Smokers and Other Risk Factors

2.7 Smoking Behaviour and Educational Level in the EU

As฀a฀part฀of฀a฀study฀conducted฀in฀12฀European฀countries,฀smoking฀behaviour฀in฀men฀and฀ women฀aged฀20–44฀years฀and฀45–74฀years฀was฀compared฀with฀educational฀level฀by฀coun- try฀–฀something฀that฀had฀only฀rarely฀been฀done฀before฀ [69–71] .฀In฀this฀study,฀smokers฀in฀ several฀countries฀were฀classiied฀in฀terms฀of฀the฀highest฀level฀of฀education฀completed฀by฀the฀ individual฀ [72] .฀This฀classiication฀comprised฀ive฀levels฀where฀“5”฀was฀tertiary฀education,฀ including฀university:฀levels฀1–3฀formed฀the฀“lower฀educated”฀group,฀while฀levels฀4฀and฀5฀ were฀the฀“higher฀educated”฀group.฀The฀data฀education฀vs.฀smoking฀behaviour฀were฀pro- cessed฀using฀regression฀analyses฀and฀ORs฀were฀calculated฀to฀indicate฀an฀association.฀If฀the฀ OR฀was฀clearly฀greater฀than฀1.0,฀an฀association฀was฀to฀be฀accepted฀between฀low฀educational฀ level฀and฀smoking฀behaviour.฀As฀is฀apparent฀from฀the฀data฀summarised฀in฀Fig.฀ 2.9 ,฀consider- able฀differences฀existed฀between฀the฀12฀countries฀studied.฀Among฀the฀younger฀men฀20–44- years฀old,฀the฀proportion฀of฀current฀smokers฀ranged฀from฀32฀to฀64,฀while฀among฀the฀older฀ men฀45–74-years฀old,฀it฀ranged฀from฀28฀to฀55.฀The฀ORs฀for฀current฀smoking฀were฀greater฀ than฀1.00,฀indicating฀an฀association฀between฀lower฀educational฀level฀and฀smoking฀preva- lence฀Fig.฀ 2.10 .฀The฀ORs฀among฀the฀younger฀men฀were฀usually฀higher฀than฀among฀the฀ older฀men฀ [64] ,฀with฀values฀2.00฀being฀calculated.฀The฀highest฀ORs฀among฀younger฀men฀ were฀observed฀in฀Norway,฀Sweden,฀France฀and฀Great฀Britain.฀Among฀the฀older฀men,฀the฀ highest฀ORs฀2.00฀were฀observed฀in฀Great฀Britain฀and฀Norway,฀indicating฀that฀smoking฀ was฀more฀prevalent฀in฀the฀lower฀educated฀group฀in฀those฀countries.฀By฀contrast,฀in฀Portugal฀ more฀than฀in฀Spain,฀smoking฀was฀more฀prevalent฀in฀higher฀educated฀men฀OR฀1.00;฀at฀the฀ same฀ time,฀ the฀ prevalence฀ of฀ smoking฀ among฀ women฀ was฀ 5.฀ In฀ the฀ more฀ Southerly฀ countries฀of฀the฀EU฀France,฀Italy,฀Spain,฀Portugal,฀smoking฀was฀more฀prevalent฀among฀ higher฀educated฀older฀women฀OR฀1.00฀Fig.฀ 2.9 ,฀Table฀ 2.5 . Portion of Smokers [] 80 70 60 50 40 30 20 10 EvSmFem CuSmFem EvSmMal CuSmMal DK FIN F I N NL D GB P E S CH Fig. 2.9 ฀฀฀Smoking฀prevalence฀among฀men฀Mal฀and฀women฀Fem฀in฀12฀European฀Union฀EU฀and฀ Switerzland฀countries.฀Data฀shown฀for฀ever฀smoking฀EvSm฀and฀current฀smoking฀CuSm฀ [72] 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]