Inequalities In Smoking Research Articles

Socio-spatial Disparities of Tobacco Outlets in Edinburgh

This paper joins spatial autocorrelation models (Global Moran's index, Local Moran index) to analyse the distribution of cigarette vending outlets in Edinburgh and utilises global regression (OLS) models and Geographically Weighted Regression models (GWR) to examine the spatial heterogeneity of fiscal and social factors that affect the distribution of retail outlets in Edinburgh. The results demonstrate that Edinburgh has a considerable spatial agglomeration of cigarette retail outlets, with a clear trend towards clustering in high and low-value areas of retail outlet distribution, showing significant geographical characteristics. The impact of each element on the distribution of cigarette retail outlets was analysed utilising the ranking of the elements in SIMD (The Scottish Index of Multiple Deprivation) as explanatory variables. It was established that data regions with a high ranking in education, skills, and training and those with a high ranking in geographic access to services revealed a positive trend in the density distribution of cigarette retail outlets, while data regions with a high ranking in housing and those with a high ranking in crime revealed a negative trend on the density distribution of cigarette retail outlets. The outcomes are different from prior observations, so this paper specifically analyses the differences in the extent to which each influencing element affects cigarette retail outlets in Edinburgh across data regions, which will supply a scientific basis for decreasing the prevalence of smoking, decreasing socio-economic inequalities in smoking, and increasing diverse local tobacco control intervention strategies.

Socioeconomic Differences in Cigarette Smoking and Alternative Tobacco Product Use Among Adolescents in a School-Based Smoking Preventive Intervention: Findings From the Second Year of the X:IT II Study.

BackgroundHealth interventions may differently impact adolescents from diverse backgrounds. This study examined whether a smoking preventive intervention was equally effective in preventing cigarette smoking and use of alternative tobacco products (ATPs, i.e., snus, e-cigarettes, and waterpipe) among students from different socioeconomic backgrounds, i.e., occupational social classes (OSC).MethodsData was from the school-based intervention X:IT II targeting 13- to 15-year-olds Danes. The intervention focused on three main components: smoke-free school time, smoke-free curriculum, and parental involvement. In total, 46 schools were included at baseline (N = 2,307, response rate = 86.3%). Using a difference-in-differences approach, changes in current smoking and ever use of ATPs were estimated among students in high versus low OSC at second follow-up. Analyses were based on available cases (N = 826) and multiple imputations of missing data at the second follow-up (N = 1,965).ResultsAt baseline (age 13), 1.0% of students from high OSC and 4.8% from low OSC currently smoked cigarettes, while this was the case among 24.5 and 25.6%, respectively, at the second follow-up (age 15). Estimates indicated that social inequalities in current smoking diminished over time (p < 0.001). Regarding ATPs, 10.0% of high OSC students and 13.9% of low OSC students had ever used ATPs at baseline, while at second follow-up, 46.8 and 60.8%, respectively, had ever used ATPs. Estimates indicated that social inequalities in ever use of ATPs widened over time (p < 0.001).ConclusionsThe X:IT II intervention seemed to diminish socioeconomic disparities in smoking over the study period. Meanwhile, social inequalities in ever use of ATPs increased. Therefore, besides focusing on narrowing the social disparities in cigarette smoking, future efforts may, to a larger extent, focus on adolescents' use of ATPs.

The effect of individual-level smoking cessation interventions on socioeconomic inequalities in tobacco smoking

The effect of individual-level smoking cessation interventions on socioeconomic inequalities in tobacco smoking

Smoking Cessation Prevalence and Inequalities in the United States: 2014-2019.

Smoking is a leading cause of premature death and health inequities in the United States. We estimated cross-sectional prevalence of smoking cessation indicators among US adult recent smokers (n = 43602) overall and by sociodemographic subgroups in the Current Population Survey Tobacco Use Supplement 2014-2015 and 2018-2019 timepoints. Respondents reported past-year quit smoking interest, attempts, sustained (successful) cessation for 6 or more months and use of e-cigarettes or behavioral or pharmacological cessation treatments to quit smoking. Past-year quit smoking attempts declined slightly from 2014-2015 (52.9%) to 2018-2019 (51.3%) overall. Quit interest (pooled = 77.1%) and sustained cessation (pooled = 7.5%) did not change across timepoints. Among smokers making past-year quit attempts, 34.4% reported using cessation treatments in 2018-2019, and using e-cigarettes to quit smoking declined from 2014-2015 (33.3%) to 2018-2019 (25.0%). Several non-White (vs White) racial and ethnic groups had higher prevalence of quit interest and attempts but lower prevalence of sustained cessation or using e-cigarettes or treatments to quit. Income, education, employment, and metropolitan residence were positively associated with sustained cessation. Sociodemographic inequalities in sustained cessation and most other outcomes did not change across timepoints. Although about half of US adult smokers made past-year quit attempts from 2014 to 2019, only 7.5% reported sustained cessation, and most who made quit attempts did not report using cessation treatments. Sociodemographic inequalities in cessation were pervasive and not entirely correspondent with sociodemographic variation in motivation to quit. Smoking cessation prevalence and inequalities did not improve from 2014 to 2019. Encouraging quit attempts and equitable access to smoking cessation aids are public health priorities.

