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Rodríguez López S, Bilal U, Ortigoza AF, Diez-Roux AV. Educational inequalities, urbanicity and levels of non-communicable diseases risk factors: evaluating trends in Argentina (2005-2013). BMC Public Health 2021; 21:1572. [PMID: 34416876 PMCID: PMC8379776 DOI: 10.1186/s12889-021-11617-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity. METHODS We used data from three large national surveys on NCD risk factors (Encuesta Nacional de Factores de Riesgo; ENFR2005-2009-2013) conducted in urban areas of Argentina (n = 108,489). We used gender-stratified logistic random-intercept models (individuals nested within provinces) to determine adjusted associations of self-reported individual NCD risk factors (hypertension, diabetes, obesity, and current smoking) with education and urbanicity. RESULTS In both men and women, the prevalence of obesity and diabetes increased over time but smoking decreased. Hypertension prevalence increased over time in men. Higher urbanicity was associated with higher odds of smoking and lower odds of hypertension in women but was not associated with NCD risk factors in men. Obesity increased more over time in more compared to less urbanized provinces (in men) while smoking decreased more over time in less urbanized provinces. All risk factors had a higher prevalence in persons with lower education (stronger in women than in men), except for diabetes in men and smoking in women. Educational inequalities in obesity (in men) and hypertension (in men and women) became stronger over time, while an initial inverse social gradient in smoking for women reverted and became similar to other risk factors over time. In general, the inverse associations of education with the risk factors became stronger with increasing levels of province urbanicity. CONCLUSION Increasing prevalence of diabetes and obesity over time and growing inequities by education highlight the need for policies aimed at reducing NCD risk factors among lower socioeconomic populations in urban environments in Argentina.
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Affiliation(s)
- Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CIECS, CONICET y UNC), Córdoba, Argentina
- Cátedra de Antropología, Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba (FCEFyN – UNC), Córdoba, Argentina
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana F. Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana V. Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Tumas N, Rodríguez López S, Bilal U, Ortigoza AF, Diez Roux AV. Urban social determinants of non-communicable diseases risk factors in Argentina. Health Place 2021; 77:102611. [PMID: 34210611 PMCID: PMC8714870 DOI: 10.1016/j.healthplace.2021.102611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
We examined associations of individual-, neighborhood- and city-level education -as proxies of SES at different levels-, with diabetes, hypertension, obesity, smoking and binge drinking (non-communicable disease risk factors -NCD/RF) among Argentinian adults. We estimated mixed models based on 21,415 individuals from the 2013 National Survey of Risk Factors, living in 2,698 neighborhoods and 33 cities. Gradients by individual-level education differed by gender and NCD/RF, and some were modified by city education. In addition, we identified contextual effects of neighborhood and city education on some NCD/RF. Urban efforts to tackle NCD/RF in Argentina should be context- and gender-sensitive, and mainly focused on socially disadvantaged groups.
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Affiliation(s)
- Natalia Tumas
- Departament de Ciències Polítiques i Socials, Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Argentina.
| | - Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Argentina; Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Argentina.
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
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Paglione L, Angelici L, Davoli M, Agabiti N, Cesaroni G. Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study. BMJ Open 2020; 10:e033776. [PMID: 32499259 PMCID: PMC7282329 DOI: 10.1136/bmjopen-2019-033776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Socioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study. DESIGN Cohort study. SETTING Rome, capital of Italy. PARTICIPANTS We used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15-65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition. MAIN OUTCOME MEASURES We investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women. RESULTS We selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively). CONCLUSIONS This study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment.
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Affiliation(s)
- Lorenzo Paglione
- Department of Civil, Constructional and Environmental Engineering, Sapienza University of Rome, Roma, Italy
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Roma, Italy
| | - Laura Angelici
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Roma, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Roma, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Roma, Italy
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Roma, Italy
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Gallus S, Pacifici R, Colombo P, Scarpino V, Zuccaro P, Bosetti C, Apolone G, La Vecchia C. Smoking in Italy 2003, with a Focus on the Young. TUMORI JOURNAL 2018; 90:171-4. [PMID: 15237577 DOI: 10.1177/030089160409000202] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To update trends in smoking prevalence in Italy to 2003, with specific focus on the young. Methods A population-based, face-to-face survey conducted in February-April 2003 on 3,535 individuals aged 15 or over, representative of the whole Italian adult population, plus an over sampling of 426 subjects aged 15 to 24 years. Results Overall, 27.6% of Italians described themselves as current cigarette smokers (33.2% men, 22.5% women); 20.1% of men and 8.0% of women smoked 15 or more cigarettes per day. Ex-smokers were 16.6% (22.5% men, 11.2% women). No appreciable difference with reference to geographic area was observed. Less educated men, but more educated women, were more frequently smokers. As compared to previous years, no noticeable change was observed in overall smoking prevalence. However, an appreciable decline was observed in the young (15 to 24 years), from 37.6% in 2001 to 32.6% in 2003 for men, and from 30.4% to 20.7% for women. Among current smokers, 40.6% had tried at least once to stop. Of these, only 6.8% had used some pharmacological and 1.8% some psychological support. Conclusions Overall self-reported smoking prevalence had not appreciably changed over the last few years. However, prevalence of smoking appears to have declined in the young. Compared to legal sale data, tobacco consumption is substantially under reported.
