Smoking Behaviour and Educational Level in the EU

According฀to฀data฀from฀the฀1995฀Microcensus฀Study฀published฀in฀1998,฀a฀deinite฀social฀ differentiation฀for฀smokers฀of฀both฀sexes฀can฀also฀be฀identiied฀in฀Germany.฀Smoking฀was฀ 2–3฀times฀more฀prevalent฀among฀men฀and฀women฀with฀a฀low฀educational฀level฀than฀among฀ those฀with฀a฀higher฀educational฀level฀or฀in฀the฀graduate฀professions฀Fig.฀ 2.3 ฀ [73] .฀The฀ highest฀smoking฀prevalences฀were฀found฀among฀men฀with฀simple฀manual฀jobs฀building฀ site฀labourers,฀road฀construction฀workers,฀etc..฀The฀highest฀rates฀among฀women฀were฀found฀ for฀workers฀in฀the฀hotel฀and฀restaurant฀trade,฀care฀assistants฀for฀the฀elderly฀and฀฀cleaners,฀etc.฀ Fig.฀ 2.3 .฀These฀results฀are฀consistent฀with฀indings฀from฀international฀surveys. Overall,฀it฀is฀concluded฀that฀cigarette฀smoking฀is฀taken฀up฀in฀stage฀1฀by฀people฀with฀a฀higher฀ educational฀level฀and฀who฀are฀inancially฀better฀off฀as฀in฀the฀USA฀in฀the฀early฀years฀of฀the฀ 3.5 3 2.5 2 1.5 1 0.5 DK FIN F I NL N D GB P E S CH Odds Ratio SmMal20-44 SmMal45-74 SmFem20-44 SmFem45-74 Fig. 2.10 ฀฀฀Odds฀ratios฀ORs฀in฀12฀EU฀countries฀for฀male฀SmMal฀and฀female฀SmFem฀smokers,฀ each฀in฀two฀age฀groups฀20–44฀years฀and฀45–74฀years฀ [72] .฀ORs฀greater฀than฀1.0฀are฀indicative฀of฀ an฀association฀between฀smoking฀and฀low฀educational฀level Stage฀1 Smoking฀is฀an฀exceptional฀behaviour฀and฀is฀mainly฀a฀habit฀of฀higher฀socio- ฀economic฀groups Stage฀2 Smoking฀becomes฀ever฀more฀common.฀Rates฀among฀men฀peak฀at฀50–80,฀ irrespective฀of฀socio-economic฀group.฀In฀women,฀these฀patterns฀usually฀lag฀ 10–20฀years฀behind฀those฀of฀men,฀but฀smoking฀is฀irst฀adopted฀by฀women฀from฀ higher฀socio-economic฀groups฀Portugal Stage฀3 Smoking฀prevalence฀rates฀among฀men฀decrease฀to฀about฀40฀since฀many฀ men฀stop฀smoking.฀Women฀reach฀their฀peak฀rate฀35–40,฀but฀at฀the฀end฀ of฀this฀stage,฀their฀rates฀start฀to฀decline฀too฀starting฀to฀happen฀in฀Spain,฀Italy,฀ France Stage฀4 Prevalence฀rates฀decline฀gradually฀for฀both฀men฀and฀women,฀and฀smoking฀ becomes฀progressively฀more฀a฀habit฀of฀lower฀socio-economic฀groups฀northern฀ European฀countries:฀Norway,฀Sweden,฀Great฀Britain Table 2.5 ฀฀฀Stages฀of฀smoking฀behaviour฀in฀12฀European฀Union฀countries฀ [72] twentieth฀century;฀see฀Table฀ 2.5 .฀In฀stage฀2,฀smoking฀is฀taken฀up฀by฀all฀strata฀of฀the฀popula- tion.฀In฀stage฀3,฀educational฀initiatives฀cause฀a฀decline฀in฀prevalence฀rates,฀irstly฀among฀men฀ and฀some฀time฀later,฀among฀women฀emancipation,฀“equality฀problems”.฀In฀stage฀4,฀smoking฀ remains฀the฀preserve฀of฀people฀with฀a฀low฀level฀of฀education฀and฀reduced฀social฀status.฀These฀ data฀are฀also฀conirmed฀by฀research฀conducted฀as฀part฀of฀the฀Microcensus฀Study฀ [42,฀73] .

2.8 Concluding Remarks

• ฀ Worldwide,฀there฀has฀been฀an฀increase฀in฀smoking฀and฀hence,฀in฀tobacco-associated฀ diseases฀and฀deaths. • ฀ In฀all฀the฀industrialised฀countries,฀as฀well฀as฀in฀the฀developing฀countries,฀cigarette฀con- sumption฀is฀the฀dominant฀form฀of฀smoking. • ฀ In฀many฀countries,฀smoking฀prevalence฀is฀determined฀by฀educational฀level฀and฀monthly฀ income,฀with฀smoking฀being฀more฀common฀among฀the฀socially฀disadvantaged. • ฀ The฀ growing฀ frequency฀ of฀ smoking฀ among฀ children฀ and฀ women฀ is฀ most฀ alarming,฀ entailing฀increases฀in฀rates฀of฀morbidity฀and฀mortality. • ฀ Regardless฀of฀how฀they฀are฀used฀e.g.฀inhalation,฀cigars฀and฀cigarillos฀also฀carry฀a฀ greater฀risk฀than฀was฀thought฀previously. 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