Trends in socioeconomic inequalities in smoking in Turkey from 2008 to 2016

BackgroundSmoking inequalities in Turkey were previously demonstrated in an early stage of the smoking epidemic model. This paper aimed to assess the trends for socioeconomic inequalities in smoking in Turkey over the years in the context of the smoking epidemic model using data from the Global Adult Tobacco Survey (GATS) Turkey 2008–2012-2016.MethodsCross-sectional data were analyzed to calculate the association of smoking with, wealth, education, occupation and place of residence using age-standardized prevalence rates, odds ratios, relative index of inequality (RII) and slope index of inequality (SII). The analysis was performed separately for age groups (younger: 20–39 years/older: 40 and above years) and sex.ResultsYounger women with higher wealth and older women with higher wealth and education smoked more. For both age groups, smoking was increased for working class and urban women. Relative wealth inequalities in smoking narrowed and then showed a reversal for younger women (RII2008 = 3.37; 95% CI:1.64–3.40; RII2012 = 2.19; 95% CI:1.48–3.24; RII2016 = 0.80; 95% CI:0.58–1.10, p-for trend < 0.0001). Relative educational inequalities in smoking for older women also showed a narrowing (RII2008 = 21.45; 95% CI:11.74–39.19; RII2012 = 15.25; 95% CI:9.10–25.55; and RII2016 = 5.48; 95% CI:3.86–7.78, p-for trend < 0.0001). For older women, a similar narrowing was observed for wealth (RII2008 = 3.94; 95% CI:2.38–6.53; RII2012 = 2.79; 95% CI:1.80–4.32; and RII2016 = 1.34; 95% CI:0.94–1.91, p-for trend = 0.0001). The only significant trend for absolute inequalities was for younger women by wealth. This trend showed a narrowing and then a reversal (SII2008 = 0.14; 95% CI:0.09–1.20; SII2012 = 0.12; 95% CI:0.06–0.18; and SII2016 = -0.05; 95% CI:-0.12–0.02, p-for trend = 0.0001). Unlike women, smoking in men showed inverse associations for wealth and education, although not statistically confirmed for all years. Smoking was increased in working classes and unemployed men in 2012 and 2016. Inequalities did not show a trend in relative and absolute terms for men.ConclusionsFor smoking inequalities in Turkey, a transition to the next stage was observed, although the previously defined Southern European pattern also existed. Low socioeconomic women deserve special attention as well as stressors at work and drivers of smoking at urban settings.

Inequalities in Smoking and Quitting-Related Outcomes Among Adults With and Without Children in the Household 2013-2019: A Population Survey in England.

IntroductionSmoking among those who live with children is an important influence on smoking initiation among children. This study assessed socioeconomic inequalities in smoking and quitting-related outcomes among all adults with and without children in the household.Aims and MethodsMonthly repeat cross-sectional household survey of adults (16+) from 2013–2019 in England (N = 138 583). We assessed the association between cigarette smoking and quitting-related outcomes and having children in the household, and whether these relationships were moderated by occupational social grade (categories AB–E from most to least advantaged). Trends in smoking prevalence among adults with and without children in the household were explored.ResultsIn adjusted analysis, the association of having children in the household with smoking prevalence depended on social grade: smoking prevalence was between 0.71 (95% confidence interval 0.66–0.77) and 0.93 (0.88–0.98) times lower among social grades AB–D with children in the household relative to those without. Conversely, it was 1.11 (1.05–1.16) times higher among social grade E. Yearly prevalence declined similarly among those with and without children (both prevalence ratio: 0.98, 95% confidence interval 0.97–0.99). Motivation to stop smoking was higher among those with children than those without, but lower among disadvantaged than more advantaged groups. Social grades D–E had greater heavy smoking, but higher prevalence of past-month quit attempts.ConclusionsAmong the most disadvantaged social grade in England, smoking prevalence was higher in those with children in the household than without. To attenuate future smoking-related inequalities, there is an urgent need to target support and address barriers to quitting and promote longer-term quit success.ImplicationsIn the most disadvantaged occupational social grade, having children in the household was associated with higher smoking prevalence compared with not having children. This contrasts with all other social grades in which there was lower comparative smoking prevalence among those with than without children in the household. Without attention this disparity could exacerbate existing and future health inequalities related to smoking.