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Affiliation(s)
- Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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Brathwaite R, Smeeth L, Addo J, Kunst AE, Peters RJG, Snijder MB, Derks EM, Agyemang C. Ethnic differences in current smoking and former smoking in the Netherlands and the contribution of socioeconomic factors: a cross-sectional analysis of the HELIUS study. BMJ Open 2017; 7:e016041. [PMID: 28698339 PMCID: PMC5541454 DOI: 10.1136/bmjopen-2017-016041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Data exploring how much of the ethnic differences in smoking prevalence and former smoking are explained by socioeconomic status (SES) are lacking. We therefore assessed ethnic differences in smoking prevalence and former smoking and the contribution of both educational level and occupational-related SES to the observed ethnic differences in smoking behaviour. METHODS Data of 22 929 participants (aged 18-70 years) from the multiethnic cross-sectional Healthy Life in an Urban Setting study in the Netherlands were analysed. Poisson regression models with a robust variance were used to estimate prevalence ratios. RESULTS Compared with the Dutch, after adjustment for age and marital status, smoking prevalence was higher in men of Turkish (prevalence ratio 1.69, 95% CI 1.54 to 1.86), African Surinamese (1.55, 95% CI 1.41 to 1.69) and South-Asian Surinamese origin (1.53, 95% CI 1.40 to 1.68), whereas among women, smoking prevalence was higher in Turkish, similar in African Surinamese but lower in all other ethnic origin groups. All ethnic minority groups, except Ghanaians, had a significantly lower smoking cessation prevalence than the Dutch. Socioeconomic gradients in smoking (higher prevalence among those lower educated and with lower level employment) were observed in all groups except Ghanaian women (a higher prevalence was observed in the higher educated). Ethnic differences in smoking prevalence and former smoking are largely, but not completely, explained by socioeconomic factors. CONCLUSIONS Our findings imply that antismoking policies designed to target smoking within the lower socioeconomic groups of ethnic minority populations may substantially reduce ethnic inequalities in smoking particularly among men and that certain groups may benefit from targeted smoking cessation interventions.
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Affiliation(s)
- Rachel Brathwaite
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Juliet Addo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke B Snijder
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eske M Derks
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
- QIMR Berghofer, Translational Neurogenomics group, Brisbane, Australia
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Barclay K, Myrskylä M. Maternal age and offspring health and health behaviours in late adolescence in Sweden. SSM Popul Health 2016; 2:68-76. [PMID: 28470034 PMCID: PMC5404114 DOI: 10.1016/j.ssmph.2016.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/27/2016] [Accepted: 02/06/2016] [Indexed: 02/06/2023] Open
Abstract
In this study we investigate the relationship between maternal age at the time of birth and a variety of health behaviours and measures of health amongst young adults in contemporary Sweden. Previous research has shown that those born to younger and older mothers tend to have worse perinatal outcomes, and worse health in middle- and later adulthood. However, previous work has not examined health in early adulthood, and no studies have explored whether maternal age is related to health behaviours. Using survey data on 1236 19-year olds born in Sweden in 1990, we find that those born to older mothers have lower self-rated health, are more likely to smoke, more likely to drink alcohol regularly, and less likely to exercise regularly. We discuss potential explanations for these findings, such as older parents exerting lower social control due to greater levels of workplace responsibilities and time demands, long-term consequences of the poor peri-natal outcomes of those born to older mothers, as well as the potential role of parental health behaviours. Our findings suggest that health behaviours may play an important mediating role in explaining the worse long-term health of those born to younger and older mothers.
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Affiliation(s)
- Kieron Barclay
- Department of Social Policy, London School of Economics and Political Science, Old Building, Houghton St., London WC2A 2AE, UK
- Department of Sociology, Stockholm University, 106 91 Stockholm, Sweden
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße, 1 18057 Rostock, Germany
| | - Mikko Myrskylä
- Department of Social Policy, London School of Economics and Political Science, Old Building, Houghton St., London WC2A 2AE, UK
- Max Planck Institute for Demographic Research, Konrad-Zuse-Straße, 1 18057 Rostock, Germany
- Population Research Unit, Department of Social Research, University of Helsinki, P.O. Box 18, 00014 Finland
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Gorini G, Carreras G, Allara E, Faggiano F. Decennial trends of social differences in smoking habits in Italy: a 30-year update. Cancer Causes Control 2013; 24:1385-91. [PMID: 23639993 DOI: 10.1007/s10552-013-0218-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/24/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To update educational inequalities in smoking in Italy up to 2009, with an in-depth analysis of female prevalence. METHODS Data from 15 national health surveys (1980, 1983, 1986-1987, 1990, 1994, 1999-2003, 2005-2009) were analyzed. The overall sample size was representative of the population older than 25 years of age (3,300,000 men and 3,620,000 women). Main measures smoking prevalence rates standardized to the 2,000 European population, prevalence ratios by educational level (high: university degree or high school diploma; low: primary or middle school diploma), area (north, center, south and islands), and age-group (25-44, 45-59, >=60 years). Trends in tobacco prevalence were also analyzed with a multivariate approach using the negative binomial distribution. RESULTS Although male prevalence steadily declined of about 2% annually from 56.1% in 1980 to 30.2% in 2009, educational inequalities slightly widened, recording in 2009 a 53% higher prevalence in men with low educational level compared to graduates. Even though female prevalence stalled around 18% in the last three decades, this was the result of opposite trends by educational group. In fact, highly educated women, with the highest prevalence during 1980s, decreased their tobacco use, determining a reversal similar to men in educational inequalities in smoking. This reversal occurred from the 1980s onwards with a time gradient starting from north to south and from younger to older women. CONCLUSION To achieve a fairer reduction in smoking habits, tobacco control policies focusing on lower social groups are needed.
