Socioeconomic Inequalities In Smoking Research Articles

Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study

BackgroundAs prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in...

Socioeconomic inequalities in smoking and drinking in adolescence: social network dynamics

Abstract Background Network-based interventions have the potential to prevent socioeconomic inequalities in health behaviors but require a good understanding of the underlying social network mechanisms. We investigated whether (1) adolescents selected friends with a similar socioeconomic status (SES), (2) smoking and alcohol consumption spread in networks, and (3) the exclusion of non-smokers or non-drinkers differed between SES groups. Methods We applied Stochastic Actor Oriented Models to the complete social network data (“Wired into Each Other” data) of 253 adolescents in eight Hungarian secondary school classes over three waves between 2010 and 2013. SES was measured based on entitlement to an income-tested regular child protection benefit. Results High SES adolescents were most likely to form friendships with peers from their own SES group (odds ratio [OR] = 1.1, 95% Confidence Interval [CI] = 1.0-1.1). Adolescents adjusted their smoking behavior (OR = 24.0, 95% CI 1.3-454.9) but not their alcohol consumption (OR = 1.6, 95% CI 0.6-4.4) to emulate the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 1.0, 95% CI 0.9-1.1), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.2, 95% CI 1.0-1.3), but this association was not significantly different according to SES. Conclusions Socioeconomic inequalities in health behaviors were driven by preferences to form friendships within their own SES group and the spread of smoking and alcohol consumption in the network. These inequalities were not amplified by SES differences in encouraging smoking or drinking. Main messages: In three waves of observations in a Hungarian adolescent cohort, the study found social network effects for inequalities in smoking and alcohol consumption. Key messages • Inequalities in health behaviors arise because adolescents with high socioeconomic backgrounds selected each other as friends and smoking/alcohol consumption spread in networks. • Inequalities were not due to socioeconomic differences in encouraging harmful behaviors.

The emergence of socioeconomic inequalities in smoking during adolescence and early adulthood

BackgroundWhile it is known that educational inequalities in smoking start during early and middle adolescence, it is unknown how they further develop until adulthood. The aim of this article is to map, in the Portuguese context, how educational inequalities in smoking emerge from pre-adolescence until young adulthood.MethodsThis study used longitudinal data from the EPITeen Cohort, which recruited adolescents enrolled in schools in Porto, Portugal. We included the 1,038 participants followed at ages 13 (2003/2004), 17, 21, and 24 years. We computed the odds ratio (OR) for the prevalence of smoking states (never smoking, experimenter, less-than-daily, daily and former smoker) and the incidence of transitions between these states, as function of age and education, stratified by sex. We also added interaction terms between age and education.ResultsEducational inequalities in daily smoking prevalence, with higher prevalence among those with lower educational level, emerged at 17 years old and persisted until higher ages. They were formed in a cumulative way by the increased risk of experimenting between 13 and 17 years, and increased risk of becoming daily smoker between 17 and 21 years. The incidence of smoking cessation was higher among the higher educated. Inequalities were formed similarly for women and men, but with lower level and showed no significance among women.ConclusionsThese results highlight that actions to prevent smoking should also take in account the potential impact in smoking inequalities, and should focus not only on middle adolescence but also on late adolescence and early adulthood.

The case for individualised public health interventions: Smoking prevalence and inequalities in Northern Ireland 1985-2015

BackgroundWhile smoking prevalence in high income countries has declined over time, socioeconomic inequalities in smoking have widened. This study is one of the few studies to examine the longitudinal pattern of income-related smoking inequalities and only the second using concentration indices in its analysis. MethodIncome-related smoking inequalities were measured using concentration indices using the Northern Ireland Continuous Household Survey data. Smoking inequalities were compared quantitatively and visually across three periods: 1985–1995, 1997–2005 and 2007–2015. Joinpoint analysis was used to measure the overall time trend of smoking inequalities. Subgroup analysis was used to examine the nature of change in smoking inequalities across population sub-groups. FindingsThroughout 1985–2015, smoking was more concentrated among the poor (standard concentration index of-0·131, p < 0·001). While prevalence declined sharply across population, income-related inequalities increased sharply in general and within subgroups. Income-related smoking inequalities were significantly larger among high educated group and those who were employed. No structural break was observed with respect to the adoption of any specific policy measures over the period. ConclusionCurrent approaches to tobacco control may be ill-suited to addressing smoking inequalities and may indeed be counterproductive. More tailored approaches that address the specific needs of population sub-groups or more draconian approaches such as extensions to prohibition may be required to reduce prevalence further while avoiding a widening of inequalities.

