Socioeconomic Inequalities in Smoking and Smoking Cessation Due to a Smoking Ban: General Population-Based Cross-Sectional Study in Luxembourg

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Abstract

This study aimed to measure changes in socioeconomic inequalities in smoking and smoking cessation due to the 2006 smoking ban in Luxembourg. Data were derived from the PSELL3/EU-SILC (Panel Socio-Economique Liewen Zu Letzebuerg/European Union—Statistic on Income and Living Conditions) survey, which was a representative survey of the general population aged ≥16 years conducted in Luxembourg in 2005, 2007, and 2008. Smoking prevalence and smoking cessation due to the 2006 smoking ban were used as the main smoking outcomes. Two inequality measures were calculated to assess the magnitude and temporal trends of socioeconomic inequalities in smoking: the prevalence ratio and the disparity index. Smoking cessation due to the smoking ban was considered as a positive outcome. Three multiple logistic regression models were used to assess social inequalities in smoking cessation due to the 2006 smoking ban. Education level, income, and employment status served as proxies for socioeconomic status. The prevalence of smoking decreased by 22.5% between 2005 and 2008 (from 23.1% in 2005 to 17.9% in 2008), but socioeconomic inequalities in smoking persisted. Smoking prevalence decreased by 24.2% and 20.2% in men and women, respectively; this difference was not statistically significant. Smoking cessation in daily smokers due to the 2006 smoking ban was associated with education level, employment status, and income, with higher percentages of quitters among those with a lower socioeconomic status. The decrease in smoking prevalence after the 2006 law was also associated with a reduction in socioeconomic inequalities, including differences in education level, income, and employment status. Although the smoking ban contributed to a reduction of such inequalities, they still persist, indicating the need for a more targeted approach of smoke-free policies directed toward lower socioeconomic groups.

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Most cited references 27

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Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

D Judge, Johan J. P. Mackenbach, N Rasmussen … (2005)

To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. 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. Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. 451 386 non-institutionalised men and women 25-79 years old. Smoking status, daily quantity of cigarettes consumed by smokers. 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. 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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Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: findings from the International Tobacco Control Four Country Survey.

, Corinne L. Reid, Geoffrey Fong … (2010)

Lower socioeconomic status (SES) groups have higher rates of tobacco use, are less likely to successfully quit, and may also be less likely to intend or attempt to quit. However, results are inconsistent for some outcomes, and little is known about how socioeconomic disparities vary across countries and over time. This study examined the associations between SES and quitting-related behaviors among representative samples of smokers in Canada, the United States, the United Kingdom, and Australia, using data from the first five waves (2002-2006/2007) of the International Tobacco Control Four Country Survey (35,532 observations from 16,458 respondents). Generalized estimating equations modeling was used to examine whether education and income were related to intentions to quit, incidence of quit attempts, and smoking abstinence. Potential differences in the associations over time and across countries were also considered. Smokers with higher education were more likely to intend to quit, to make a quit attempt, and to be abstinent for at least 1 and 6 months; smokers with higher income were more likely to intend to quit and to be abstinent for at least 1 month. Some between-country differences were observed: U.K. and U.S. smokers were less likely to intend to quit than Australians and Canadians; and, although U.K. respondents were least likely to attempt to quit, those that did were more likely to be abstinent. The results suggest that socioeconomic disparities exist at multiple stages in the path to smoking cessation. Potential effects on socioeconomic disparities should be considered when implementing cessation interventions.

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Educational differences in smoking: international comparison.

Johan J. P. Mackenbach, N Rasmussen, A Mielck … (2000)

To investigate international variations in smoking associated with educational level. International comparison of national health, or similar, surveys. Men and women aged 20 to 44 years and 45 to 74 years. 12 European countries, around 1990. Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.

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Author and article information

Contributors

Thomas Behrens: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 21 April 2016

Publication date Collection: 2016

Volume: 11

Issue: 4

Electronic Location Identifier: e0153966

Affiliations

[1 ]Luxembourg Institute of Socio-Economic Research (LISER), Department of Living Conditions, Health Research Team, Esch-sur-Alzette, Luxembourg

[2 ]Scientific Institute of Public Health (WIV-ISP), OD Public Health and Surveillance, Brussels, Belgium

Universität Bochum, GERMANY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: AT. Analyzed the data: AT NL. Wrote the paper: AT NL SD.

* E-mail: anastase.tchicaya@ 123456liser.lu

Article

Publisher ID: PONE-D-15-43580

DOI: 10.1371/journal.pone.0153966

PMC ID: 4839754

PubMed ID: 27100293

SO-VID: 51bb59ec-4f0d-467c-8c9d-052c35c5fd90

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 6 October 2015

Date accepted : 6 April 2016

Page count

Figures: 1, Tables: 5, Pages: 15

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100001866, Fonds National de la Recherche Luxembourg;

Award ID: Project FNR/C12/BM/3978355

Award Recipient : Anastase Tchicaya

This work was supported by Project FNR/C12/BM/3978355: Monitoring and Dynamics of Health Status through the Risk Factors for Cardiovascular Disease in Luxembourg -MDYNRFC ( www.fnr.lu).

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Data Availability Due to ethical and legal restrictions, data are available upon request. Data are from the PSELL/EU-SILC survey (Panel Socio-Economique Liewen zu Letzerbuerg /European Union – Survey on Income and Living Conditions) and is part of the Luxembourg Socio-economic panel, conducted by LISER and Statec, and part of the EU-SILC is managed by Eurostat. Interested researchers who meet criteria for access to sensitive data may contact the LISER management board. LISER, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg Furthermore, due to the new law on research Institutes in Luxembourg, LISER currently discusses the property rights of databases with its partners.

Socioeconomic Inequalities in Smoking and Smoking Cessation Due to a Smoking Ban: General Population-Based Cross-Sectional Study in Luxembourg

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Most cited references 27

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: findings from the International Tobacco Control Four Country Survey.

Educational differences in smoking: international comparison.

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