The Mediating Role of Parental Factors in the Social Patterning of Smoking among Adolescents in Urban Indonesia.

Introduction:Parental factors may explain part of the social patterning of smoking among adolescents. This study aims at assessing the association between adolescent smoking and family characteristics (parental education, family wealth, and religion) and the mediating role of parental factors (smoking, control, and permissiveness towards smoking). Methods:In 2017, a cross-sectional survey was conducted in eight Indonesian cities among 2,393 students aged 13–18 years. Multilevel logistic regression analysis estimated the associations between family characteristics and adolescent smoking. Generalized Structural Equation Models (GSEM) quantified mediation of these associations by parental factors. Analyses were stratified by gender. Results:Smoking prevalence was 35.8% among boys and 2.6% among girls. Odds of smoking were higher among those with lower parental education among boys (low vs. high: OR:1.57, 95%CI:1.01-2.43), but not girls (OR:0.91, 95%CI:0.24-3.43). The association among boys was partially mediated by father’s smoking status, parental control, and parental permissiveness towards smoking. High family wealth was associated with higher odds of smoking among girls (poorer vs. wealthier: OR:0.39, 95%CI:0.15-0.99), but not boys (OR:0.76, 95%CI:0.52-1.10). This association among girls was not clearly mediated by parental factors. Religion was not associated with smoking among boys or girls. Conclusions:In Indonesia’s urban settings, inequalities in boys’ smoking by educational background may be addressed by measures aimed at supporting lower educated parents to improve parental control and to reduce permissiveness towards smoking.

460Social inequalities in second-hand smoking among Japanese adults: A repeated cross-sectional study

Abstract Background We aimed to examine the association between educational history and second-hand smoke (SHS) exposure in Japanese adults. Methods We conducted a repeated cross-sectional study using data from the 2007-2011 baseline and the 2013-2016 follow-up survey in a Japanese suburban area. Overall, 5,562 male and 5,381 female non-smokers participated in the study, which evaluated the SHS exposure and educational history of the participants through self-reported questionnaires. We performed a multilevel ordered logistic regression analysis with survey year as the first level and the individual as the second level, SHS exposure as the dependent variable, educational history as the explanatory variable, and age, smoking history, marital status as covariates, stratified by gender and working status. Results The prevalence of SHS exposure was 45.4% in males and 41.9% in females in the 2007-2011 survey, and 31.6% in males and 28.7% in females in the 2013-2016 survey. Multilevel analysis indicated that less educational history was associated with higher SHS exposure in both genders (among males, the odds ratio compared with ≥13 years was 1.75 for 10-12 years and 1.64 for ≤9 years; among females, it was 1.79 for 10-12 years and 2.43 for ≤9 years). Stratified analysis by working status showed that for females, education-based inequalities in SHS exposure more strongly impacted for workers than non-workers (p for interaction &amp;lt;0.001). Conclusions Education-based inequalities in SHS exposure exist in Japan and might be severe among female workers. Key messages Measures against SHS in Japan should be promoted to reduce social and gender inequalities.

989Relationship between housing tenure and cigarette smoking among adolescents – A population-based study

Abstract Background Cigarette smoking leads to significant morbidity and pre-mature mortality. We examined the relationship between housing tenure at ages 15, 16, 17 and 18 and smoking five years later using data from a well-established cohort study. Methods We analysed the data on 15-18-year-old adolescents (n = 2305) from the Household Income and Labour Dynamics in Australia (HILDA) survey. We applied augmented inverse probability treatment weights to maximise exchangeability between those in social housing and homeowners, and private renters. By estimating potential outcomes for the exposed and unexposed, we compared risk of smoking five years later on both absolute and relative scale. Baseline covariates included household income, age at study entry, sex, family type, smoking at baseline and highest household education. Results Adolescents in social housing had an increased risk of current smoking five years later (average treatment effect (ATE): 0.24, 95% CI: 0.02, 0.47) than homeowners. On the relative scale those in social housing had 2.23 times (95% CI: 1.08, 3.39) higher risk of being a smoker than homeowners. Those in social housing also had an increased risk of being a smoker (ATE: 0.14, 95%CI: 0.04, 0.25) than private renters. On the relative scale we estimated that those in social housing had 1.46 times (95% CI: 1.09, 1.83) higher risk of smoking than private renters. Conclusions Adolescents in social housing have a higher risk of smoking than those living in owned or private rented homes. Key messages Tobacco control efforts must target adolescent in social housing for reducing inequalities in cigarette smoking.