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Affiliation(s)
- Giuseppe Gorini
- Environmental and Occupational Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy.
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Marinacci C, Grippo F, Pappagallo M, Sebastiani G, Demaria M, Vittori P, Caranci N, Costa G. Social inequalities in total and cause-specific mortality of a sample of the Italian population, from 1999 to 2007. Eur J Public Health 2013; 23:582-7. [DOI: 10.1093/eurpub/cks184] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Federico B, Mackenbach JP, Eikemo TA, Kunst AE. Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group. Addiction 2012; 107:1677-86. [PMID: 22360495 DOI: 10.1111/j.1360-0443.2012.03853.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To estimate the immediate as well as the longer-term impact of the 2005 smoke-free law on smoking prevalence, cessation and intensity both in the overall population and separately by educational level. DESIGN Interrupted time-series analyses of 11 cross-sectional nationally representative surveys. SETTING Italy, 1999-2010. PARTICIPANTS Adults aged 20-64 years. MEASUREMENTS For each year we computed the prevalence of current smoking, the quit ratio and the mean number of cigarettes smoked per day. All measures were standardized by age. Segmented linear regression analyses were performed for each smoking variable separately by sex. FINDINGS Among males, smoking prevalence decreased by 2.6% (P = 0.002) and smoking cessation increased by 3.3% (P = 0.006) shortly after the ban, but both measures tended to return to pre-ban values in the following years. This occurred among both highly and low-educated males. Among low-educated females, the ban was followed by a 1.6% decrease (P = 0.120) in smoking prevalence and a 4.5% increase in quit ratios (P < 0.001). However, these favourable trends reversed over the following years. Among highly educated females, trends in smoking prevalence and cessation were not altered by the ban. Among both males and females, long-term trends in the daily number of cigarettes, which were already declining well before the implementation of the policy, changed to a minor extent. CONCLUSION The impact of the Italian smoke-free policy on smoking and inequalities in smoking was short-term. Smoke-free policies may not achieve the secondary effect of reducing smoking prevalence in the long term, and they may have limited effects on inequalities in smoking.
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Affiliation(s)
- Bruno Federico
- Department of Health and Sport Sciences, University of Cassino, Cassino, Italy.
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Charafeddine R, Demarest S, Van der Heyden J, Tafforeau J, Van Oyen H. Using multiple measures of inequalities to study the time trends in social inequalities in smoking. Eur J Public Health 2012; 23:546-51. [DOI: 10.1093/eurpub/cks083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Semyonov L, Iarocci G, Boccia A, La Torre G. Socioeconomic differences in tobacco smoking in Italy: is there an interaction between variables? ScientificWorldJournal 2012; 2012:286472. [PMID: 22536132 PMCID: PMC3317588 DOI: 10.1100/2012/286472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 11/21/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess the influence of sociodemographic factors on smoking habits in Italy and if an interaction exists between these variables. METHODS Data from the national survey "Health Conditions and Healthcare Services Use" in 2005 were used. The independent association between tobacco smoking and sociodemographical variables was assessed using logistic regression analysis. Interactions between variables were investigated calculating the synergism index (SI). RESULTS Sample population consists of 109.829 subjects (over 15 years). 21.9% are current and 21.8% are former smokers. Current smokers are mostly 45-54-years old males, from Central Italy, unemployed, divorced or separated but having a good health status without chronic medical conditions. Ever smokers are mostly 45-54 years old males, from Northeast Italy, unemployed, with chronic conditions. People with a university degree and with a good household income have the lowest OR for both conditions. A synergistic effect was found between marital status and educational level (for ever smokers SI = 1.96; for current smokers SI = 1.67). CONCLUSIONS Smoking is prevalent in lower socioeconomic groups and there is the strong need to increase social, economic and cultural capital in order to reduce it.
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Affiliation(s)
- Leda Semyonov
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00181 Rome, Italy
| | - Gianluca Iarocci
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), 00144 Rome, Italy
| | - Antonio Boccia
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00181 Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00181 Rome, Italy
- Eleonora Lorillard Spencer Cenci Foundation Rome, Italy
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Généreux M, Roy M, Montpetit C, Azzou SAK, Gratton J. Regional surveillance of social and geographic inequalities in smoking: the case of Montréal, Canada. Health Place 2011; 18:240-9. [PMID: 22019850 DOI: 10.1016/j.healthplace.2011.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 07/08/2011] [Accepted: 09/22/2011] [Indexed: 11/30/2022]
Abstract
Surveillance of social inequalities in health is a platform for action. We examined the trends in smoking behaviours (current and ever smoking, quit ratios) according to education and place of residence and we quantified the observed inequalities. Data were from repeated cross-sectional surveys (2003-2009) of Montreal (Canada) residents ≥15 years (n=12,053). Trends in smoking behaviours according to education were measured with logistic and log-binomial regressions. Spatial distribution of smoking behaviours across local areas was assessed with Morans' Index. Observed inequalities were quantified with prevalence ratio and difference, population attributable risk, and slope index of inequality. Results showed that ever smoking rose among low-educated individuals. Among their high-educated fellow-citizens, current smoking decreased and quit ratios increased. Adverse smoking behaviours (current and ever smoking) were clustered in south-central areas. We conclude that smoking inequalities in Montreal are growing. We thus encourage a closer monitoring of smoking social differentials.