Trends in the distribution of socioeconomic inequalities in smoking and cessation: evidence among adults aged 18 ~ 59 from China Family Panel Studies data

IntroductionCigarette smoking is usually more prevalent among those with a lower socioeconomic status (SES), which can be driven by inequalities in the initiation and cessation of smoking, giving rise to SES disparities in health. This study aimed to gauge the SES inequalities in smoking related behaviours and their evolving trends based on a nationally representative database.MethodData were extracted from repeated cross-sectional China Family Panel Studies (CFPS) of adults aged ≥18 and <60 years in 2012, 2014, 2016 and 2018. SES was constructed by principal component analysis based on income, education and occupation. Regression-based odds ratios and coefficients as the relative effect index of inequality were applied to quantify the degree of socioeconomic inequality in smoking related behaviours and to adjust for possible confounding factors. Multivariable regressions were utilized to explore the temporal trends in smoking inequalities.ResultsThe smoking prevalence among men decreased from 61.16% to 2012 to 57.88% in 2018, cigarette consumption among current smokers declined from 16.71 to 15.49 cigs/per day, and the cessation rate increased from 17.55% to 24.08%. Cigarette consumption for women decreased from 13.39 in 2012 to 11.01 cigs/per day in 2018. Smoking prevalence showed significant SES inequalities among men and women from 2012 to 2018 (men: OR2012 (95%CI)= 0.72 (0.63, 0.83), OR2014 = 0.60 (0.52, 0.69), OR2016 = 0.58 (0.50, 0.67), OR2018 = 0.56 (0.48, 0.66); women: OR2012 = 0.63 (0.41, 0.97), OR2014 = 0.50 (0.32, 0.79), OR2016 = 0.44 (0.26, 0.73), OR2018 = 0.50 (0.30, 0.85)). Cigarette consumption showed significant SES inequalities among men from 2012 to 2018 (β2012=-1.39 (-2.22, -0.57), β2014=-2.37 (-3.23, -1.50), β2016=-2.35 (-3.25, -1.44), β2018=-2.91 (-3.86, -1.97)). In 2018, inequality emerged in smoking cessation rates among men and smoking intensity among women. However, all tests for trends in changes over time were not statistically significant (P varied from 0.072 to 0.602).ConclusionThe smoking prevalence declined between 2012 and 2018 in China. However, SES inequalities in smoking persist, while socioeconomic inequalities in smoking were not alleviated among adults aged 18 ~ 59 in China. Tobacco control measures should be implemented by giving more attention to people with lower SES who are more vulnerable to tobacco use.

Leaving nobody behind? Widening socio-economic inequalities in smoking as Ireland moves towards being tobacco-free

Leaving nobody behind? Widening socio-economic inequalities in smoking as Ireland moves towards being tobacco-free

Smokers’ strategies to reduce tobacco spending: self-reported use and differences across subgroups. Findings from the International Tobacco Control (ITC) Netherlands Survey

