Socioeconomic Inequalities In Smoking Research Articles

The impact of governmental antismoking policy on socioeconomic disparities in cigarette smoking in South Korea

With enactment of the 1995 Health Promotion Act, the Korean government has developed numerous antismoking policies, including smoke-free buildings and zones, a public media campaign, and tobacco taxation. The present study examined whether governmental antismoking policy during the past decade was associated with reduced socioeconomic differentials in cigarette smoking in South Korea. Data from 99,980 men and 105,193 women aged 25-64 years were analyzed from four rounds of Social Statistical Surveys of Korea between 1995 and 2006. Socioeconomic position (SEP) indicators were education, occupational class, employment status, and household income. Age-adjusted prevalence of smoking was calculated. Prevalence ratios and the relative index of inequality (RII) were estimated using log-binomial regression analysis. Absolute socioeconomic differentials in age-adjusted prevalence of smoking increased between 1995 and 2006. Increases were found in both men and women. Prevalence ratios and RIIs also showed widening relative inequalities in smoking in all four SEP indicators in men. For women, increases in RIIs for education and income were statistically significant. The magnitude of change in prevalence ratios and RIIs by SEP indicators between 1999 and 2003 was statistically significant, whereas the difference between 2003 and 2006 was not. Despite reducing overall cigarette smoking rates in males, the governmental antismoking policies of South Korea did not reduce socioeconomic inequalities in smoking in both genders. However, the recent tobacco taxation policy is likely to dampen the ever-increasing trends in smoking inequalities. More progressive antismoking policies to reduce socioeconomic inequalities in smoking are warranted in South Korea.

Monitoring of socio-economic inequalities in smoking: Learning from the experiences of recent scientific studies

To support policies to tackle socio-economic inequalities in smoking, monitoring systems should include information on smoking according to socio-economic position (SEP). This paper aims to review the methods applied in recent scientific studies on inequalities in smoking, with the aim of drawing lessons for the monitoring of smoking inequalities. Literature review. Seventy studies on socio-economic inequalities in smoking, published since 1990, were selected and reviewed, with particular focus on study design, indicators of SEP and smoking outcomes. Most studies had a cross-sectional design and measured smoking prevalence rates among adults in relation to educational level. In addition to educational level, measures of household wealth and occupational class had strong associations with smoking outcomes. In addition to smoking prevalence, other outcome measures such as initiation rates, cessation rates and consumption level are needed to provide in-depth knowledge of the effect of SEP on smoking, especially from a life-course perspective. It is recommended that, as well as educational level, other socio-economic indicators should be used to identify socio-economic groups where smoking rates are highest. Estimates of inequalities in initiation and cessation rates are needed to identify the most important age groups and entry points for policies to tackle inequalities in smoking.

Time perspective in socioeconomic inequalities in smoking and body mass index.

To determine if time perspective plays a mediating role in the relationship between socio-economic position (SEP) and both smoking and body mass index (BMI). 2000 adults aged 18 years and over were randomly selected from the edited electoral register for the city of Newcastle upon Tyne, England and sent a postal questionnaire. Two reminders were sent. Socio-economic position was measured using the Index of Multiple Deprivation (IMD) of the area of residence. Time perspective was measured using the Consideration of Future Consequences Scale (CFCS). Smoking and BMI were self-reported. Full data was available for 804 individuals (response rate: 40.2%). After controlling for age, gender and health status, IMD was significantly associated with BMI, smoking status and CFCS score (p < .001), and CFCS score was significantly associated with BMI (p < .001), but not smoking status. There was evidence that CFCS score played a partial mediating role in the relationship between IMD and BMI but not that between IMD and smoking status. Further longitudinal work is required to confirm the mediating role of time perspective in socio-economic inequalities in BMI. Interventions tailored to individuals time perspective may be effective in reducing obesity and socio-economic inequalities in obesity.