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Affiliation(s)
- Mélissa Généreux
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
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Cosci F, Pistelli F, Lazzarini N, Carrozzi L. Nicotine dependence and psychological distress: outcomes and clinical implications in smoking cessation. Psychol Res Behav Manag 2011; 4:119-28. [PMID: 22114542 PMCID: PMC3218785 DOI: 10.2147/prbm.s14243] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nicotine dependence is characteristically a chronic and relapsing disease. Although 75%-85% of smokers would like to quit, and one-third make at least three serious lifetime attempts, less than 50% of smokers succeed in stopping before the age of 60. Relevant and complex factors contributing to sustained cigarette consumption, and strongly implicated in the clinical management of smokers, are the level of nicotine dependence and psychological distress. In this review of the literature, these two factors will be examined in detail to show how they may affect smoking cessation outcome and to encourage clinicians to assess patients so they can offer tailored support in quitting smoking.
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Affiliation(s)
| | - Francesco Pistelli
- University Unit of Pulmonology and Respiratory Pathophysiology, Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy
| | | | - Laura Carrozzi
- University Unit of Pulmonology and Respiratory Pathophysiology, Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy
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Luy M, Di Giulio P, Caselli G. Differences in life expectancy by education and occupation in Italy, 1980–94: Indirect estimates from maternal and paternal orphanhood. Population Studies 2011; 65:137-55. [DOI: 10.1080/00324728.2011.568192] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Socio-demographic factors and processes associated with stages of change for smoking cessation in pregnant versus non-pregnant women. BMC WOMENS HEALTH 2011; 11:3. [PMID: 21261957 PMCID: PMC3037321 DOI: 10.1186/1472-6874-11-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 01/24/2011] [Indexed: 12/04/2022]
Abstract
Background The tobacco control community assumes that the most effective interventions are personalized. Nevertheless, little attention is paid to understanding differences between pregnant and non-pregnant European women in terms of the social factors that influence tobacco use and the processes of change used to quit smoking. Methods The study consecutively enrolled 177 pregnant women who acknowledged smoking the year before pregnancy and 177 non-pregnant women who acknowledged smoking the year before their clinic visit for a Pap test. Results With respect to socio-demographic factors, the stages of change in pregnant women were associated with level of education, marital status, and the presence of roommates, partners and friends who smoke. In pregnant women, there was no statistically significant difference in the processes used to stop smoking among the stages of change. Furthermore, behavioral processes were higher in non-pregnant women than in pregnant women, and the difference was statistically significant in the advanced stages of behavioral change. Both pregnant and non-pregnant women showed higher levels of acceptance towards smoking in the earlier stages of change, but the acceptability of smoking in the pre-contemplative stage was higher in non-pregnant women. Greater craving was detected in non-pregnant vs. pregnant women at all stages and reached a statistically significant level at the pre-contemplative stage. Conclusion Pregnancy is a favorable time to stop smoking since pregnant women are more likely to be in an advanced stage of behavioral change. Pregnant and non-pregnant women are distinct populations in the types and processes of change involved in smoking cessation. The intervention programs to promote smoking cessation and prevent relapses will need to take these differences into account.
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Tramacere I, Gallus S, Zuccaro P, Colombo P, Rossi S, Boffetta P, La Vecchia C. Socio-demographic variation in smoking habits: Italy, 2008. Prev Med 2009; 48:213-7. [PMID: 19159645 DOI: 10.1016/j.ypmed.2008.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 12/10/2008] [Accepted: 12/18/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To provide updated information on smoking prevalence in Italy, with a focus on demographic and socio-economic characteristics. METHOD The survey was conducted during March-April 2008 on a sample of 3035 individuals (1459 men and 1576 women) aged 15 years or over representative of the Italian population in terms of age, sex, geographic area, and socio-economic characteristics. RESULTS In 2008, 22.0% (95% confidence interval, CI: 20.5-23.5) of Italians described themselves as current cigarette smokers (26.4% of men, 17.9% of women); ex-smokers were 18.4% (95% CI: 17.0-19.8; 24.1% of men, 13.2% of women). By the year 2012 the number of former could exceed that of current smokers. Smoking prevalence in the young (15-24 years) was around 30% in males, and almost 20% in females. For both sexes, current smoking was less prevalent in higher (22.9% of men, 20.1% of women) than in lower educated participants (34.8% of men, 22.1% of women), and in northern (22.5% of men, 16.1% of women) than southern Italy (31.8% of men, 18.4% of women). CONCLUSION In 2008, smoking prevalence was the lowest observed over the last 50 years, in Italy. However, part of the fall is likely due to increased under-reporting, since these survey figures are appreciably under-estimated as compared to sale data. Subjects with less privileged socio-economic characteristics should be considered target populations for tobacco control.
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Affiliation(s)
- Irene Tramacere
- Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156 Milan, Italy
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17
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Monitoring of socio-economic inequalities in smoking: Learning from the experiences of recent scientific studies. Public Health 2009; 123:103-9. [DOI: 10.1016/j.puhe.2008.10.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 08/29/2008] [Accepted: 10/21/2008] [Indexed: 11/21/2022]
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18
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Mereu A, Sardu C, Minerba L, Contu P. Smoking trends and educational level in Italy in the age group 20-24, from 1950 to 2000. Subst Use Misuse 2009; 44:163-71. [PMID: 19142818 DOI: 10.1080/10826080802345267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Smoking represents an important world research issue because of its diffusion among people and its effects on health. This study analyses, according to gender and educational level, the prevalence of smoking, in order to highlight the relationship between sociocultural status and smoking. Prevalence was calculated, with reference to Italian national data in 2000, by dividing a weighted population of 38,720,629 into 10 five-year birth cohorts. Results suggest that smoking is no longer perceived as being socially acceptable behavior. The prevalence declines for both sexes and educational levels, but in low educational levels the decline is slower. The study limitations are noted.