BackgroundThe cost of tobacco is one of the most reported reasons for smoking cessation. Rather than quitting, smokers can use also strategies to reduce tobacco expenditure while continuing smoking, such as smoking less or using price-minimising strategies. The Netherlands announced to increase the price of a pack cigarettes from seven (2018) to ten euros (2023), to reduce tobacco prevalence and consumption. This study explores the self-reported strategies to reduce tobacco spending among Dutch smokers, and whether this differed per age, income, and education. Additionally, we analysed among quitters in these subgroups whether price played a role in their decision to quit.MethodsCross-sectional survey data from the International Tobacco Control (ITC) Netherlands Wave 2 (September–November 2020, N = 1915) was used. Strategies to reduce spending among smokers (N = 1790) were: reducing consumption, bulk buying, switching to cheaper products or buying from low-taxed sources. These were collapsed into: reducing consumption (solely or in combination with other behaviours), solely price-minimising behaviours (such as buying cheaper brands), or no strategies to reduce spending. Associations between strategies and characteristics were analysed through multinomial and binary logistic regression models. Second, we explored which subgroups were more likely to report that price played a role in their decision to quit among quitters (N = 125).ResultsThe majority of smokers used strategies to reduce tobacco spending: 35.6% reduced consumption and 19.3% used solely price-minimising strategies. 82.1% of quitters reported that price played a role in their decision to quit. Low-income individuals were more likely to report price as a reason for quitting and reduce consumption, but also to buy cheaper products. Highly nicotine dependent smokers were more likely to use price-minimising behaviours, and less likely to reduce consumption.ConclusionsThe majority reported using strategies to reduce spending or that price played a role in their decision to quit. Reducing consumption was the most reported strategy. Low-income smokers were more likely to reportedly reduce consumption, buy cheaper products, or quit. Price policies have the potential to reduce socioeconomic inequalities in smoking. To discourage price-minimising behaviours, such as switching to cheaper products, reducing price differences between products should be prioritized.

Prevalence and intensity of cigarette smoking in Iranian households: measurement of socioeconomic inequality

ABSTRACT Background Cigarette smoking is one of the most important behavioral risk factors for chronic diseases. This study aimed to investigate socioeconomic inequalities in cigarette smoking (CS) among Iranian households. Methods Concentration index (C) was calculated to measure socioeconomic inequality in smoking and number of smoked cigarettes per month among households using data from the income-expenditure survey of the statistical center of Iran (SCI) in 2017. To identify the contribution of socioeconomic and demographic variables to the measured socioeconomic inequality, the C index was decomposed using Wagstaff method. Results The results indicated that 19.89% (N = 7547) of the households were smoking cigarettes with an average number of 87.91 (SD = 235.22) per month. The C index was −0.009 for smoking households (95% CI = −0.023, 0.006) and 0.004 (95% CI = −0.011, 0.019) for the number of cigarettes smoked per month and were not statistically significant. Most of provinces had pro-rich inequality in prevalence and intensity of CS. The province of residence had the highest contribution to inequality in smoking (66.82%) followed by SES and age of the household head. Conclusions The study concluded that the prevalence and intensity of cigarette smoking were more concentrated among low-SES groups. The strategies to control CS should be modified based on the province of residence, and socioeconomic inequalities in CS among households.

Socioeconomic inequality in smoking: Evidence from a decomposition analysis

ProblemVietnam is a lower-middle-income country with a very high prevalence of smoking among men. The poor are more likely to smoke than the better off. In this study, we examine socioeconomic inequality in smoking and factors associated with the wealth-related inequality of smoking in Vietnam. MethodsWe use data from the 2010 and 2015 Global Adult Tobacco Surveys (GATS). We use a concentration index approach to assess differences in smoking behavior over the distribution of wealth levels. We also use the regression-based decomposition method developed by Wagstaff et al. (2003) and Doorslaer and Koolman (2004) to decompose wealth-related inequality in smoking into inequalities in wealth and other explanatory variables, such as men's age and education. ResultsPoorer men are more likely to smoke and smoke more than those better off. In 2015, 47.9% in the poorest wealth quintile smoked every day compared to 29.1% in the richest quintile. In 2015, the concentration index of wealth-related inequality in daily smoking was estimated at −0.104 (CI: 0.135; −0.072). Education and occupation are important factors in wealth-related inequality in smoking, because the poor tend to have lower education levels and are employed in unskilled jobs but are more likely than the rich to be smokers. At 41.4%, unskilled workers make the largest contribution to wealth-related inequality in smoking. ConclusionsOur findings suggest that tobacco prevention efforts should be focused on poor, less educated people. Policies that boost the access of the poor to education and better employment can help them not only increase their wealth level but also reduce smoking, thereby narrowing the wealth-inequality gap in smoking.

Yet another reason we need to tackle socioeconomic inequalities in smoking.

Yet another reason we need to tackle socioeconomic inequalities in smoking.

Educational inequalities in exposure to tobacco promotion at the point of sale among adolescents in four Dutch cities.

