Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women?

International Journal for Equity in Health

Anton E Kunst¹  Margot I Witvliet¹  Selma Mehmedovic¹  Jizzo R Bosdriesz¹ 

[1] Department of Public Health, Academic Medical Centre -University of Amsterdam, Amsterdam, The Netherlands

关键词: World health survey;    Global;    Smoking epidemic;    Inequalities;    Women;    Socio-economic status;    Smoking;   

Others  :  804051
DOI  :  10.1186/1475-9276-13-14

 received in 2013-08-07, accepted in 2014-01-19,  发布年份 2014

【 摘 要 】

Background

In Southern Europe, smoking among older women was more prevalent among the high educated than the lower educated, we call this a positive gradient. This is dominant in the early stages of the smoking epidemic model, later replaced by a negative gradient. The aim of this study is to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world.

Methods

We used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. We stratified results by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region.

Results

In Eastern Europe and the Eastern Mediterranean, we observed a positive gradient in smoking among older women and a negative gradient among younger women. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. In South-East Asia and East Asia a strong negative gradient was observed. Among men, no positive gradients were observed, and like women the strongest negative gradients were seen in South-East Asia and East Asia.

Conclusions

A positive socio-economic gradient in smoking was found among older women in two regions, but not among younger women. But contrary to predictions derived from the smoking epidemic model, from a worldwide perspective the positive gradients are the exception rather than the rule.