Monitoring trends in socioeconomic health inequalities: it matters how you measure

BackgroundOdds ratio (OR), a relative measure for health inequality, has frequently been used in prior studies for presenting inequality trends in health and health behaviors. Since OR is not a good approximation of prevalence ratio (PR) when the outcome prevalence is quite high, an important problem may arise when OR trends are used in data in which the outcome variable (e.g., smoking or ill-health) is of relatively high prevalence and varies significantly over time. This study is to compare time trends of odds ratio (OR) and prevalence ratio (PR) for examining time trends in socioeconomic inequality in smoking.MethodsA total of 147,805 subjects (71,793 men and 76,017 women) aged 25–64 from three Social Statistics Surveys of Korea from 1999 to 2006 were analyzed. Socioeconomic position indicators were occupational class and education.ResultsWhile there were no significant p values for trend in ORs of occupational class among men, trends for PRs were significant. In women, p values for OR trends were similar to those for PR trends. In males, RII by log-binomial regression showed a significant increasing tendency while RII by logistic regression was stable between years. In females, trends of RIIs by logistic regression and log-binomial regression produced a similar level of p values.ConclusionDifferent methods of measuring trends in socioeconomic health inequalities may lead to different conclusions about whether relative inequalities are increasing or decreasing. Trends in ORs may overstate or understate trends in relative inequality in health when the outcome is of relatively high prevalence and that prevalence varies significantly with time.

Emergence of Socioeconomic Inequalities in Smoking and Overweight and Obesity in Early Adulthood: The National Longitudinal Study of Adolescent Health

We examined whether socioeconomic inequalities in smoking and overweight and obesity emerged in early adulthood and the contribution of family background, adolescent smoking, and body mass index to socioeconomic inequalities. Using data from the National Longitudinal Study of Adolescent Health we employed multinomial regression analyses to estimate relative odds of heavy or light-to-moderate smoking to nonsmoking and of overweight or obesity to normal weight. For smoking, we found inequalities by young adult socioeconomic position in both genders after controlling for family background and smoking during adolescence. However, family socioeconomic position was not strongly associated with smoking in early adulthood. For overweight and obesity, we found socioeconomic inequalities only among women both by young adult and family socioeconomic position after adjusting for birthweight, other family background, and body mass index during adolescence. Socioeconomic inequalities in smoking emerged in early adulthood according to socioeconomic position. Among women, inequalities in overweight or obesity were already evident by family socioeconomic position and strengthened by their own socioeconomic position. The relative importance of family background and current socioeconomic circumstances varied between smoking and overweight or obesity.

Applying an Equity Lens to Tobacco-Control Policies and Their Uptake in Six Western-European Countries

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

Socioeconomic inequality in cigarette smoking: Trends by gender, age, and socioeconomic position in South Korea, 1989–2003

Objective. The aim of this study was to examine trends of socioeconomic differentials in smoking rates by gender, age, and socioeconomic position in South Korea. Methods. We used data from five Social Statistical Surveys of Korea National Statistical Office from 1989 to 2003. This study included 344,969 men and women aged 20 or over. Socioeconomic position indicators were education and occupation. Results. Age-standardized smoking rates decreased in all age groups of men and women aged 45+ between 1989 and 2003, while smoking rates among women aged 20–44 did not decrease. Education was inversely associated with smoking in both genders. Those with manual occupations had greater smoking rates than those who performed non-manual labor. Based on the relative index of inequality, unfavorable inequality trends toward low education were detected in both genders aged 20–44. However, these trends were not found at ages 45–64. For occupational class, the relative inequality in smoking measured by odds ratios remained stable among men and women between 1995 and 2003. Conclusions. Continuous and progressive anti-smoking policy measures should be directed toward South Korean men whose smoking rates are still high. Policy efforts to reduce socioeconomic inequality in smoking, especially among young adult men and women, should be exercised. In addition, additional anti-smoking policy measures toward young women's smoking habits need to be developed in South Korea.

Trends in educational inequalities in smoking in northern, mid and southern Italy, 1980–2000

Background. We aimed to determine the direction and magnitude of socioeconomic inequality in smoking in Italy over the last two decades, focusing on both national and macro-regional patterns. Methods. We used data from six National Health Interview Surveys from 1980 to 2000, whose sample size ranged between 60,000 and 140,000. We calculated age-adjusted prevalence rates of current smoking and estimated odds ratios (OR) and relative indexes of inequality (with 95% confidence intervals) using logistic regression analysis. Results. In men aged 25–49, the OR of current smoking of low compared to high educated was 1.26 (95% CI: 1.16, 1.37) in 1980 and 1.71 (95% CI: 1.62, 1.80) in 2000. A reversal of the association between education and tobacco use from positive (OR = 0.43) to negative (OR = 1.12) was found for women of the same age group. Changes in educational inequalities in smoking were similar between different macro-regions for men, whereas among women, smaller differentials over all the study period were found in southern regions compared to central and northern regions, despite similar direction in trends. Conclusions. The gap between high- and low-educated groups has widened, especially in the youngest generations. Southern regions lag behind central and northern Italy in the progression of the smoking epidemic.