This study aimed to assess educational differences in adolescents' exposure to tobacco outlets. Data were collected among 312 13-17-year-old non-smoking secondary school students in four Dutch cities. In a smartphone app, exposure (≤10m from outlet) was measured using GPS and participants reported their educational track (pre-vocational vs. pre-university). Associations were estimated in negative binomial regression models. Mean exposure to tobacco outlet was 16.6 times in 14 days. Pre-vocational education was associated with higher exposure compared to pre-university education (IRR:1.46, 95%CI:1.08-1.98), especially around school (IRR:2.61,95%CI:1.50-4.55). These differences may contribute to socioeconomic inequalities in smoking.

Trends in Socio-economic Inequality in Smoking Among Middle-aged and Older Adults in China: Evidence From the 2011 and 2018 China Health and Retirement Longitudinal Study.

Socio-economic inequalities in smoking and related health problems are a public health concern worldwide. To support the development of effective tobacco control policies, this study examines trends in smoking rates according to socio-economic status (SES) in China. We analyzed data from repeated cross-sectional China Health and Retirement Longitudinal Study (CHARLS) on adults aged ≥45 years for the years 2011 and 2018, which involved 16 471 participants in 2011 and 19 367 in 2018. We then estimated the SES of individuals based on four types of wealth-related variables, namely, education, occupation, household characteristics, and durable consumer goods. Principal-component analysis was conducted to measure SES, and the Erreygers normalised concentration index (ECI) was used to calculate socio-economic inequality in current smoking by gender, age, and region. The overall ECI (95% confidence interval) for women was -0.042 (-0.054 to -0.031) and -0.038 (-0.047 to -0.029) for 2011 and 2018, respectively. The ECI (95% confidence interval) for men was -0.077 (-0.101 to -0.050) and -0.019 (-0.042 to 0.005) for 2011 and 2018, respectively. The inequality in smoking by SES for adults aged < 60 years in the Northeast region increased during 2011-2018, from -0.069 (-0.144 to 0.006) to -0.119 (-0.199 to -0.038) for women and from 0.009 (-0.115 to 0.132) to -0.164 (-0.296 to -0.032) for men. smoking inequality by socio-economic among adults aged ≥45 years declined in recent years in China. However, smoking inequality by SES increased in other population groups. Our research indicated that socio-economic inequality of current smoking among residents aged 45 years and older declined in 2018 when compared with 2011 numbers, particularly for men aged ≥ 60 years. Women in the Northeast region displayed more significant smoking inequality by SES than women in other regions did. During the study period, there was an increase in inequality in smoking by SES for adults aged < 60 years in the Northeast region. Thus, tobacco control policies and interventions should be targeted at high-risk subpopulations with lower SES, particularly in Northeast China.

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.

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.

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.

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.

The importance of socioeconomic position in smoking, cessation and environmental tobacco smoke exposure during pregnancy

Tobacco is still a leading cause of premature death and morbidity. Particular attention has been given to pregnant women due to the scientific evidence on the importance of early life exposures for disease onset later in life. The purpose of this study was to assess smoking prevalence, smoking cessation rate and environmental tobacco smoke (ETS) exposure, and the role of socioeconomic position (SEP) on these behaviors among pregnant women. Cross-sectional data of 619 pregnant women, aged between 18 and 46 years, from Porto Metropolitan Area, Portugal, on current smoking, ETS exposure and SEP indicators was collected, face-to-face, using a questionnaire filled in during a personal interview at the postpartum hospital stay. The smoking prevalence, and ETS exposure among non-smokers before pregnancy was 27.6% and 57.4%, respectively. 4.1% of the participants reported to have stopped smoking before pregnancy, whereas about 41% quitted along pregnancy, resulting in a smoking prevalence at birth of 14.6%. Exposure to ETS also decreased throughout pregnancy to 49.8% at birth. Lower educational level was significantly associated with both higher smoking prevalence and exposure to ETS and lower smoking cessation. This study demonstrates that smoking and ETS exposure during pregnancy remains high, and that there are still significant socioeconomic inequalities in smoking; thus tobacco-focused preventive interventions need to be reinforced.

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.

Change in the Prevalence and Social Patterning of First-and Second-Hand Smoking in PORTUGAL: A Repeated Cross-Sectional Study (2005 and 2014).

Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first- and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%–54% among men, and 52%–38% among women), and a reduction in smoking among men (27%–26%), and an increase among women (9%–12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective.