CHD deaths (2200–4700), or about 2% fewer (1.4%–2.9%). The most disadvantaged quintile would benefit more, reducing the slope index of inequality for premature CHD mortality by approximately 260 deaths (170–540), or about 4% (3%–9%). Conclusion Further, feasible improvements in tobacco control policy in England could substantially improve population health AND reduce health-related inequalities. The health benefits would extend beyond CHD, most notably slowly reducing respiratory diseases and diverse cancers.

Two decades of inequalities in smoking prevalence, initiation and cessation in a southern European region: 1986-2007

The smoking epidemic is still progressing in southern Europe. We aimed to analyse the magnitude and trend of social inequalities in smoking prevalence, initiation and cessation in the Basque Country, a southern European region, from 1986 to 2007, determining the patterns by sex and age. This was a cross-sectional time trend study on the population aged >24 years using the Basque Country Health Surveys of 1986, 1992, 1997, 2002 and 2007. Age-adjusted prevalence of current and ever smoking and cessation were calculated, as were relative index of inequality and population-attributable risk by occupational social class and educational level. Relative risk of starting smoking was estimated using Cox proportional hazard regression models. Calculations were performed separately by sex and for two age groups (25-44 years and >44 years). Men and young women in the Basque Country have evolved towards the last stage of the epidemic, with an increasing concentration of smoking in disadvantaged groups, by educational level, especially among the youngest population. In older women, smoking continues rising, especially among higher socio-economic groups, though differences between groups are diminishing. The role of initiation and cessation inequalities as determinants of smoking inequalities differed considerably by age and sex. Inequalities in smoking prevalence widened from 1986 to 2007 in the Basque Country, especially among the youngest population. The changing pattern of these inequalities and the different roles of initiation and cessation dynamics need to be taken into account to improve the results of tobacco control policies and their effect on smoking inequalities.

Trends in socioeconomic inequalities in smoking prevalence, consumption, initiation, and cessation between 2001 and 2008 in the Netherlands. Findings from a national population survey

BackgroundWidening of socioeconomic status (SES) inequalities in smoking prevalence has occurred in several Western countries from the mid 1970’s onwards. However, little is known about a widening of SES inequalities in smoking consumption, initiation and cessation.MethodsRepeated cross-sectional population surveys from 2001 to 2008 (n ≈ 18,000 per year) were used to examine changes in smoking prevalence, smoking consumption (number of cigarettes per day), initiation ratios (ratio of ever smokers to all respondents), and quit ratios (ratio of former smokers to ever smokers) in the Netherlands. Education level and income level were used as indicators of SES and results were reported separately for men and women.ResultsLower educated respondents were significantly more likely to be smokers, smoked more cigarettes per day, had higher initiation ratios, and had lower quit ratios than higher educated respondents. Income inequalities were smaller than educational inequalities and were not all significant, but were in the same direction as educational inequalities. Among women, educational inequalities widened significantly between 2001 and 2008 for smoking prevalence, smoking initiation, and smoking cessation. Among low educated women, smoking prevalence remained stable between 2001 and 2008 because both the initiation and quit ratio increased significantly. Among moderate and high educated women, smoking prevalence decreased significantly because initiation ratios remained constant, while quit ratios increased significantly. Among men, educational inequalities widened significantly between 2001 and 2008 for smoking consumption only.ConclusionsWhile inequalities in smoking prevalence were stable among Dutch men, they increased among women, due to widening inequalities in both smoking cessation and initiation. Both components should be addressed in equity-oriented tobacco control policies.

Successful Smoking Cessation and Duration of Abstinence—An Analysis of Socioeconomic Determinants

Smoking does not affect every socioeconomic subgroup of the population equally, resulting in major inequalities in terms of smoking-related morbidity and mortality. While previous studies mainly focused on inequalities in smoking prevalence, we have analysed the socioeconomic dimensions that might be associated with two other smoking-related outcomes: the odds of successfully quitting and the duration of abstinence. Using nationally representative Swiss data, we found evidence of a socioeconomic gradient in successful cessation and abstinence duration with respect to education level and income for both men and women.

Smoking Has Declined But Not for All

Smoking is one of the leading causes of death and two-thirds of the world's smokers live in 10 countries, including Bangladesh. This study examines the trend and differentials in smoking in Chakaria, Bangladesh. Data from 2 surveys conducted in 1994 and 2008 in Chakaria were used. showed that smoking declined from 41% in 1994 to 27% in 2008. However, the decline was lower among the poor and the rate remained the same for the female illiterate. Interventions to prevent smoking need to be designed such that they are effective in disadvantaged groups and do not contribute to widening of socioeconomic inequalities in smoking prevalence and tobacco-related ill health and death.