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Affiliation(s)
- Alessandra Mereu
- Department of Public Health, University of Cagliari, Cagliari, Italy.
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19
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Siahpush M, McNeill A, Borland R, Fong GT. Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2007; 15 Suppl 3:iii71-5. [PMID: 16754950 PMCID: PMC2593052 DOI: 10.1136/tc.2004.008763] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the effect of socioeconomic status (SES) on nicotine dependence, self-efficacy, and intention to quit. DESIGN SETTING AND PARTICIPANTS Data were from the first wave (2002) of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a panel study of over 2000 adult smokers from each of four countries: the United States, Canada, the United Kingdom, and Australia. Data were collected via telephone interviews. MAIN OUTCOME MEASURES Nicotine dependence, intention to quit, and self-efficacy to quit smoking were the main outcome measures used in this study. RESULTS Lower levels of education were associated with higher nicotine dependence. The effect of lower income on higher heaviness of smoking index (HIS) scores was significant in Canada, the UK, and Australia. Respondents with low education had 35% larger odds of low self-efficacy than those with high education. Respondents with low education had 40% larger odds of having no intention to quit than those with high education. Respondents with low income had 23% larger odds of having no intention to quit than those with high income. Country was not a moderator of the association of SES with self-efficacy and intention to quit. CONCLUSION To the extent that lower SES smokers are more addicted, they are likely to need more intensive support if they are to be successful in their attempts to quit. Given their lower incomes, this places a special responsibility on government to provide or subsidise such services. This should include access to the widest possible range of effective pharmacotherapies complemented with evidence based counselling and support.
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Affiliation(s)
- M Siahpush
- Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, 100 Drummond Street, Carlton 3053, Australia.
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20
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Siahpush M, McNeill A, Hammond D, Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tob Control 2007; 15 Suppl 3:iii65-70. [PMID: 16754949 PMCID: PMC2593062 DOI: 10.1136/tc.2005.013276] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Socioeconomic status is strongly associated with smoking prevalence and social class differences contribute substantially to social inequalities in mortality. This research investigated socioeconomic and country variations in smokers' knowledge that smoking causes heart disease, stroke, impotence and lung cancer, that smoke contains cyanide, mercury, arsenic and carbon monoxide, and whether nicotine causes most of the cancer. METHODS Data were from the International Tobacco Control (ITC) Four Country Survey, a cohort survey of over 9000 adult smokers from four countries: the United States, Canada, the United Kingdom, and Australia. Data were collected via telephone interviews in 2002. RESULTS Higher education and income were associated with higher awareness. For example, the odds of knowing that smoking causes heart disease, stroke and lung cancer were respectively 71%, 34% and 83% larger for respondents with high versus low income. The odds of knowing that smoke contains cyanide, mercury, arsenic and carbon monoxide were respectively 66%, 26%, 44% and 108% larger for respondents with a university degree than those with a high school diploma or lower level of education. Results also revealed that awareness of harms of smoking was generally the highest in Canada and the lowest in the UK. CONCLUSIONS Lower socioeconomic status was associated with lower awareness of the harms of smoking and misunderstanding around nicotine. There is a need to improve knowledge of the dangers of smoking among the disadvantaged segments of the population.
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Affiliation(s)
- M Siahpush
- Centre for Behavioural Research in Cancer, The Cancer Council Victoria, 100 Drummond Street, Carlton VIC 3053, Australia.
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21
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Gallus S, Schiaffino A, La Vecchia C, Townsend J, Fernandez E. Price and cigarette consumption in Europe. Tob Control 2006; 15:114-9. [PMID: 16565459 PMCID: PMC2563577 DOI: 10.1136/tc.2005.012468] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyse the variation in demand for tobacco according to price of cigarettes across the European region. DESIGN Cross-sectional study. SETTING All the 52 countries of the European region. PARTICIPANTS For each European country, data were collected on annual per adult cigarette consumption (2000), smoking prevalence (most recent), retail price of a pack of local and foreign brand cigarettes (around 2000), the gross domestic product adjusted by purchasing power parities, and the adult population (2000). MAIN OUTCOME MEASURE Price elasticity of demand for cigarettes (that is, the change in cigarette consumption according to a change in tobacco price) across all the European countries, estimated by double-log multiple linear regression. RESULTS Controlling for male to female prevalence ratio, price elasticities for consumption were -0.46 (95% confidence interval (CI) -0.74 to -0.17) and -0.74 (95% CI -1.13 to -0.35) for local and foreign brand, respectively. The inverse relation between cigarette price and consumption was stronger in countries not in the European Union (price elasticity for foreign brand cigarettes of -0.8) as compared to European Union countries (price elasticity of -0.4). CONCLUSIONS The result that, on average, in Europe smoking consumption decreases 5-7% for a 10% increase in the real price of cigarettes strongly supports an inverse association between price and cigarette smoking.