Trends and Regional Variation in Prevalence of Cardiovascular Risk Factors and Association With Socioeconomic Status in Canada, 2005-2016

Cardiovascular disease remains the second leading cause of death in Canada. Monitoring and tracking the trends and disparities in major cardiovascular risk factors could provide benchmarks for future cardiovascular health strategies. To investigate the temporal trends, regional variations, and socioeconomic disparities in major cardiovascular risk factors in Canada from 2005 to 2016. This repeated cross-sectional survey study included adults aged 20 years and older from 6 Canadian Community Health Survey cycles between 2005 and 2016. Cardiovascular risk factors included hypertension, diabetes, obesity, and current smoking. Socioeconomic status was measured using equivalized household income. Data analysis was performed from September 2019 to April 2020. A total of 112 health regions and socioeconomic status. Age- and sex-adjusted prevalence of hypertension, diabetes, obesity, and current smoking by year; health regions; and socioeconomic status. Absolute numbers were rounded to base 100 for confidentiality purposes, and percentages were based on weighted numbers. Slope index of inequality (SII) and relative index of inequality (RII) were calculated to assess absolute and relative socioeconomic inequalities, respectively. A total of 670 000 respondents (329 000 [49.1%] men; 341 000 [50.9%] women) aged 20 years and older from 6 survey cycles were enrolled for this study. The largest age group was those aged 40 to 59 years (eg, 2005 cycle: 40.2% [95% CI, 39.9%-40.6%]). In the 2015/2016 cycle, the overall age- and sex-adjusted prevalence rates of hypertension, diabetes, obesity, and current smoking were 20.7% (95% CI, 20.4%-21.1%), 7.2% (95% CI, 7.0%-7.5%), 20.1% (95% CI, 19.7%-20.6%), and 17.8% (95% CI, 17.4%-18.2%), respectively. From 2005 to 2016, there was a significant increase in the prevalence of hypertension, diabetes, and obesity (eg, prevalence of diabetes in both sexes, 2005: 5.8% [95% CI, 5.6%-6.0%]; 2015/2016: 7.2% [95% CI, 7.0%-7.5%]; P < .001) but a significant decrease in the prevalence of current smoking (both sexes, 2005: 22.1% [95% CI, 21.7%-22.5%]; 2015/2016: 17.8% [95% CI, 17.4%-18.2%]; P < .001). The prevalence of all the risk factors varied widely across health regions (eg, obesity, Vancouver Health Service Delivery Area: 6.7% [95% CI, 4.5%-9.0%]; Miramichi Area: 36.8% [95% CI, 27.3%-46.3%]). In addition to obesity among men, all risk factors tended to be more common among those with lower income (eg, prevalence of hypertension in both sexes, 2015/2016, lowest income group: 23.2% [95% CI, 22.4%-24.0%]; highest income group: 18.4% [95% CI, 17.7%-19.1%]). The SII and RII indicated consistent absolute and relative socioeconomic inequalities in hypertension, diabetes, and current smoking over time (eg, RII for hypertension in both sexes, 2005: 1.25; 95% CI, 1.18-1.33; 2015/2016: 1.34; 95% CI, 1.26-1.43). However, the phenomenon of absolute and relative socioeconomic inequalities in obesity was only observed among women (eg, RII for 2015/2016 for obesity in women; 1.74 (95% CI, 1.56-1.93); men: 1.09; 95% CI, 0.99-1.21). During the study period, the prevalence of hypertension, diabetes, and obesity significantly increased, while the prevalence of current smoking significantly decreased. Geographic and socioeconomic gaps should be considered and addressed in future interventions and policies targeted at reducing these cardiovascular risk factors in Canada.

Socioeconomic inequalities in tobacco smoking in women aged 15-54 in Iran: a multilevel model.