【 授权许可】

   
2014 Bosdriesz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Shafey O, Eriksen M, Ross H, Mackay J: The future. In The tobacco Atlas. 3rd edition. Atlanta, Georgia: American Cancer Society; 2013:88-89. Also available at http://www.TobaccoAtlas.org webcite. -See more at: http://www.tobaccoatlas.org/more#sthash.tTUjXvKH.dpuf webcite
• [2]WHO framework convention on tobacco control: why is it important?. http://www.who.int/features/qa/34/en/index.html webcite
• [3]Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grotvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, et al.: Educational differences in smoking: international comparison. BMJ 2000, 320:1102-1107.
• [4]Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, Dalstra JA, Federico B, Helmert U, Judge K, et al.: Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health 2005, 59:395-401.
• [5]Kunst AE: Describing socioeconomic inequalities in health in European countries: an overview of recent studies. Rev Epidemiol Sante Publique 2007, 55:3-11.
• [6]Huisman M, Kunst AE, Mackenbach JP: Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 2005, 14:106-113.
• [7]Federico B, Kunst AE, Vannoni F, Damiani G, Costa G: Trends in educational inequalities in smoking in northern, mid and southern Italy, 1980-2000. Prev Med 2004, 39:919-926.
• [8]Lopez AD, Collishaw N, Piha T: A descriptive model of the cigarette epidemic in developed countries. Tob Control 1994, 3:242-247.
• [9]Pampel F: Tobacco use in sub-Sahara Africa: estimates from the demographic health surveys. Soc Sci Med 2008, 66:1772-1783.
• [10]Pampel FC: Patterns of tobacco use in the early epidemic stages: Malawi and Zambia, 2000-2002. Am J Public Health 2005, 95:1009-1015.
• [11]Pampel FC, Denney JT: Cross-national sources of health inequality: education and tobacco use in the world health survey. Demography 2011, 48:653-674.
• [12]Hosseinpoor AR, Parker LA, Tursan dE, Chatterji S: Socioeconomic inequality in smoking in low-income and middle-income countries: results from the world health survey. PLoS One 2012, 7:e42843.
• [13]Hosseinpoor AR, Bergen N, Kunst A, Harper S, Guthold R, Rekve D, d’Espaignet ET, Naidoo N, Chatterji S: Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the world health survey. BMC Public Health 2012, 12:912. BioMed Central Full Text
• [14]World Health Organisation: World health survey. http://who.int/healthinfo/survey/en/index.html webcite . 2011. 19-2-2013
• [15]Global health observatory data repository http://apps.who.int/gho/data/# webcite
• [16]United nations statistics division http://unstats.un.org/unsd/demographic/default.htm webcite
• [17]WHO Global Observatory for eHealth: Source of country indicators in the atlas. 2013. http://www.who.int/goe/publications/atlas/source/en/ webcite
• [18]WHO regional offices http://www.who.int/about/regions/en/index.html webcite
• [19]Age standardization of rates: a new WHO standard http://www.who.int/healthinfo/paper31.pdf webcite
• [20]Pampel FC: Global patterns and determinants of sex differences in smoking. Int J Comp Sociol 2006, 47:466-487.
• [21]Ustün TB, Chatterji S, Mechbal A, Murray CJL, WHO Collborating Groups: The world health surveys. In Health systems performance assessment. Edited by Murray CJL, Evans DB. Geneva: World Health Organisation; 2003:797-808.
• [22]Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, Peto R, Zatonski W, Hsia J, Morton J, et al.: Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet 2012, 380:668-679.
• [23]Gupta PC, Ray CS: Smokeless tobacco and health in India and South Asia. Respirology 2003, 8:419-431.
• [24]Hashibe M, Jacob BJ, Thomas G, Ramadas K, Mathew B, Sankaranarayanan R, Zhang ZF: Socioeconomic status, lifestyle factors and oral premalignant lesions. Oral Oncol 2003, 39:664-671.
• [25]Gorber SC, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M: The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009, 11:12-24.
• [26]Caraballo RS, Giovino GA, Pechacek TF, Mowery PD: Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: third national health and nutrition examination survey, 1988-1994. Am J Epidemiol 2001, 153:807-814.
• [27]Suadicani P, Hein HO, Gyntelberg F: Serum validated tobacco use and social inequalities in risk of ischaemic heart disease. Int J Epidemiol 1994, 23:293-300.
• [28]Wagenknecht LE, Burke GL, Perkins LL, Haley NJ, Friedman GD: Misclassification of smoking status in the CARDIA study: a comparison of self-report with serum cotinine levels. Am J Public Health 1992, 82:33-36.
• [29]Wewers ME, Dhatt RK, Moeschberger ML, Guthrie RM, Kuun P, Chen MS: Misclassification of smoking status among Southeast Asian adult immigrants. Am J Respir Crit Care Med 1995, 152:1917-1921.
• [30]Harper S, McKinnon B: Global socioeconomic inequalities in tobacco use: internationally comparable estimates from the world health surveys. Cancer Causes Control 2012, 23(1):11-25.
• [31]Palipudi KM, Gupta PC, Sinha DN, Andes LJ, Asma S, McAfee T: Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from global adult tobacco survey. PLoS One 2012, 7:e33466.
• [32]Macias F, Malmusi D, Borrell C: Different patterns by age-group and gender of socioeconomic inequalities in smoking in Colombia. Nicotine Tob Res 2013, 15:1745-1755.
• [33]Hassoy H, Ergin I, Kunst AE: Socioeconomic inequalities in current daily smoking in five Turkish regions. Int J Public Health 2013. [Epub ahead of print]
• [34]Usmanova G, Neumark Y, Baras M, McKee M: Patterns of adult tobacco use in Uzbekistan. Eur J Public Health 2012, 22:704-707.
• [35]Gupta R: Smoking, educational status and health inequity in India. Indian J Med Res 2006, 124:15-22.
• [36]Stevens AR, Caan W: Gender, economics and culture: diversity and the international evolution of smoking prevalence. J R Soc Promot Health 2008, 128:113-116.
• [37]Cutler DM, Lleras-Muney A: Understanding differences in health behaviors by education. J Health Econ 2010, 29:1-28.
• [38]Businelle MS, Kendzor DE, Reitzel LR, Costello TJ, Cofta-Woerpel L, Li Y, Mazas CA, Vidrine JI, Cinciripini PM, Greisinger AJ, et al.: Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach. Health Psychol 2010, 29:262-273.
• [39]Mullin S: Global anti-smoking campaigns urgently needed. Lancet 2011, 378:970-971.
• [40]World health organization framework convention on tobacco control. http://www.who.int/fctc/en/ webcite
• [41]Guindon GE, Tobin S, Yach D: Trends and affordability of cigarette prices: ample room for tax increases and related health gains. Tob Control 2002, 11:35-43.
• [42]Hill S, Amos A, Clifford D, Platt S: Impact of tobacco control interventions on socioeconomic inequalities in smoking: review of the evidence. Tob Control 2013. [Epub ahead of print]
• [43]Blecher E: The impact of tobacco advertising bans on consumption in developing countries. J Health Econ 2008, 27:930-942.
• [44]Amos A, Haglund M: From social taboo to “torch of freedom”: the marketing of cigarettes to women. Tob Control 2000, 9:3-8.
• [45]Waldron I: Patterns and causes of gender differences in smoking. Soc Sci Med 1991, 32:989-1005.
• [46]Thun M, Peto R, Boreham J, Lopez AD: Stages of the cigarette epidemic on entering its second century. Tob Control 2012, 21:96-101.