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Affiliation(s)
- S Gallus
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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22
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Schulze A, Mons U. The evolution of educational inequalities in smoking: a changing relationship and a cross-over effect among German birth cohorts of 1921-70. Addiction 2006; 101:1051-6. [PMID: 16771897 DOI: 10.1111/j.1360-0443.2006.01458.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the evolution of the relationship between education and smoking behaviour (ever-smoking and age of initiation) among German birth cohorts of 1921-70. PARTICIPANTS A total of 5297 respondents to the German Federal Health Survey of 1998 were divided into 10-year sex-birth-education cohorts. MEASUREMENTS Self-reported smoking histories (ever-smoking and the age of starting smoking). FINDINGS There was an inversion of the educational gradient around the birth cohorts of 1931-40 for men and 1941-50 for women. For men, the educational cross-over in smoking was due to a stronger decrease of the ever-smoking prevalence of the highly educated compared to the least educated. In women it was due to a stronger increase in ever-smoking prevalence among the least educated compared to the highly educated. This educational cross-over effect was also be detected for the average age of starting smoking, and involved the same cohorts. Additionally, in the youngest birth cohorts the differences between the least and highest educated of each gender were greater than the differences between the genders. CONCLUSIONS The educational differences in smoking prevalence are stable in men but in women they are widening. Hence, socio-economic inequalities in health due to smoking will rise in women in the next decades, while they will stabilize in men.
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Affiliation(s)
- Alexander Schulze
- German Cancer Research Center, Unit Cancer Prevention, WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany.
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23
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Federico B, Costa G, Kunst AE. Educational inequalities in initiation, cessation, and prevalence of smoking among 3 Italian birth cohorts. Am J Public Health 2006; 97:838-45. [PMID: 16809593 PMCID: PMC1854860 DOI: 10.2105/ajph.2005.067082] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined socioeconomic inequalities in initiation and cessation rates of smoking and the resultant inequality in smoking prevalence among 3 consecutive Italian birth cohorts. METHODS We used data from the 1999-2000 Italian National Health Interview Survey, which included 28958 men and 29769 women who were born between 1940 and 1969. The association between smoking variables and level of education was assessed with logistic regression and life table analyses. RESULTS Inequalities in the lifetime prevalence of smoking increased across the 3 birth cohorts in Italy. At age 40, lower-educated persons in the youngest cohort reported on average 1 to 5 years of additional exposure to regular smoking compared with higher-educated persons. Inequalities in smoking prevalence increased among both men and women because of widening inequalities in initiation rates. Among women, growing inequalities in cessation rates also played a role. CONCLUSIONS The relative contribution of initiation and cessation to socioeconomic inequalities in smoking rates varied by both gender and birth cohort. For the youngest birth cohort, policies that address inequalities in smoking should focus on both initiation and cessation.
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Affiliation(s)
- Bruno Federico
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
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24
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Costanza MC, Salamun J, Lopez AD, Morabia A. Gender differentials in the evolution of cigarette smoking habits in a general European adult population from 1993-2003. BMC Public Health 2006; 6:130. [PMID: 16696858 PMCID: PMC1479327 DOI: 10.1186/1471-2458-6-130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 05/12/2006] [Indexed: 11/23/2022] Open
Abstract
Background Describe the recent evolution of cigarette smoking habits by gender in Geneva, where incidence rates of lung cancer have been declining in men but increasing in women. Methods Continuous cross-sectional surveillance of the general adult (35–74 yrs) population of Geneva, Switzerland for 11 years (1993–2003) using a locally-validated smoking questionnaire, yielding a representative random sample of 12,271 individuals (6,164 men, 6,107 women). Results In both genders, prevalence of current cigarette smoking was stable over the 11-year period, at about one third of men and one quarter of women, even though smoking began at an earlier age in more recent years. Older men were more likely to be former smokers than older women. Younger men, but not women, tended to quit smoking at an earlier age. Conclusion This continuous (1993–2003) risk factor surveillance system, unique in Europe, shows stable prevalence of smoking in both genders. However, sharp contrasts in age-specific prevalence of never and former smoking and of ages at smoking initiation indicate that smoking continues a long-term decline in men but has still not reached its peak in women.
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Affiliation(s)
- Michael C Costanza
- Division of Clinical Epidemiology, Geneva University Hospitals, 25, Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
| | - Julien Salamun
- Division of Clinical Epidemiology, Geneva University Hospitals, 25, Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
| | - Alan D Lopez
- School of Population Health, University of Queensland, Herston Rd, Herston, 4006, Brisbane, Australia
| | - Alfredo Morabia
- Division of Clinical Epidemiology, Geneva University Hospitals, 25, Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
- Center for the Biology of Natural Systems, Queens College-CUNY, 163-03 Horace Harding Expressway, Flushing, NY 11365, USA
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25
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Gallus S, Pacifici R, Colombo P, Scarpino V, Zuccaro P, Bosetti C, Fernandez E, Apolone G, La Vecchia C. Prevalence of smoking and attitude towards smoking regulation in Italy, 2004. Eur J Cancer Prev 2006; 15:77-81. [PMID: 16374235 DOI: 10.1097/01.cej.0000180667.89087.b9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS AND BACKGROUND To update trends in smoking prevalence in Italy to 2004, and describe the attitudes towards forthcoming regulation of smoking. METHODS Population-based face-to-face survey conducted in March-April 2004 on a sample of 3050 individuals (1509 men and 1541 women) aged 15 or over, representative of the general adult Italian population in terms of age, sex, geographic area, habitat, education and working status. RESULTS Overall, 26.2% of the Italians aged 15 or over described themselves as current cigarette smokers (30.0% of men, 22.5% of women); 19.1% of men and 11.2% of women smoked 15 or more cigarettes per day. Ex-smokers were 17.9% (24.8% of men, 11.2% of women). The difference in smoking prevalence between men and women was greater in the elderly. More educated men, and those residing in northern Italy were less frequently current smokers. Conversely, women with a low level of education (19%) were less frequently current smokers than those with higher education (24%). More than 85% of Italian adult population were in favour of restrictions of smoking in public places, such as cafes and restaurants, and to ban smoking in workplaces. CONCLUSIONS Self-reported smoking prevalence is decreasing in men but not in females. There is widespread support for smoking restriction in public areas.
