Explaining socio-economic inequalities in daily smoking: a social-ecological approach

M. Huisman, F. van Lenthe, K. Giskes, C.B.M. Kamphuis, J. Brug, J.P. Mackenbach

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Background: This study assessed the contributions of individual, household and neighbourhood-level factors to socio-economic
inequalities in smoking. Methods: Data came from 2706 participants of the 2004 wave of the Dutch GLOBE study. Participants
were asked about several social and material characteristics of their households, neighbourhoods and smoking in their environment.
Indicators of socio-economic position were education and income. Associations with daily smoking were examined
using logistic regression analyses. Results: Education and income were independently associated with daily smoking (mutually
adjusted odds ratios for the lowest education and income groups: odds ratio (OR): 2.87, 95% confidence interval (95% CI):
1.78–4.62; OR: 1.55, 95% CI: 1.09–2.23, respectively). Individual beliefs about smoking contributed most to the association of
education with daily smoking. Individual beliefs about smoking and household material adversity contributed most to the
association of income with daily smoking. We found no evidence that negative perceptions of the neighbourhood
contributed to smoking inequalities. In fully adjusted models, associations between income and smoking were
fully attenuated, but an independent association between education and smoking remained. Conclusion: Education and
income were related to smoking through partly different pathways. Reducing inequalities in smoking may require a multidimensional
approach targeting material and social factors, with strategies targeted towards the individual and the
household level.
Original languageEnglish
Pages (from-to)238-243
JournalEuropean Journal of Public Health
Issue number2
Publication statusPublished - 2012

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