Cigarette Smoking in the USA Since 1965

Differences฀in฀educational฀level฀are฀also฀apparent฀among฀smokers:฀37฀of฀individuals฀ in฀education฀for฀9–11฀years฀were฀smokers฀compared฀with฀only฀14฀of฀those฀who฀were฀in฀ education฀for฀16฀years฀ [30] .฀Higher฀educational฀levels฀were฀correlated฀with฀a฀willingness฀ to฀quit฀smoking฀ [6,฀33] .฀Willingness฀to฀quit฀smoking฀also฀increased฀with฀age,฀with฀educa- tional฀level฀also฀being฀a฀decisive฀factor฀in฀this฀context฀ [21,฀34,฀35] . Smoking฀prevalence฀was฀highest฀among฀people฀living฀below฀the฀poverty฀line฀ [30] ,฀blue- collar฀workers฀ [2,฀36] ,฀single฀or฀divorced฀people฀ [13] ฀and฀military฀personnel฀ [37,฀38] .฀Tobacco฀ use฀declined฀most฀rapidly฀among฀the฀medical฀professionals;฀at฀the฀beginning฀of฀the฀1990s,฀ only฀3฀of฀doctors฀in฀the฀USA฀were฀smokers฀ [35] ,฀compared฀with฀some฀20฀of฀doctors฀in฀ Germany฀ [27] .฀However,฀there฀seems฀to฀be฀a฀rethinking฀of฀smoking฀habits฀in฀the฀United฀States.฀ The฀prevalence฀of฀cigarette฀smoking฀among฀US฀adults฀has฀declined฀by฀almost฀half฀since฀ 1965,฀with฀positive฀trends฀observed฀among฀people฀in฀almost฀all฀sociodemographic฀groups฀ and฀efforts฀to฀reduce฀disparities฀recognized฀as฀an฀important฀goal฀in฀public฀health฀ [39] .

2.3 Smoking Habits in Germany

In฀Germany,฀in฀people฀between฀the฀age฀of฀21฀and฀50฀years,฀smoking฀prevalence฀is฀about฀ 33฀in฀women฀and฀44฀in฀men฀Fig.฀ 2.2 .฀Simultaneously,฀as฀direct฀consequences฀of฀ciga- rette฀ smoking,฀ approximately฀ 80,000–90,000฀ new฀ cases฀ of฀ cardiovascular฀ disease฀ and฀ 30,000฀new฀cases฀of฀bronchial฀carcinoma฀are฀recorded฀every฀year.฀Above฀the฀age฀of฀35,฀ tobacco-attributable฀mortality฀rates฀in฀the฀federal฀German฀states฀range฀from฀5.6฀to฀13.2฀ for฀women฀and฀from฀24.3฀to฀29.2฀for฀men.฀The฀highest฀mortality฀statistics฀are฀recorded฀ for฀women฀in฀Hamburg,฀Berlin฀and฀Bremen฀ [27] .฀With฀an฀overall฀mortality฀rate฀in฀Germany฀ of฀17,฀smoking฀represents฀the฀commonest฀avoidable฀and฀exclusively฀behaviour-related฀ cause฀of฀death฀ [40] . According฀to฀the฀Microcensus฀Study,฀a฀representative฀survey฀conducted฀in฀1995฀among฀ the฀ population฀ in฀ Germany,฀ interesting฀ conclusions฀ can฀ be฀ drawn฀ concerning฀ smoking฀ behaviour฀as฀a฀function฀of฀gross฀income฀and฀educational฀level฀see฀Fig.฀ 2.3 .฀Similar฀results฀ are฀also฀evident฀from฀the฀latest฀Microcensus฀Study฀ [27] ฀with฀regard฀to฀the฀postulated฀con- nection฀between฀school฀and฀university฀education฀and฀smoking฀behaviour฀Fig.฀ 2.3 .฀The฀ inluence฀of฀the฀educational฀level฀on฀smoking฀pattern฀in฀different฀social฀classes฀might฀be฀ explained฀by฀the฀eficiency฀of฀anti-smoking฀campaigns฀and฀the฀awareness฀about฀health฀ effects฀of฀smoking฀among฀persons฀with฀different฀educational฀levels฀ [41] . Thus,฀according฀to฀self-reported฀information฀in฀April฀1995,฀30.9฀of฀men฀and฀18.2฀of฀ women฀were฀regular฀cigarette฀smokers.฀In฀both฀sexes,฀smoking฀prevalence฀fell฀with฀increas- ing฀age:฀among฀men฀and฀women฀over฀the฀age฀of฀64,฀smoking฀prevalence฀was฀only฀12.9฀ and฀4.9,฀respectively฀ [42] .฀The฀data฀summarised฀in฀Figs.฀ 2.4 ฀and฀ 2.5 ฀indicate฀that฀the฀ ฀relationship฀between฀monthly฀income฀and฀smoking฀behaviour฀applies฀more฀for฀men฀than฀for฀ women.฀Smoking฀prevalence฀is฀higher฀42.6฀among฀men฀in฀the฀lowest฀income฀category฀ ฀700฀EUR฀than฀among฀those฀with฀a฀high฀monthly฀income฀6,500฀DM,฀though฀the฀rate฀ is฀still฀23.1.฀For฀women,฀the฀most฀pronounced฀income-speciic฀differences฀are฀found฀in฀ the฀youngest฀age฀group฀18–29-year฀olds.฀Here฀too฀there฀is฀a฀considerable฀difference฀in฀ smoking฀prevalence฀41.4฀vs.฀18.5฀for฀the฀lowest฀and฀highest฀income฀groups฀ [42] . Catering trade, hotel business Construction workers Mining industry, metal processing Driver, taxi driver Painters, varnish workers Unskilled workers Metalworking industry Watchers, security officers Nursing staff, midwifes Shop assistents Typists Management consultants Farmers, stockbreeding, forestry, gardeners Bankers, insurance agents Representatives, administrators Engineers, physicists, chemists, mathematicians Teacher male, female Physicians, pharmacists 10 20 Frequency [] female smokers male smokers 30 40 50 60 Fig. 2.3 ฀฀฀Smoking฀ prevalence฀ in฀ different฀ occupational฀ groups฀ [27] .฀ By฀ kind฀ permission฀ of฀ the฀ German฀Federal฀Statistics฀Ofice Fig. 2.4 ฀฀฀Correlations฀between฀smoking฀behaviour฀and฀average฀gross฀monthly฀income฀for฀men.฀Results฀ of฀the฀Microcensus฀Study฀ [42] 60 Portion of Smokers [] 50 40 30 20 10 700 1,100 18-29 LJ 30-49 LJ 50-64 LJ 65 LJ 1,725 Net income of the Household [ €] 2,500 3,250 3,250