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Affiliation(s)
- Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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26
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Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, Dalstra JAA, Federico B, Helmert U, Judge K, Lahelma E, Moussa K, Ostergren PO, Platt S, Prattala R, Rasmussen NK, Mackenbach JP. Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health 2005; 59:395-401. [PMID: 15831689 PMCID: PMC1733079 DOI: 10.1136/jech.2004.025684] [Citation(s) in RCA: 381] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. DESIGN Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. SETTING Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. PARTICIPANTS 451 386 non-institutionalised men and women 25-79 years old. MAIN OUTCOME MEASURES Smoking status, daily quantity of cigarettes consumed by smokers. RESULTS Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. CONCLUSIONS Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.
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Affiliation(s)
- K Giskes
- Department of Public Health, Erasmus Medical Centre, 3000DR Rotterdam, Netherlands.
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27
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Manzoli L, Di Giovanni P, Dragani V, Ferrandino MGF, Morano JP, Rauti I, Schioppa F, Romano F, Staniscia T. Smoking behaviour, cessation attempts and the influence of parental smoking in older adult women: a cross-sectional analysis from Italy. Public Health 2005; 119:670-8. [PMID: 15893347 DOI: 10.1016/j.puhe.2004.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 11/10/2004] [Accepted: 12/20/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the association between parental smoking during infancy/adolescence and smoking prevalence in older adult women, and to provide a description of smoking and smoking cessation patterns in this subset of the population. STUDY DESIGN Cross-sectional survey. METHODS Between 1999 and 2001, trained physicians in 11 health agencies throughout the Abruzzo Region, Italy, conducted semi-structured interviews on 9708 women aged 50-70 years attending mammographic screening (overall response rate 89%). Information was collected on sociodemographic characteristics, smoking habits, parental smoking during their infancy and/or adolescence, and exposure to environmental tobacco smoke (ETS) inside or outside the family. RESULTS AND CONCLUSIONS The overall prevalence of current smoking was 15.6% (n=1516), and that of former smoking was 13.2%. Women whose parent(s) smoked were more likely to be current smokers, especially if only the mother smoked (adjusted odds ratio 4.27; 95% confidence interval 2.24-8.12). Other factors significantly associated with current smoking in the multivariate analysis were younger age, lower body mass index, higher level of education, unmarried status, and exposure to ETS either inside or outside the family environment. Eighteen percent of all current smokers were non-inhalers, and more than 60% of ex-smokers quit smoking on their first attempt. Our findings expand the existing evidence suggesting that a strong effect of parental conduct on a daughter's smoking behaviour may persist throughout life. Although more research is needed, especially to clarify the role of genetic and environmental factors in determining the mother-child smoking association, our results suggest that intensifying smoking prevention efforts directed at women with children might considerably reduce the risk of ever smoking in future female generations.
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Affiliation(s)
- L Manzoli
- Section of Epidemiology and Public Health, University 'G. d'Annunzio', Chieti, Italy.
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28
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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; 14:106-13. [PMID: 15791020 PMCID: PMC1748002 DOI: 10.1136/tc.2004.008573] [Citation(s) in RCA: 210] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine those groups who are at increased risk of smoking related diseases, we assessed in which male and female generations smoking was more prevalent among lower educated groups than among the higher educated, in 11 European countries. DESIGN Cross sectional analysis of data on smoking, covering the year 1998, from a social survey designed for all member states of the European Union. SUBJECTS Higher and lower educated men and women aged 16 years and older from 11 member states of the European Union. OUTCOME MEASURES Age standardised prevalence rates by education and prevalence odds ratios of current and ever daily smoking comparing lower educated groups with higher educated groups. RESULTS A north-south gradient in educational inequalities in current and ever daily smoking was observed for women older than 24 years, showing larger inequalities in the northern countries. Such a gradient was not observed for men. A disadvantage for the lower educated in terms of smoking generally occurred later among women than among men. Indications of inequalities in smoking in the age group 16-24 years were observed for all countries, with the exception of women from Greece and Portugal. CONCLUSIONS Preventing and reducing smoking among lower educated subgroups should be a priority of policies aiming to reduce inequalities in health in Europe. If steps are not taken to control tobacco use among the lower educated groups specifically, inequalities in lung cancer and other smoking related diseases should be anticipated in all populations of the European Union, and both sexes.