SummarySignificant evidence suggests an inverse relationship between socioeconomic status and tobacco smoking, where inequality is visible among different social and economic strata. The aim of this study was to investigate the prevalence and economic and social inequalities in tobacco smoking in women aged 15-54 in Iran. This study is a cross-sectional study. Sampling in this study was a randomized clustered multistage sampling with equal clusters. A total of 35,305 women aged 15-55 enrolled in the study. Data analysis was in two stages. In the first stage, the social and economic inequalities were investigated using the concentration index and concentration curve method, and in the second method, and multilevel method was used to identify the determinants. The prevalence of tobacco smoking in women was 12.24%. The concentration index for smoking was CI = -0.07 [95% CI (-0.09, -0.05)], which represents smoking in people with low socioeconomic status. The results of the multilevel analysis indicated that the marital status of people over the age of 35 and the economic class was related to smoking in women. Inequality in tobacco smoking in women is to the interest of the well-off group, and this inequality varies in different provinces. Marital status, place of residence, age and socioeconomic status of women are factors influencing the prevalence of tobacco smoking in women, and these issues should be noticed to reduce inequalities.

How do educational disparities in smoking develop during early life? A Swedish longitudinal study

Smoking contributes to health inequalities, but how social inequalities in smoking develop in early life remains unclear. This study examines how measures of education attained over the early life course (representing socioeconomic position of origin, socioeconomic position of destination, and in-between) contribute to smoking behavior in a Swedish longitudinal sample. We used data obtained from the Swedish Level-of-Living Surveys in addition to national register data. Young adults (aged 20–28, n = 749) self-reported their educational attainment and smoking behavior (initiation and cessation) in 2010. Ten years earlier, their parents self-reported their own education and smoking behavior. We used linked register data on school performance in adolescence (in grade 9). Logistic regression models showed that lower parental education, lower adolescent school performance, and low young adult educational attainment were respectively associated with young adult smoking initiation. The association between parental education and young adult smoking initiation was explained by adolescent school performance and not parental smoking. Young adult smoking cessation was associated with high parental education and high adolescent school performance (marks in the top quartile), but only school performance remained significant in the final model, which included all measures of education and parental smoking. Results suggest that school performance in adolescence (which connects adolescents’ socioeconomic position of origin with their destination) may play an important role in how educational disparities in smoking form over the life course.

Future smoking prevalence by socioeconomic status in England: a computational modelling study

BackgroundThe difference in smoking across socioeconomic groups is a major cause of health inequality. This study projected future smoking prevalence by socioeconomic status, and revealed what is needed to achieve...

Widening Socioeconomic Inequalities in Smoking in Japan, 2001-2016.

BackgroundJapan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.MethodsWe analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every 3 years (n ≈ 700,000 per year) in Japan, during 2001–2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures.ResultsOverall smoking prevalence (25–64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25–64 years) increased from 11.9% (95% confidence interval [CI], 11.0–12.9%) to 14.6% (95% CI, 13.5–15.6%) during 2001–2016. In 2016, smoking prevalence (25–64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern.ConclusionsSocioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.

Smokers' Use of E-Cigarettes in Situations Where Smoking Is not Permitted in England: Quarterly Trends 2011-2020 and Associations With Sociodemographic and Smoking Characteristics.

IntroductionThis study aimed to examine how the proportion of dual users of cigarettes and e-cigarettes who use e-cigarettes in situations where smoking is not permitted has changed since e-cigarettes became popular in England, and to characterize those who do so.MethodsData were from 5081 adults in England who reported current smoking and current use of e-cigarettes (‘dual users’) participating in a nationally-representative monthly survey between April 2011 and February 2020. We modeled quarterly changes in prevalence of e-cigarette use in situations where smoking is not permitted and assessed multivariable associations with sociodemographic and smoking characteristics.ResultsBetween 2011 and 2020, prevalence of e-cigarette use in situations where smoking is not permitted followed a positive cubic trend, with a decelerating increase from an estimated 52.5% of dual users in Q2-2011 to 72.7% in Q3-2014, followed by a small decline to 67.5% in 2018, and subsequent increase to 74.0% in 2020. Odds were higher among those who were from more disadvantaged social grades, reported stronger smoking urges, or had made a past-year quit attempt, and lower among those who were aged at least 65 years (vs. 16–24 years), from the south (vs. north) of England, reported currently cutting down on their cigarette consumption or currently using nicotine replacement therapy.ConclusionsIn England, use of e-cigarettes in situations where smoking is not permitted is common among dual cigarette and e-cigarette users, has increased nonlinearly since 2011, and is particularly prevalent among those who are younger, disadvantaged, more addicted, have recently failed to quit, and are not attempting to cut down.ImplicationsThe ability to use nicotine in smoke-free settings appears to be an important part of the appeal of e-cigarettes. It is possible that if e-cigarette use was prohibited in public places, smokers may be deterred from using e-cigarettes alongside combustible tobacco, which could undermine quitting. Our results suggest disadvantaged and more addicted smokers would be disproportionately affected, suggesting such restrictions may contribute to inequalities in smoking and associated health outcomes.

Socioeconomic Determinants of Smoking in the Kingdom of Saudi Arabia.

Tobacco consumption, or smoking, is a major cause of preventable morbidity and mortality worldwide, including in the Kingdom of Saudi Arabia (KSA). In order to reduce the consumption of tobacco products, it is necessary to understand the factors that drive it. However, little is known about the socioeconomic determinants of tobacco smoking in the KSA. This study, therefore, investigates the socioeconomic factors that influence tobacco smoking in the KSA. Using a national health survey, the study employs logistic and negative binomial regressions to examine the socioeconomic factors associated with smoking. Moreover, the inequality concentration indices (CIs) are used to assess inequalities in smoking. The results reveal that the smoking prevalence is 14.09% of the 8813 respondents considered in this study. The prevalence of smoking is higher among men (25.34%) than among women (1.91%). On the determinants of smoking, the logistic regression results show that higher income is associated with lower likelihood of smoking. Other factors significantly associated with current smoking status are marital status, gender, age, and region of residence. Similarly, gender, age and region of residence are significantly associated with smoking intensity. As regards the inequality analysis, at the national level, the results show that smoking is concentrated among those with higher socioeconomic status (income: CI = 0.071, p < 0.01; education: CI = 0.095, p < 0.01), but with significant regional variations. By gender disaggregation, the results also show that the income-based CIs are positive for both males and females, but statistically insignificant. Education-based CI is positive for males and significant (CI = 0.057, p < 0.05), while it is negative and insignificant for females during the study period. The findings call for targeted tobacco control measures focusing on those with higher socioeconomic status, as well as factors such as age, gender, marital status and region of residence.

Investigating smoking and nicotine dependence among people with severe mental illness during the COVID-19 pandemic: analysis of linked data from a UK Closing the Gap cohort.

Smoking rates are higher for people who use mental health services, which contributes substantially to health inequalities. Smoking can lead to worse COVID-19 outcomes, yet it remains unclear whether smoking has changed for people who use mental health services. We examined smoking patterns in a large clinical cohort of people with severe mental illness, before and during the pandemic. We found high levels of nicotine dependence and heavier patterns of smoking. Although some people had reported quitting, it is likely that smoking inequalities have become further entrenched. Mental health services should seek to mitigate this modifiable risk and source of poor health.

Association between educational level and smoking cessation in an 11-year follow-up study of a national health survey.

Aims: There is a lack of longitudinal, population-based studies on the association between education and smoking cessation. A more thorough examination of this association is needed to address inequalities in smoking. Methods: The longitudinal Health 2000 Survey and Health 2011 Survey, representing the Finnish population aged ⩾30 years, were analysed. Of the 1352 baseline daily smokers, 945 (70%) provided a smoking status at the follow-up. The analytic sample size was 884 (excluding the follow-up occasional smokers). Self-reported questionnaire data and measurements (e.g. plasma cotinine) from the baseline were utilised. The outcome variable was smoking cessation at the follow-up, and the main explanatory variable was education. Logistic regression was the main method for statistical analyses. All of the analyses accounted for the sampling design. Results: At the follow-up, 28% of the baseline daily smokers had quit smoking. An adjusted regression model showed that highly educated respondents had a higher likelihood of quitting smoking compared with those with basic education. Controlling for demographic and health-related variables had a modest effect on this association. Higher scores for plasma cotinine, symptoms of depression and heavy alcohol use were associated with a lower likelihood of quitting smoking. The association between education and smoking cessation was weaker for women than it was for men. Conclusions: High education is associated with smoking cessation among the general adult population, especially among men. A higher plasma cotinine level is strongly associated with continued smoking among both sexes. Background variables only modestly affected the association between education and smoking cessation.

Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008\u20132016: a repeated cross-sectional study

BackgroundSmoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016.MethodsWe conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated.ResultsSmoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time.ConclusionsSmoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.

Simulating the density reduction and equity impact of potential tobacco retail control policies

BackgroundReducing the provision of tobacco is important for decreasing inequalities in smoking and smoking-related harm. Various policies have been proposed to achieve this, but their impacts—particularly on equity—are often unknown....