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Affiliation(s)
- M Huisman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Marinacci C, Spadea T, Biggeri A, Demaria M, Caiazzo A, Costa G. The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north west Italy. J Epidemiol Community Health 2004; 58:199-207. [PMID: 14966232 PMCID: PMC1732696 DOI: 10.1136/jech.2003.014928] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To evaluate the independent and mutual effects of neighbourhood deprivation and of individual socioeconomic conditions on mortality and to assess the trends over the past 30 years and the residual neighbourhood heterogeneity. DESIGN General and cause specific mortality was analysed as a function of time period, highest educational level achieved, housing conditions, and neighbourhood deprivation, using multilevel Poisson models stratified by gender and age class. SETTING The study was conducted in Turin, a city in north west Italy with nearly one million inhabitants and consisting of 23 neighbourhoods. PARTICIPANTS The study population included three cohorts of persons aged 15 years or older, recorded in the censuses of 1971, 1981, and 1991 and followed up for 10 years after each census. MAIN RESULTS Individual and contextual socioeconomic conditions showed an independent and significant impact on mortality, both among men and women, with significantly higher risks for coronary heart and respiratory diseases among people, aged less than 65 years, residing in deprived neighbourhoods (9% and 15% excess for coronary heart diseases, 20% and 24% for respiratory diseases, respectively for men and women living in deprived neighbourhoods compared with rich). The decreasing time trend in general mortality was less pronounced among men with lower education and poorer housing conditions, compared with their more advantaged counterparts; the same was found in less educated women aged less than 65 years. CONCLUSIONS These results and further developments in the evaluation of impact and mechanisms of other contextual effects can provide information for both health and non-health oriented urban policies.
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30
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Galobardes B, Costanza MC, Bernstein MS, Delhumeau C, Morabia A. Trends in risk factors for lifestyle-related diseases by socioeconomic position in Geneva, Switzerland, 1993-2000: health inequalities persist. Am J Public Health 2003; 93:1302-9. [PMID: 12893619 PMCID: PMC1447961 DOI: 10.2105/ajph.93.8.1302] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We report on trends in risk factors for lifestyle-related diseases among socioeconomic position (SEP) groups. METHODS We continuously surveyed the adult population of Geneva, Switzerland, for 8 years (1993-2000) with independent, cross-sectional surveys of representative samples (4207 men and 3987 women aged 35-74 years). Age-adjusted linear regression slopes estimated annual risk factor trends. Interaction terms were tested for trend differences between SEP groups. RESULTS Overall, low-SEP persons had the worst risk factor profiles. Eight-year trends indicate that (1) number of pack-years smoked decreased by half a pack-year among high-SEP female current smokers only; (2) obesity prevalence more than doubled from 5% to 11% among high-SEP men only; (3) systolic and diastolic blood pressures decreased similarly in all SEP groups; (4) unsaturated-to-saturated dietary fat ratio declined in the low-SEP group only; and (5) physical inactivity and current/former cigarette smoking prevalences remained unchanged in all SEP groups. CONCLUSIONS Smoking, obesity, high blood pressure, and physical inactivity are more prevalent among low-SEP persons. Most socioeconomic risk factor differences remained stable in the 1990s. Thus, social inequalities in chronic disease morbidity and mortality will persist in the next decades.
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Affiliation(s)
- Bruna Galobardes
- Division of Clinical Epidemiology, Geneva University Hospitals, Switzerland
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31
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Gallus S, Fernandez E, Townsend J, Schiaffino A, La Vecchia C. Price and consumption of tobacco in Italy over the last three decades. Eur J Cancer Prev 2003; 12:333-7. [PMID: 12883388 DOI: 10.1097/00008469-200308000-00015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Changes in cigarette price have had an appreciable impact on smoking consumption in several countries. We analysed the price elasticity of demand for cigarettes in Italy over the period 1970-2001. A 1% increase in price of cigarettes led to a 0.30% decline in smoking prevalence and to a 0.43% decline in cigarette consumption. The present analyses confirm the existence of an inverse association between price and prevalence/consumption of cigarettes in Italy, and indicate that economic aspects may have important public health implications in tobacco control.
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Affiliation(s)
- S Gallus
- Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea, 62, 20157 Milan, Italy.
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32
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Rohrmann S, Becker N, Kroke A, Boeing H. Trends in cigarette smoking in the German centers of the European Prospective Investigation into Cancer and Nutrition (EPIC): the influence of the educational level. Prev Med 2003; 36:448-54. [PMID: 12649053 DOI: 10.1016/s0091-7435(02)00047-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several studies in Germany and other European countries have already shown smoking prevalence to be related to education. This study was aimed to investigate time trends in smoking habits in the German cohorts Heidelberg and Potsdam of the European Prospective Investigation into Cancer and Nutrition (EPIC) according to sex, birth cohort, and level of education. METHODS Within EPIC, 25,546 and 27,548 participants were recruited in Heidelberg and Potsdam, respectively. Data on smoking were collected by means of a computer-guided interview during the baseline examination between 1994 and 1998. For each birth cohort smoking prevalence and mean number of cigarettes smoked per day at different ages were calculated. Odds ratios and 95% confidence interval for associations between smoking prevalence and educational level were computed by using logistic regression. RESULTS Smoking prevalence was higher among men than among women, with a smaller difference in younger birth cohorts. Between 1950 and 1960, smoking prevalence among women in the Heidelberg cohort rose sharply (from 12.8% to 51.8% in the least educated group). This strong increase was delayed by 10 years in the Potsdam cohort. Men and women in Heidelberg smoked more cigarettes per day than their counterparts in Potsdam, but in both study centers less educated subjects smoked more than subjects with a higher education. CONCLUSIONS Smoking patterns in the Potsdam and Heidelberg cohorts are quite similar with respect to prevalence and years of lifetime smoking. Since an increasing difference between smoking prevalence of less and high educated individuals is observable, programs on smoking cessation should especially concentrate on persons of lower educational level.
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Affiliation(s)
- Sabine Rohrmann
- German Cancer Research Center, Division of Clinical Epidemiology, Heidelberg, Germany
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